Patient Perspectives on Improving Patient-Provider Relationships and Provider Communication During Opioid Tapering

Background Efforts to reduce opioid overdose fatalities have resulted in tapering (i.e., reducing or discontinuing) opioid prescriptions despite a limited understanding of patients’ experiences. Objective To explore patients’ perspectives on opioid taper experiences to ultimately improve taper processes and outcomes. Design Qualitative study. Participants Patients on long-term opioid therapy for chronic pain who had undergone a reduction of opioid daily prescribed dosage of ≥50% in the past 2 years in two distinct medical systems and regions. Approach From 2019 to 2020, we conducted semi-structured interviews that were audio-recorded, transcribed, systematically coded, and analyzed to summarize the content and identify key themes regarding taper experiences overall and with particular attention to patient-provider relationships and provider communication during tapers. Key Results Participants (n=41) had lived with chronic pain for an average of 17.4 years (range, 3–36 years) and described generally adverse experiences with opioid tapers, the initiation of which was not always adequately justified or explained to them. Consequences of tapers ranged from minor to substantial and included withdrawal, mobility issues, emotional distress, exacerbated mental health symptoms, and feelings of social stigmatization for which adequate supports were typically unavailable. Narratives highlighted the consequential role of patient-provider relationships throughout taper experiences, with most participants describing significant interpersonal challenges including poor provider communication and limited patient engagement in decision making. A few participants identified qualities of providers, relationships, and communication that fostered more positive taper experiences and outcomes. Conclusions From patients’ perspectives, opioid tapers can produce significant physical, emotional, and social consequences, sometimes reducing trust and engagement in healthcare. Patient-provider relationships and communication influence patients’ perceptions of the quality and outcomes of opioid tapers. To improve patients’ experiences of opioid tapers, tapering plans should be based on individualized risk-benefit assessments and involve patient-centered approaches and improved provider communication.

Privatized Medicare Advantage for All: The Latest Assault on U.S. Health Care

Privatized Medicare Advantage has grown rapidly among seniors in the United States in recent years. It is now being promoted actively by corporate stakeholders and even by the Centers for Medicare and Medicaid Services itself as a new proposal to extend this approach to cover all Americans. There is little public awareness, however, of the current costs and adverse impacts of Medicare Advantage on enrollees’ access, costs, and outcomes of care while deceptive marketing and disinformation prevails. This article traces the history of Medicare Advantage, outlines false assertions being made by proponents of Medicare Advantage for All, and refutes them based on evidence and their track record. If ever enacted, it would end up lining the pockets of corporate stakeholders and Wall Street investors while limiting access to care, increasing costs, and reducing quality and outcomes of care. The United States already ranks last for access, equity, and outcomes of care in periodic studies by the Commonwealth Fund. This proposal would worsen that situation while costing patients, families, and taxpayers more as their health suffers.

Making Use of Comparable Health Data to Improve Quality of Care and Outcomes in Diabetes: The EUBIROD Review of Diabetes Registries and Data Sources in Europe

BackgroundRegistries and data sources contain information that can be used on an ongoing basis to improve quality of care and outcomes of people with diabetes. As a specific task of the EU Bridge Health project, we carried out a survey of diabetes-related data sources in Europe.ObjectivesWe aimed to report on the organization of different sources of diabetes information, including their governance, information infrastructure and dissemination strategies for quality control, service planning, public health, policy and research.MethodsSurvey using a structured questionnaire to collect targeted data from a network of collaborating institutions managing registries and data sources in 17 countries in the year 2017.ResultsThe 18 data sources participating in the study were most frequently academic centres (44.4%), national (72.2%), targeting all types of diabetes (61.1%) covering no more than 10% of the target population (44.4%). Although population-based in over a quarter of cases (27.8%), sources relied predominantly on provider-based datasets (38.5%), fewer using administrative data (16.6%). Data collection was continuous in the majority of cases (61.1%), but 50% could not perform data linkage. Public reports were more frequent (72.2%) as well as quality reports (77.8%), but one third did not provide feedback to policy and only half published ten or more peer reviewed papers during the last 5 years.ConclusionsThe heterogeneous implementation of diabetes registries and data sources hampers the comparability of quality and outcomes across Europe. Best practices exist but need to be shared more effectively to accelerate progress and deliver equitable results for people with diabetes.

P015 Home (Level 2) sleep studies are feasible in children

Introduction In-hospital polysomnography (PSG or Level 1 study) is the “gold-standard” for investigating sleep disorders in children. There are long waiting lists for sleep studies in Australian tertiary centres. Level 2 home-PSG has been proposed as an alternate option. However, there are limited data regarding the feasibility in a clinical population. The aim of this study is to assess the feasibility and patient experience of home-PSG in a clinical cohort. Methods The signal quality and outcomes of a home-PSG in young people undergoing sleep investigation in a single centre were reviewed. A successful home-PSG was defined as a study with ≥ 6hrs of sleep and all channels present for ≥90% of sleep time. Feedback from the guardian/young person was collected using a questionnaire. Results Fifty-five patients (4m-18yrs) were included. Successful home-PSG, on the first attempt, was achieved for 48/55 (87%) patients. There were no differences in success when accounting for neurodevelopmental conditions, OSA severity or age. A clinical diagnosis was confidently made in 53 (96%) patients. The majority (76%) rated their sleep as the same or better than normal and only 12% found having the study conducted at home difficult. Following the study, only 8% would have preferred a hospital sleep study. Discussion Home-PSG produced technically adequate recordings for most subjects and families found the experience of having a home sleep study to be positive. These data support, in appropriate circumstances, home-PSG as a viable alternative to an in-patient sleep study.