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      Implementation of Patient-Centered Education for Chronic-Disease Management in Uganda: An Effectiveness Study

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Background

          The majority of non-communicable disease related deaths occur in low- and middle-income countries. Patient-centered care is an essential component of chronic disease management in high income settings.

          Objective

          To examine feasibility of implementation of a validated patient-centered education tool among patients with heart failure in Uganda.

          Design

          Mixed-methods, prospective cohort.

          Settings

          A private and public cardiology clinic in Mulago National Referral and Teaching Hospital, Kampala, Uganda.

          Participants

          Adults with a primary diagnosis of heart failure.

          Interventions

          PocketDoktor Educational Booklets with patient-centered health education.

          Main Measures

          The primary outcomes were the change in Patient Activation Measure (PAM-13), as well as the acceptability of the PocketDoktor intervention, and feasibility of implementing patient-centered education in outpatient clinical settings. Secondary outcomes included the change in satisfaction with overall clinical care and doctor-patient communication.

          Key Results

          A total of 105 participants were enrolled at two different clinics: the Mulago Outpatient Department (public) and the Uganda Heart Institute (private). 93 participants completed follow up at 3 months and were included in analysis. The primary analysis showed improved patient activation measure scores regarding disease-specific knowledge, treatment options and prevention of exacerbations among both groups (mean change 0.94 [SD = 1.01], 1.02 [SD = 1.15], and 0.92 [SD = 0.89] among private paying patients and 1.98 [SD = 0.98], 1.93 [SD = 1.02], and 1.45 [SD = 1.02] among public paying patients, p<0.001 for all values) after exposure to the intervention; this effect was significantly larger among indigent patients. Participants reported that materials were easy to read, that they had improved knowledge of disease, and stated improved communication with physicians.

          Conclusions

          Patient-centered medical education can improve confidence in self-management as well as satisfaction with doctor-patient communication and overall care in Uganda. Our results show that printed booklets are locally appropriate, highly acceptable and feasible to implement in an LMIC outpatient setting across socioeconomic groups.

          Related collections

          Most cited references 14

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          Development and testing of a short form of the patient activation measure.

          The Patient Activation Measure (PAM) is a 22-item measure that assesses patient knowledge, skill, and confidence for self-management. The measure was developed using Rasch analyses and is an interval level, unidimensional, Guttman-like measure. The current analysis is aimed at reducing the number of items in the measure while maintaining adequate precision. We relied on an iterative use of Rasch analysis to identify items that could be eliminated without loss of significant precision and reliability. With each item deletion, the item scale locations were recalibrated and the person reliability evaluated to check if and how much of a decline in precision of measurement resulted from the deletion of the item. The data used in the analysis were the same data used in the development of the original 22-item measure. These data were collected in 2003 via a telephone survey of 1,515 randomly selected adults. Principal Findings. The analysis yielded a 13-item measure that has psychometric properties similar to the original 22-item version. The scores for the 13-item measure range in value from 38.6 to 53.0 (on a theoretical 0-100 point scale). The range of values is essentially unchanged from the original 22-item version. Subgroup analysis suggests that there is a slight loss of precision with some subgroups. The results of the analysis indicate that the shortened 13-item version is both reliable and valid.
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            Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology.

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              • Article: not found

              A reengineered hospital discharge program to decrease rehospitalization: a randomized trial.

              Emergency department visits and rehospitalization are common after hospital discharge. To test the effects of an intervention designed to minimize hospital utilization after discharge. Randomized trial using block randomization of 6 and 8. Randomly arranged index cards were placed in opaque envelopes labeled consecutively with study numbers, and participants were assigned a study group by revealing the index card. General medical service at an urban, academic, safety-net hospital. 749 English-speaking hospitalized adults (mean age, 49.9 years). A nurse discharge advocate worked with patients during their hospital stay to arrange follow-up appointments, confirm medication reconciliation, and conduct patient education with an individualized instruction booklet that was sent to their primary care provider. A clinical pharmacist called patients 2 to 4 days after discharge to reinforce the discharge plan and review medications. Participants and providers were not blinded to treatment assignment. Primary outcomes were emergency department visits and hospitalizations within 30 days of discharge. Secondary outcomes were self-reported preparedness for discharge and frequency of primary care providers' follow-up within 30 days of discharge. Research staff doing follow-up were blinded to study group assignment. Participants in the intervention group (n = 370) had a lower rate of hospital utilization than those receiving usual care (n = 368) (0.314 vs. 0.451 visit per person per month; incidence rate ratio, 0.695 [95% CI, 0.515 to 0.937]; P = 0.009). The intervention was most effective among participants with hospital utilization in the 6 months before index admission (P = 0.014). Adverse events were not assessed; these data were collected but are still being analyzed. This was a single-center study in which not all potentially eligible patients could be enrolled, and outcome assessment sometimes relied on participant report. A package of discharge services reduced hospital utilization within 30 days of discharge. Agency for Healthcare Research and Quality and National Heart, Lung, and Blood Institute, National Institutes of Health.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                16 November 2016
                2016
                : 11
                : 11
                Affiliations
                [1 ]Division of Pulmonary and Critical Care, Johns Hopkins University, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
                [2 ]Department of Medicine, Yale School of Medicine, Yale University, New Haven, Connecticut, United States of America
                [3 ]Global Health Leadership Institute, Yale University, New Haven, Connecticut, United States of America
                [4 ]College of Health Sciences, Makerere University, Kampala, Uganda
                [5 ]Department of Surgery, University Hospital Basel, Basel, Switzerland
                [6 ]Department of Nephrology, Mt. Sinai Hospital, Mount Sinai School of Medicine, New York, New York, United States of America
                [7 ]Department of Nephrology, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
                Universite de Bretagne Occidentale, FRANCE
                Author notes

                Competing Interests: Felix Knauf and Phillip Kirchhoff are co-founders of PocketDoktor Medical Booklets. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                • Conceptualization: TS FK RK SC TR AR.

                • Data curation: TS FN.

                • Formal analysis: TS SC MC.

                • Funding acquisition: TS FK.

                • Investigation: TS FN RK.

                • Methodology: TS FK SC TR.

                • Resources: FK PK.

                • Supervision: FK TR RK.

                • Visualization: TS MC SC FK.

                • Writing – original draft: TS FK TR.

                • Writing – review & editing: TS TR MC FN RK AR FK.

                Article
                PONE-D-16-24103
                10.1371/journal.pone.0166411
                5112982
                27851785
                © 2016 Siddharthan et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                Page count
                Figures: 0, Tables: 6, Pages: 12
                Product
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000061, Fogarty International Center;
                Award ID: 5R25TW009340
                Award Recipient :
                Funded by: Fulbright Scholar Award
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/501100003042, Else Kröner-Fresenius-Stiftung;
                Award ID: 2016_HA44
                Award Recipient :
                Trishul Siddharthan received funding in part from a Fulbright Scholar Award and from the Fogarty International Center of the National Institutes of Health under Award No. 5R25TW009340. Felix Knauf, Trishul Siddharthan, Tracy Rabin, Robert Kalyesubula and Asghar Rastegar are supported by the Else Kröner-Fresenius-Stifung to establish a center of excellence for patient-centered care and non-communicable disease management in Uganda (2016_HA44). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health or respective government or non-governmental organizations. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
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