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      Patient understanding of liver cirrhosis and improvement using multimedia education

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          Abstract

          Objective

          For patients to engage with the long-term management of liver cirrhosis, sufficient understanding of their condition is essential. The aim of this study was to assess baseline patient knowledge and to test whether a condition-specific multimedia screencast could improve this.

          Design

          Service quality improvement study.

          Setting

          A UK tertiary liver centre. Patients were recruited during 12 general hepatology outpatient clinics.

          Patients

          Fifty-two patients with liver cirrhosis were included. Sixty-two per cent were male; their median age was 56 years and their median clinic attendance period was 3 years.

          Interventions

          Participants completed a baseline questionnaire assessing their knowledge of the management and complications of cirrhosis. They then watched a tailored screencast discussing this condition, which had been developed by expert hepatologists in collaboration with patient representatives. Knowledge was reassessed using a new copy of the original questionnaire after an interval of at least one month.

          Main outcome measures

          Patient scores on knowledge questionnaires at baseline and follow-up.

          Results

          Fifty-two patients achieved a median score of 25.0% before viewing the screencast. Thirty-five patients then completed a follow-up questionnaire after an interval period. The median questionnaire score in this group improved from 25.0% to 66.7%; an increase of 41.7% compared with baseline (p<0.001).

          Conclusions

          Despite regular review at a specialist clinic, participants had poor baseline knowledge of liver cirrhosis. Delivering information by screencast led to a significant improvement. We therefore present an effective way to empower patients with accurate, up-to-date and retainable information that can easily be translated to many other conditions.

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          Most cited references7

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          Medication misuse, nonadherence, and clinical outcomes among liver transplant recipients

          Medication nonadherence after liver transplantation (LT) is associated with adverse clinical outcomes such as graft rejection and graft loss. Few studies have examined nonadherence and its impact on clinical outcomes in LT. The study objectives were (1) to evaluate medication understanding (with treatment knowledge and demonstrated regimen use scores) and medication adherence or nonadherence to entire regimens among LT recipients and (2) to examine associations of these exposures with clinical outcomes. We conducted a 2-site study of 105 recipients between 2011 and 2012 at 2 transplant centers in Chicago, IL and Atlanta, GA. Data were collected via detailed, in-person interviews and medical record reviews. Study participants were middle-aged and predominantly male; 15% of the sample had limited literacy. On average, patients were taking 11 medications [standard deviation (SD) = 4], and 39% had undergone a medication change within the last month. The average scores for the entire medication regimen were 86% (SD = 22%) for treatment knowledge and 78% (SD = 22%) for demonstrated regimen use. The mean score for self-reported nonadherence to the entire regimen was 14% (SD = 20%), whereas 32% of the patients were nonadherent according to tacrolimus levels. In multivariate analyses, lower income, less time since transplantation, a higher number of medications, and limited literacy were inversely associated with treatment knowledge scores (all P < 0.05), whereas limited literacy was associated with nonadherence according to tacrolimus levels ( P < 0.05). In multivariate models, higher scores for treatment knowledge [incidence rate ratio (IRR) = 0.85, 95% confidence interval (CI) = 0.74–0.97] and demonstrated regimen use (IRR = 0.87, 95% confidence interval = 0.77–0.98) were independently associated with 15% and 13% reductions in the number of posttransplant rehospitalizations, respectively. Inadequate treatment knowledge and improper regimen use may be significant determinants of unintentional nonadherence among LT recipients and are associated with adverse clinical outcomes.
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            Patient involvement in healthcare is associated with higher rates of surveillance for hepatocellular carcinoma.

            Surveillance for hepatocellular carcinoma (HCC) is recommended in patients with cirrhosis, but earlier studies suggest that it is used less than one-third of the time. Patient factors associated with surveillance rates are incompletely understood. The aims of our study were to determine HCC surveillance rates in a tertiary-care center and to identify patient predictors of receiving surveillance. Patients with Child A or B cirrhosis seen in the University of Michigan liver clinics between October 2008 and March 2009 were enrolled to complete a self-administered survey. Surveillance rates and clinical data were extracted from the patient electronic medical record. Of the 160 patients enrolled, 74.4% had HCC surveillance performed in the past year. On multivariate analysis, predictors of receiving surveillance included male sex (odds ratio 7.1, 95% confidence interval, 1.2-43.2) and patient involvement in their care (odds ratio 3.4, 95% confidence interval, 1.5-7.9). Patients expressed high levels of concern regarding HCC, desired more information from their physicians, and wanted to be more involved in their care. HCC surveillance rates in a tertiary-care center were significantly higher than earlier reported rates. Direct patient involvement in decisions regarding HCC surveillance may help to improve surveillance rates.
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              The challenges of conceptualizing patient engagement in health care: a lexicographic literature review

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                Author and article information

                Journal
                Frontline Gastroenterol
                Frontline Gastroenterol
                flgastro
                fg
                Frontline Gastroenterology
                BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )
                2041-4137
                2041-4145
                July 2017
                19 January 2017
                : 8
                : 3
                : 214-219
                Affiliations
                [1 ]School of Medicine, University of Leeds , Leeds, UK
                [2 ]NIHR Digestive Diseases Biomedical Research Unit, Nottingham University Hospitals NHS Trust and The University of Nottingham , Nottingham, UK
                [3 ]College of Health and Wellbeing, University of Central Lancashire , Preston, UK
                [4 ]Department of Hepatology, Leeds Teaching Hospitals NHS Trust , Leeds, UK
                Author notes
                [Correspondence to ] Dr Waleed Fateen, NIHR Nottingham Digestive Diseases Biomedical Research Unit, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK; waleed.fateen@ 123456nottingham.ac.uk
                Author information
                http://orcid.org/0000-0002-3536-3982
                Article
                flgastro-2016-100761
                10.1136/flgastro-2016-100761
                5502237
                28706622
                c6873eb4-f5e3-412f-b12a-9bd5826896af
                Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

                This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

                History
                : 18 October 2016
                : 26 December 2016
                : 1 January 2017
                Categories
                1506
                Liver
                Research
                Custom metadata
                unlocked

                Gastroenterology & Hepatology
                liver cirrhosis
                Gastroenterology & Hepatology
                liver cirrhosis

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