Highlights Health Professionals

Christina BodeDepartment of Psychology, Health & Technology

Selection of the highlights is a balance of:

Dominant theme’s

High attendance

Personal highlights

(I am psychologist, researcher & teacher)

Quality of studies/presentations:

Good balance of qualitative and quantitative research

Systematic reviews with clear description of the quality of included studies and the validity of the conclusions

Thorough summaries of the literature

Effectiveness studies with different designs

Cross sectional studies on associations

Sharing of lived experiences

=> Adequate interpretations of the results according to the design of the study, used methods and quality of data => improve acceptability of your conclusions

Topics

Professional roles and multidisciplinary team care

Interventions

Patient reported outcome measures (PROs)

Suggestion

..what’s going on with European collaboration…

EULAR nursing task force: recommendations of role of nurses (van Eijk-Hustings)

European survey on extended roles of health professionals (mainly nurses) (Hill)

STAR-ETIC: Study of Arthritis Team rehabilitation, a cooperation between Sweden, Norway, Denmark and the Netherlands

Professional roles and

multidisciplinary team care

Models (van den Ende)

• Models of care are very different in European countries

• Shift from provider centred care to patient centred care

• Not all patient have the same needs thus a shift to tailored

interventions is necessary, patient empowerment will get more

attention

• Thinking in longer time perspectives: continuity of care must be

guaranteed, monitoring changes over time and communication

between health care providers

• Medical treatments gets more complex and patients are better

informed, better prepared and have higher expectations regarding

patient education and coaching (Welin Henriksson)

Professional roles and

multidisciplinary team care

Expectations

Benefits of extended tasks are expected for

Patients: better (quicker) access and improved communication,

satisfaction with care

Health professionals: using their potential and knowledge more

effectively, job satisfaction and career development

Health Care system: timely service, continuity of care, possibly cost

containment in the long run

(Prodinger)

Precondition: Adequate basic education and regular extra training and

refresher courses for HPs

Professional roles and

multidisciplinary team care

Professional roles and

multidisciplinary team care

Experiences

Belgium model of a nurse specialist role: training in different domains

from patho-physiology to communication and counselling (Esselens)

How to capture (measure) the activities and contributions of specialised

nurses: The SNAP: Specialist nurse activity profile, (content validity

and reliability studied) (Ryan)

Evidence

?

=> The start is made, future research have to demonstrate whether the

high expectations of extended roles for health professionals for

patients, professionals and the health care system can be fulfilled.

Professional roles and

multidisciplinary team care

Experiences and Evidence

Study of Arthritis Team rehabilitation: STAR-ETIC, a cooperation

between Sweden, Norway, Denmark and the Netherlands

Outcomes:

1. Patients with worse disease improved the most in HRQoL after

multidisciplinary team rehabilitation (Bremander)

2. The Star-Etic framework checklist is appropriate to describe the

content of complex interventions and can be used for clinical and

research reports (Grotle)

3. The number of goals set in arthritis rehabilitation varied clearly

between the participating countries. Most of the goals were set with

regard to movement related functions. (Vliet Vlieland)

Model for the development of interventions

(also useful for reporting interventions) (Taal)

Interventions

Implementation (Osborne)

system approach: patient, provider and system

Web based tool for JIA parents

• Good example for systematic developing a tool:

Needs assessment, prototype testing, evaluation by thinking aloud, evaluation study

• Appealing with quiz and video

(Buerkle)

Interventions

Brief training for self-monitoring of MTX

Patients were keen to be involved

After 3rd assessment 100% of the decisions were correct, nearly 100% correct responses whether an appointment should be made

Everyone felt confident about the decision unless he/she made mistakes in the evaluation

(James)

Interventions

Management of hand OA in older adults

comparing joint protection education and hand exercises

no effects for hand exercises

joint protection education effective 6 months follow up for hand pain and disability, and effective to improve pain self-efficacy at each measurement point

(Dziedzic)

Interventions

Acceptance-oriented psychological intervention for highly distressed patients with rheumatic disease

proof of the concept study with 25 patients

20 treatment sessions

For 3 out of 4 patients psychological distress decreased below clinical levels

Acceptance of disease increased

(Vriezekolk)

Interventions

Tai Chi for people with rheumatic diseases

Traditional Chinese daily exercise with slow and gentle movements combined with mental focus, popular in the elderly, beside other results, effective in reduction of falls (Uhlig)

Cochrane review: Beneficial effects on physical and psychological functioning, recommend as safe (Niedermann)

Interventions

Physical activity in health promotion and rehabilitation

• Arthritis Care in Northern Ireland built a network to offer appropriate physical activities combined with fun and social interaction to their members, well received, participants enjoyed especially the social interaction (Fleck)

• Another plea for FUN while exercising: integration of WiiFit and Wii balance board in rehabilitation and maintenance of exercises in daily life post rehabilitation (Tal-Akabi)

More questions than answers

Instruments are validated and have norm standards on the group level but do they also properly cover individual experiences and measure individual change? (Opava)

How to cover individual preferences? From the individual perspective, some items should actually have a higher weight in the sumscore.

Specific indices exist but the interpretation of the numeric scores on the individual and the group level is still unclear (Jolles- Haeberli)

Possible solutions:

?? Different PROs in clinical practice and research????

?? Short forms for clinical practice and long forms for research???

?? Other measurement technologies: computer adaptive testing??

Patient reported outcome measures (PROs)

More questions than answers

Instruments are validated and have norm standards on the group level but do they also properly cover individual experiences and measure individual change?

How to cover individual preferences? From the individual perspective, some items should have a higher weight in the sumscore.

Specific indices exist but the interpretation of the numeric scores on the individual and the group level is still unclear

Possible solutions:

?? Different PROs in clinical practice and research????

?? Short forms for clinical practice and long forms for research???

?? Other measurement technologies: computer adaptive testing??

Patient reported outcome measures (PROs)

SIMILAR QUESTIONS WERE DISCUSSED IN

THE CLINICAL SESSION ON PROs YESTERDAY:

TOPIC FOR A JOINT SESSION?

Influence of literacy and language on the use of PROs (Oesch)

• Selectivity in studies because of drop out of patients who did not understand the questions (low literacy in mother tongue, countries with different official languages or migration background)

• Estimate 15%-20% prevalence of low literacy in RA patients

• Initiative for migrant friendly hospitals

• Working with translators during consultations

• Use of picture based instruments

• Use of reading age as proxi (material should have no higher levels than reading age = 7 years)

Patient reported outcome measures (PROs)

Some talks refereed to demographic changes, ageing societies and ageing patient populations on a general level

It might be an idea to include a life span perspective more directly in the analyses and in the understanding of the phenomena we are studying, chronological age and living circumstances not only for the description of the sample

Example from the work session:

How to extend the working life with special attention for the work restrictions that increased with age and how to tackle environmental barriers which effect individual functioning (Wilkie)

Some final remarks

Studies on use and effectiveness of care in different age groups

In depth interviews on the experience of fatigue in RA: coping strategies seem to differ between age groups, perhaps because of their coping competencies but also simply because the older patients have more flexibility to take a short break whenever they want during the day => patient education can be tailored

In the evaluation of a self-management intervention we found that patients in young and middle adulthood did not appreciate to follow the course together with patients in older ages because the living circumstances were not comparable. They would have liked to have more peers in the groups to exchange experiences on similar problems with daily life.

Some final remarks

Thank you very much for your attention!