Volunteer Behavioral Health Care System

BackgroundResponding to online patient feedback is considered integral to patient safety and quality improvement. However, guidance on how to respond effectively is limited, with limited attention paid to patient perceptions and reactions.ObjectivesTo identify factors considered potentially helpful in enhancing response quality; coproduce a best‐practice response framework; and quality‐appraise existing responses.DesignA four‐stage mixed methodology: (i) systematic search of stories published on Care Opinion about adult mental health services in the South West of England; (ii) collaborative thematic analysis of responses to identify factors potentially helpful in enhancing response quality; (iii) validation of identified factors by a patient‐carer group (n = 12) leading to the coproduction of a best‐practice response framework; and (iv) quality appraisal of existing responses.ResultsA total of 245 stories were identified, with 183 (74.7%) receiving a response. Twenty‐four (9.8%) had been heard but not yet responded to. 1.6% (n = 4/245) may lead to a change. Nineteen factors were considered influential in response quality. These centred around seven subject areas: (i) introductions; (ii) explanations; (iii) speed of response; (iv) thanks and apologies; (v) response content; (vi) signposting; and (vii) response sign‐off that were developed into a conceptual framework (the Plymouth, Listen, Learn and Respond framework). Quality appraisal of existing responses highlighted areas for further improvement demonstrating the framework's utility.ConclusionThis study advances existing understanding by providing previously unavailable guidance. It has clear practical and theoretical implications for those looking to improve health‐care services, patient safety and quality of care. Further validation of the conceptual framework is encouraged.

Currently there are no universally accepted approaches for the prevention of recurrent Clostridium difficile infections (CDI) following the initial infection. Several studies have identified common risk factors for the emergence of recurrent CDI. Identifying patients at high risk for recurrent CDI through the assessment of risk factors at initial diagnosis could enable health care providers to optimize available treatment options. A vancomycin hydrochloride-tapered regimen may be an effective treatment option for the prevention of recurrent CDI following the initial infection. In this single-center, prospective study, we examined the efficacy of orally administered vancomycin-tapered regimens for the prevention of recurrent CDI in high-risk patients. High-risk patients were identified using patient risk factors found in a retrospective chart review. The primary objective was to decrease hospital readmissions for recurrent CDI. The secondary objective was to improve the discharge coordination-of-care process by providing a pharmacy benefits evaluation, which ensured vancomycin affordability and assistance in prescription attainment, and discharge counseling. Of the 83 patients enrolled in the study, 5 experienced recurrent CDI (6%). Memorial Health Care System's (Chattanooga, Tennessee) historical recurrent CDI rate was 8.2%. Thirty-one of the 83 patients received a vancomycin-tapered regimen following their initial infection (37%). A pharmacy benefits evaluation was performed on 35 of the 57 patients who were discharged home on vancomycin (61%). Vancomycin-tapered regimens may provide a cost-effective method for the prevention of recurrent CDI following an initial infection in patients at high risk for recurrence.

Qualitative and quantitative data from Safer Choices, a school-based multicomponent HIV prevention program, were examined to determine the impact of HIV-positive speakers on inner-city adolescents' HIV risk perception and empathy for people with HIV or AIDS. Inductive analyses were used to assess student reactions to speakers. Multilevel regression modeling techniques were used to analyze student survey data (n = 1,491) to determine the effect of speakers alone, as well as in combination with the multicomponent intervention, and a knowledge-based curriculum (comparison condition). Results showed that speakers were highly popular with students and teachers, and had a positive short-term impact on students' attitudes. Although not statistically significant, the combination of intervention and speakers had the greatest impact on outcome variables. Integrating HIV-positive speakers into multicomponent programs may have a positive impact on inner-city youth. Utilizing speakers without other educational components may have minimal effects. Strategies for training and utilizing HIV-positive speakers in school settings are included.