Focus Groups

ImportanceSocial determinant of health (SDOH) data are essential to individualized care and reducing health disparities. However, there is little standardization in the way that SDOH data are collected, and barriers to increasing the collection of such data exist at both the patient and clinician levels.ObjectiveTo evaluate clinician, patient, and care partner perspectives on the barriers to and facilitators of patients sharing SDOH information with their clinicians.Design, setting, and participantsThis qualitative study included clinicians, patients, and care partners across the United States. Focus groups were conducted between September 2022 and February 2023 to understand the experience of collecting, documenting, and exchanging SDOH data.Main outcomes and measuresRapid assessment procedures were used to analyze focus group transcripts, creating summaries, codes, and themes mapped directly to the project research questions.ResultsA total of 235 individuals participated, including 109 (46.4%) clinicians (60 [55.0%] male; 25 [22.9%] Asian, 2 [1.8%] Black, and 74 [67.9%] White) and 126 (53.6%) patients and care partners (45 [35.7%] male; 1 [0.8%] Asian, 48 [38.1%] Black, and 64 [50.8%] White). Clinicians and patients agreed that SDOH data are important for clinicians to know. Both clinicians and patients wanted a structured, standardized way to collect SDOH data in the future, accompanied by time for more in-depth discussion during the visit. However, they highlighted numerous issues that impact collecting these data, including beliefs about how the information will be used, the clinician-patient relationship, having enough of the right staff, time needed to collect SDOH information, and technology used to collect the data (eg, usability, standardization).Conclusions and relevanceThis qualitative study of the experience of collecting, documenting, and exchanging SDOH data underscores the ongoing barriers to widespread adoption of uniform approaches to SDOH data documentation as well as factors that may help lower those barriers, such as trusting patient-clinician relationships, greater transparency in how the data will be used, and targeted resources. A multifaceted approach to addressing the concerns raised by clinicians, patients, and care partners is required to ensure that such data can be captured in a way that improves care and allows for progress toward an equitable health care system.

BackgroundThe proliferation of electronic health records (EHR) in health systems of many high-income countries has ushered in profound changes to how clinical information is used, stored, and disseminated. For patients, being able to easily access and share their health information electronically through interoperable EHRs can often impact safety and their experience when seeking care across healthcare providers. While extensive research exists examining how EHRs affected workflow and technical challenges such as limited interoperability, much of it was done from the viewpoint of healthcare staff rather than from patients themselves. This leaves a critical knowledge gap in our evidence base to inform better implementation of health information technologies which needs addressing.Aims and objectivesThis study aimed to explore how patients with chronic conditions or polypharmacy and their caregivers perceive the current state of EHR interoperability, identify instances where it was associated with negative health outcomes, and elucidate patient-driven recommendations to address concerns raised.MethodsA total of 18 patients and caregivers participated in five online focus groups between May-July 2022. Thematic analysis was performed to generate codes and derive higher-order themes.ResultsParticipants highlighted that EHR interoperability in the NHS does not meet patient needs and expectations. While patients' understanding of the concept of EHR interoperability was mixed, most were able to describe how the inability to seamlessly share health information within EHR has negatively impacted care. Limited interoperability contributed to inaccurate medical records, perpetuated existing incorrect information, impaired clinical decision-making, and often required patients to resort to using workarounds. Patients also voiced ideas for potential solutions for consideration. These included a move towards a one-centralised system approach, strengthening data security measures to augment other efforts to increase interoperability, prioritising health information technology training for NHS staff, and involving more allied health professionals and patients themselves in the EHR data curation process.ConclusionOur study contributes to the existing body of literature by providing the perspectives of patients and carers most likely to encounter interoperability challenges and therefore those most ideally positioned to propose potential solutions. As highlighted by patients, researchers and policymakers should consider social, educational, and organisational solutions, in addition to technical solutions. Lack of interoperability (i.e., the ability to share a patient's health information electronically between healthcare providers) can affect the quality of care received. However, much of the existing research was done from the viewpoint of healthcare staff rather than from patients themselves. This study explored the views of patients regarding what they feel interoperability in the NHS is currently like, how they think it affects their care, and what they think can be done to improve it. Patients reported interoperability to often be poor. It caused inconvenience both to themselves and their healthcare provider, and negatively impacted their experience getting care overall. Patient suggestions for improvement included centralising and reducing the number of existing systems, having more training for healthcare staff, and supporting patients and other healthcare staff in managing their health data.

