Project description:PurposeThe absence of a best practice treatment standard contributes to clinical variation in medicine. Often in the absence of evidence, a standard of care is developed and treatment protocols are implemented. The purpose of this study was to examine whether the standard of care for the treatment of nondisplaced scaphoid fractures is uniform among orthopedic surgeons.MethodsA survey of orthopedic surgeons actively practicing in the US or abroad was conducted to elicit preferred treatment strategies for nondisplaced scaphoid fractures. The surgeons were recruited at orthopedic conferences, clinical visits, and via email. The survey included demographic questions along with a short clinical vignette. The option for fracture management included surgical versus nonsurgical treatment. For those who chose nonsurgical treatment, type/duration of immobilization was recorded. Cost analysis was performed to estimate direct and indirect costs of various treatment options.ResultsA total of 494 orthopedic surgeons completed the survey. The preference for surgical treatment was preferred in 13% of respondents. Hand/upper extremity specialists were significantly more likely to operate compared with generalists (p = 0.0002). Surgeons younger than forty-five were nearly twice as likely to choose surgery (p = 0.01). There was no clear consensus on duration of immobilization as 30% of surgeons chose 6 weeks, 33% selected 8 weeks, and 27% opted for 12 weeks. Total cost of surgery was 49% greater than that of nonoperative treatment. With each additional week of immobilization for nonoperative treatment, the total costs of surgical treatment near that of nonoperative treatment.ConclusionThere exist clear trends in how specific demographic groups choose to treat the nondisplaced scaphoid fracture. Whether these trends are the result of generational gaps or additional subspecialty training remains difficult to determine, but there is need to pursue a more consistent approach that benefits the patients and the health care system as a whole.

Project description:BackgroundHealth information delivered via daily modes of communication such as email, text, or telephone reportedly supports improved health behavior and outcomes. While different modes of communication beyond clinical visits have proven successful for patient outcomes, preferences for communication modes have not been comprehensively studied among older primary care patients. We addressed this gap by assessing patient preferences for receiving cancer screening and other information from their doctors' offices.ObjectiveWe explored stated preferences by communication modes through the lens of social determinants of health (SDOH) to gauge acceptability and equity implications for future interventions.MethodsA cross-sectional survey was mailed to primary care patients aged 45-75 years, in 2020-2021, which assessed respondents' use of telephones, computers, or tablets in daily life and their preferred modes of communication for different types of health information, including educational materials about cancer screening, tips for taking prescription medication, and protection from respiratory diseases from their doctors' offices. Respondents indicated their willingness to receive messages from their doctors' offices via each of the provided modes of communication, including telephone, text, email, patient portals, websites, and social media, on a 5-point Likert scale ranging from "unwilling" to "willing." We present the percentage of respondents who indicated that they were "willing" to receive information via specific electronic mode. Chi-square tests were used to compare participants' willingness by social characteristics.ResultsIn total, 133 people completed the survey (response rate 27%). The average respondent age was 64 years, 82 (63%) respondents were female, 106 (83%) were White, 20 (16%) were Black, and 1 (1%) was Asian. In total, 75 (58%) respondents had a bachelor's degree or higher; 26 (20%) resided in rural areas, 37 (29%) in suburban areas, 50 (39%) in a town, and 15 (12%) in a city. The majority, 73 (57%), reported being comfortable with their income. Preferences of respondents for electronic communication about cancer screening were distributed as follows: 100 (75%) respondents were willing to receive information from their doctor's office via their patient portal, 98 (74%) via email, 75 (56%) via text, 60 (45%) via the hospital website, 50 (38%) via telephone, and 14 (11%) via social media. About 6 (5%) respondents were unwilling to receive any communication via electronic modes. Preferences were distributed similarly for other types of information. Respondents reporting lesser income and education consistently preferred receiving telephone calls relative to other communication modes.ConclusionsTo optimize health communication and reach a socioeconomically diverse population, telephone calls should be added to electronic communication, especially for people with less income and education. Further research needs to identify the underlying reasons for the observed differences and how best to ensure that socioeconomically diverse groups of older adults can access reliable health information and health care services.

Project description:BACKGROUND:Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. OBJECTIVE:Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. METHODS:The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. RESULTS:A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (P=.03) and were more satisfied with their communication experiences (P=.02). Overall, older people tended to favor telephone calls (73/132, 55.3%) over video calls (59/132, 44.7%); however, their satisfaction degree was similar regardless of the chosen method (P=.1), with no effect of age (P=.97) or gender (P=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98%) and video calls (33/38, 87%) in older patients (P=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93%) versus the use of telephone calls (6/12, 50%; P=.02). CONCLUSIONS:Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. TRIAL REGISTRATION:ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849.

Project description:BackgroundOlder people with hypertension and multiple chronic conditions (MCC) receive complex treatments and face challenging trade-offs. Patients' preferences for different health outcomes can impact multiple treatment decisions. Since evidence about outcome preferences is especially scarce among people with MCC our aim was to elicit preferences of people with MCC for outcomes related to hypertension, and to determine how these outcomes should be weighed when benefits and harms are assessed for patient-centered clinical practice guidelines and health economic assessments.MethodsWe sent a best-worst scaling preference survey to a random sample identified from a primary care network of Kaiser Permanente (Colorado, USA). The sample included individuals age 60 or greater with hypertension and at least two other chronic conditions. We assessed average ranking of patient-important outcomes using conditional logit regression (stroke, heart attack, heart failure, dialysis, cognitive impairment, chronic kidney disease, acute kidney injury, fainting, injurious falls, low blood pressure with dizziness, treatment burden) and studied variation across individuals.ResultsOf 450 invited participants, 217 (48%) completed the survey, and we excluded 10 respondents who had more than two missing choices, resulting in a final sample of 207 respondents. Participants ranked stroke as the most worrisome outcome and treatment burden as the least worrisome outcome (conditional logit parameters: 3.19 (standard error 0.09) for stroke, 0 for treatment burden). None of the outcomes were always chosen as the most or least worrisome by more than 25% of respondents, indicating that all outcomes were somewhat worrisome to respondents. Predefined subgroup analyses according to age, self-reported life-expectancy, degree of comorbidity, number of medications and antihypertensive treatment did not reveal meaningful differences.ConclusionsAlthough some outcomes were more worrisome to patients than others, our results indicate that none of the outcomes should be disregarded for clinical practice guidelines and health economic assessments.

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Treatment of olecranon fractures in older individuals: a cross-sectional survey of surgeon treatment preferences

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