Abstract:BackgroundAdvanced osteoarthritis and total joint replacement (TJR) recovery are painful experiences and often prompt opioid use in developed countries. Physicians participating in the philanthropic medical mission Operation Walk Boston (OpWalk) to the Dominican Republic have observed that Dominican patients require substantially less opioid medication following TJR than US patients. We conducted a qualitative study to investigate approaches to pain management and expectations for postoperative recovery in pat… Show more
“…They reported a reliance on nonpharmacologic therapies, as well as family and religious support. They had limited knowledge of opioids, and trusted God and their doctors to cure their pain 28 .…”
Section: Resultsmentioning
confidence: 99%
“…Notably, Op-Walk Boston’s use of qualitative studies allowed for an increased understanding of the differences in medical practices, catalyzed adaptation to cultural norms, and identified needed interventions. For example, studies on patient opioid use and physician opinions on prescription medications showed that HGPS physicians rarely prescribed opioids, and patients had limited experience with them 27,28 . These observations prompted the Op-Walk clinical leaders to reduce the role of opioids in the postoperative pain management protocols for the program, as well as to evaluate the reasoning for their prescription practices at their home institutions.…”
Background:Medical missions to low and middle-income countries are increasingly frequent, with an estimated 6,000 trips sponsored by U.S. organizations accounting for approximately 200,000 surgical cases and $250 million in costs annually. However, these missions have received little critical evaluation. This paper describes the research program Operation Walk (Op-Walk) Boston, and proposes an evaluation model for similar surgical missions.Methods:We propose an evaluation model, borrowing from the work of Donabedian and enriched by evidence from our research program. The model calls for evaluation of the salient contextual factors (culture and beliefs), system management (structure, process, and outcomes), and sustainability of the program’s interventions. We used these domains to present findings from the quantitative and qualitative research work of Op-Walk Boston.Results:Op-Walk’s qualitative research findings demonstrated that cultural factors are important determinants of patients’ perceptions of arthritis etiology, physical activity patterns, and treatment preferences. Quantitative assessments documented that Dominican patients had worse lower-extremity functional status (mean Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function score of 33.6) and pain preoperatively than patients undergoing total hip or knee replacement in the U.S. (WOMAC function score of 43.3 to 54), yet they achieved excellent outcomes (50-point improvement), comparable to those of their U.S. counterparts. Assessments of the quality and sustainability of the Op-Walk program showed that the quality of care provided by Op-Walk Boston meets Blue Cross Blue Shield Centers of Excellence (Blue Distinction) criteria, and that sustainable changes were transferred to the host hospital.Conclusions:Our proposed model offers a method for formal assessment of medical missions that addresses the call for evidence of their merit. We suggest that surgical missions adopt quantitative and qualitative strategies to document their impact, identify areas of improvement, and justify program continuation, growth, and support.
