La recherche au service de la performance en Santé
U.INSERM 1290 - La recherche au service de la performance en Santé
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Université Claude Bernard Lyon 1
U.INSERM 1290 - La recherche au service de la performance en Santé

Actualités du laboratoire Hesper

Réunion Scientifique RESHAPE 19 novembre 2021 à 12h30

 - Marie Rambure « PHARMA ILIADE Study : Determinants of the implementation of communication techniques adapted to patients' health literacy levels in French community pharmacies & intervention proposals, using the Theoretical Domains Framework and the Behaviour Change Wheel »

Background


Community pharmacy professionals have a crucial role to play to enhance patients’ understanding and empowerment about their disease in accordance with their health literacy (HL) level. We aimed to explore the determinants of the implementation of patient HL level assessment and HL-tailored communication practices towards chronic patients among community pharmacy professionals.

Methods


We conducted a cross-sectional sequential explanatory mixed-method study. As a first step, an online self-completed questionnaire underpinned by the Theoretical Domain Framework (TDF) was sent to community pharmacy workers (pharmacists and pharmacy technicians of the Auvergne-Rhône-Alpes region, France). Findings were analysed using the confidence interval-based estimation of relevance (CIBER) method. As a second step, semi-structured interviews were conducted with a sample of survey respondent volunteers, to deepen the information previously gathered. The determinants explored, within these two steps, were the 12 domains of the TDF. Finally, we used the Behaviour Change Wheel (BCW), to propose, in a structured way, intervention ideas.

Results


Among the 111 respondents (91 pharmacists and 20 technicians), count (84%) were not familiar with HL. However, after being shortly introduced to the concept, most claimed to informally assess patient HL level and adapt their communication to the understanding of patients. Key determinants that impeded these behaviours were the lack of adapted environment (no clear signage in the pharmacy environment) and resources (lack of time, staff, adapted remuneration system, tools dedicated to assess patients' HL level), the lack of automatism (they did not assess all patients’ HL and the time of the day influenced whether they adapt or not their communication to patients’ HL level), and the difficulties to contact other healthcare providers. Thanks to the BCW and based on the AHRQ universal precaution toolkit and the Effective Practice and Organisation of Care (EPOC) taxonomy, we identified implementation strategies that might be useful for these behaviours ( the creation of trainings, specific tools, checklists and practices community or the reorganisation of the pharmacy...).

Conclusions


Several target TDF determinants of the implementation of the HL-tailored communication techniques in community pharmacy were identified in this study. Our results might guide the design of effective theory-based interventions to improve the implementation of HL-tailored behaviours among community pharmacy workers.

Descriptive Analysis of Patient Misidentification From Incident Report System Data in a Large Academic Hospital Federation

Abraham P, Augey L, Duclos A, Michel P, Piriou V.

Abstract:

Introduction: Patient misidentification continues to be an issue in everyday clinical practice and may be particularly harmful. Incident reporting systems (IRS) are thought to be cornerstones to enhance patient safety by promoting learning from failures and finding common root causes that can be corrected. The aim of this study was to describe common patient misidentification incidents and contributory factors related to perioperative care.

Design and settings: We retrospectively analyzed IRS data reported by healthcare workers from a large academic hospital federation from 2011 to 2014. All patient misidentification incidents that occurred during perioperative care were reviewed and classified using the international classification for patient safety taxonomy. Incident type, contributory factor, error type, and consequences for the patient and for the organization were extracted for each incident report.

Results: Among the 293 reported incidents, the most frequent errors were missing wristbands (34%), wrong charts or notes in files (20%), administrative issues (19%), and wrong labeling (14%). The main contributory factors included the absence of patient identity control (30%), patient transfer (30%), and emergency context (8%). Data on patient and institutional consequences were scarce. Events of missing and wrong identities on wristbands were rarely detected when patients were transferred from the admission ward to the operating room or the radiology department.

Conclusion: These results illustrate that misidentification errors are still common in France. This work contributes to enhancing interest in IRS data analysis to define or refine patient safety improvement strategies related to misidentification errors in healthcare institutions.

 

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Perceptions and Experiences of Older Persons in Two Types of Institution in France: Foster Care Family Institution and Medico-Social One.

Chammem R, Domi S, Schott AM

Abstract:

Background: The rapid increase in the number of older people with loss of autonomy and requiring human support, medical services, and adapted accommodation is a challenge in many countries. Beside institutions for older people, foster care families may offer an interesting innovative and affordable alternative that should to be evaluated. As the place of living has a major impact on the quality of life, our objective was to compare the perceptions and experience of older adults depending on the type of accommodation in which they live in.

Rita Chammem, Serge Domi and Anne-Marie Schott

Methods: This study was based on a mixed method approach, with a quantitative assessment and a qualitative study with semi-structured interviews conducted with older people living in two different types of institutions: medico-social institution and foster care families. We explored the perceptions and the quality of life of the participants.

Results: Institutionalization, chosen or not, can represent a trauma for older people as it disrupts their personal habits. Participants described medico-social institutions as an institutional framework supported by a strict professional team and rules, as impersonal structures (i.e., somewhat neutral), and as offering a very present, prepared, and respected reception protocol on the first day of arrival, which remained marked in memories. On the other hand, foster care families were considered as more spontaneous and family-oriented structures relying on internal and negotiable rules, offering personalized and close support in the face of loss of autonomy, but in which the reception protocol on the first day of arrival was almost absent.

Conclusions: Foster care families and medico-social institutions presented different advantages and disadvantages from the point of view of the participants. This can help health policy makers to rethink the way seniors are housed by taking into consideration their perception and quality of life.

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