BackgroundImmigrant populations, especially women, continue facing challenges in accessing quality healthcare, particularly sexual and reproductive health services (SRH). Poor cultural competent health systems contribute to communication challenges between immigrant women and healthcare providers perpetuating health disparities. This exploratory study describes these communication barriers from the perspective of Moroccan and Pakistani immigrant women and healthcare providers within the Catalan health system and its implications to ensure an equitable provision of SRH services.MethodsAn exploratory-descriptive qualitative study was conducted in various municipalities of Barcelona with high concentration of immigrants. Eight focus groups (N = 51) and semi-structured interviews (N = 22) with Moroccan and Pakistani immigrant women were combined with key informant interviews (N = 13) with healthcare professionals. Thematic analysis and data triangulation were performed primarily using an inductive approach.ResultsLanguage barriers and cultural differences in health needs, expectations, care-seeking behaviours and understanding of quality healthcare provision hindered the ability of immigrant women and providers to interact effectively. Limited availability of intercultural mediators and inadequate cultural competence training opportunities for health staff were also identified. Findings suggest a lack of minority representation in the Catalan health workforce and leadership roles.ConclusionThis study reinforces the evidence of persistent inequities in accessing healthcare among immigrant populations by focusing on the cultural competence barriers of the Catalan health system in the provision and access to SRH services. The regularization of adequately trained intercultural mediators, quality training in cultural competence for health staff and a commitment to increase workforce diversity would contribute to improve intercultural communication between immigrant patients and providers. An urgent call to action in this direction is needed to ensure an equitable access to SRH services among immigrant women.

IntroductionMultiple medication safety recommendations to reduce preventable medication-related hospitalisations have been introduced in the Netherlands. Still, these hospitalisations remain prevalent. This might be due to suboptimal implementation in clinical practice. Therefore, more insight is needed into barriers and facilitators for the implementation of these medication safety recommendations across healthcare sectors.AimThis study aimed to identify barriers and facilitators for implementing medication safety recommendations across healthcare sectors from the perspective of various stakeholders.MethodA selection of 17 Dutch medication safety recommendations targeting medications responsible for a large proportion of medication-related hospitalisations was evaluated in focus groups to identify barriers and facilitators to their implementation. These included recommendations for: reducing fall risk in elderly; initiating prophylactic medication; monitoring patients at risk of electrolyte disorders; clarifying responsibilities for patient care; informing patients about alarm symptoms; and prescribing antithrombotics on strict indication. Stakeholders were selected through purposive sampling based on their profession and healthcare sector. Transcripts of audio-recordings were analysed inductively, after which implementation factors were categorised using the Consolidated Framework for Implementation Research.ResultsThirty stakeholders were divided into five focus groups. These included community pharmacists (n = 9), general practitioners (n = 4), hospital pharmacists (n = 3), representatives from healthcare knowledge organisations (n = 3), patient representatives (n = 2), medical specialists (n = 2), nurses (n = 2), and other stakeholders (n = 5). Forty-nine barriers and facilitators were identified. Key themes were lack of specified responsibilities, limited information exchange, local collaboration and protocol adherence. Recommendations with a lower level of implementation often required collaboration with multiple healthcare providers, whereas recommendations with a higher level of implementation were frequently supported by clinical decision support systems.ConclusionA broad range of barriers and facilitators to the implementation of medication safety recommendations was identified. Overall, the findings highlight the need for recommendations with specified responsibilities, improved information exchange, strengthened local collaboration, and increased protocol adherence.