“…They reported a reliance on nonpharmacologic therapies, as well as family and religious support. They had limited knowledge of opioids, and trusted God and their doctors to cure their pain 28 .…”
Section: Resultsmentioning
confidence: 99%
“…Notably, Op-Walk Boston’s use of qualitative studies allowed for an increased understanding of the differences in medical practices, catalyzed adaptation to cultural norms, and identified needed interventions. For example, studies on patient opioid use and physician opinions on prescription medications showed that HGPS physicians rarely prescribed opioids, and patients had limited experience with them 27,28 . These observations prompted the Op-Walk clinical leaders to reduce the role of opioids in the postoperative pain management protocols for the program, as well as to evaluate the reasoning for their prescription practices at their home institutions.…”
Background:Medical missions to low and middle-income countries are increasingly frequent, with an estimated 6,000 trips sponsored by U.S. organizations accounting for approximately 200,000 surgical cases and $250 million in costs annually. However, these missions have received little critical evaluation. This paper describes the research program Operation Walk (Op-Walk) Boston, and proposes an evaluation model for similar surgical missions.Methods:We propose an evaluation model, borrowing from the work of Donabedian and enriched by evidence from our research program. The model calls for evaluation of the salient contextual factors (culture and beliefs), system management (structure, process, and outcomes), and sustainability of the program’s interventions. We used these domains to present findings from the quantitative and qualitative research work of Op-Walk Boston.Results:Op-Walk’s qualitative research findings demonstrated that cultural factors are important determinants of patients’ perceptions of arthritis etiology, physical activity patterns, and treatment preferences. Quantitative assessments documented that Dominican patients had worse lower-extremity functional status (mean Western Ontario and McMaster Universities Osteoarthritis Index [WOMAC] function score of 33.6) and pain preoperatively than patients undergoing total hip or knee replacement in the U.S. (WOMAC function score of 43.3 to 54), yet they achieved excellent outcomes (50-point improvement), comparable to those of their U.S. counterparts. Assessments of the quality and sustainability of the Op-Walk program showed that the quality of care provided by Op-Walk Boston meets Blue Cross Blue Shield Centers of Excellence (Blue Distinction) criteria, and that sustainable changes were transferred to the host hospital.Conclusions:Our proposed model offers a method for formal assessment of medical missions that addresses the call for evidence of their merit. We suggest that surgical missions adopt quantitative and qualitative strategies to document their impact, identify areas of improvement, and justify program continuation, growth, and support.
“…Two previous qualitative studies in the same setting (Hospital General de la Plaza de la Salud, Santo Domingo) investigated modes of coping with arthritis. Yu and colleagues found that participants coped with pain while utilizing relatively little pain medication, in part by using nonpharmacologic therapies and social support networks . Niu et al similarly identified strategies that patients used to manage pain without medication (e.g., prayer) and to obtain medication (e.g., family financial support) .…”
Section: Discussionmentioning
confidence: 99%
“…In the latter category, religion often plays an important role in dealing with illness . Purchasing treatments places a sizeable financial burden on individuals in low‐ and middle‐income countries , leaving them to forego part of the treatment or identify additional resources . Higher out‐of‐pocket costs contribute to lower adherence , and individuals with lower socioeconomic status are less likely to adhere to treatment regimens .In a middle‐income country with stark income inequality (Dominican Republic), there is societal decision‐making that perpetuates a lack of access to health care.When available resources are insufficient for accessing health care, there is a range of strategies used by Dominican individuals to manage chronic illness.Knowledge regarding strategies that patients may use to manage chronic illness when lacking resources for medications is beneficial for clinicians working in resource‐limited settings.There is a need for policies that address underinsurance and transportation‐related barriers to care.…”
This qualitative study illuminates the range of strategies Dominicans with limited resources use to obtain healthcare and manage chronic illness. The findings raise hypotheses that warrant further study and could help guide provider-patient conversations regarding treatment adherence. This article is protected by copyright. All rights reserved.
“…Although some qualitative studies have examined the experiences of patients of the management of chronic pain [15][16][17][18] as well as OA pain, they have examined pharmacotherapy for pain management in developed countries [19] or have examined the patients' experiences after surgical interventions [20]. No comprehensive studies have yet investigated the expectations of patients with OA of pharmacological pain management strategies and the challenges faced in developing countries in accordance with their local culture, beliefs and attitudes.…”
Despite the effectiveness of pharmacotherapy for pain management in patients with osteoarthritis (OA), personal biases in the selection, administration, and continuation of pharmacotherapy challenge the proper management of symptoms and the effectiveness of the therapy. This study was conducted to carry out an in-depth examination of the experiences of patients with OA about their use of pharmacotherapy for the OA pain management and the existing challenges.
The present qualitative study was conducted on 17 patients with OA, 5 of their family members and 8 healthcare personnel using a conventional content analysis approach. Data were collected through 35 interviews, which were unstructured at first but became semi-structured later on. Data collection continued until data saturation and analyzed simultaneously. The criteria used to determine the rigor of the study included the credibility, transferability, dependability and conformability of the data.
The analysis of the data revealed 3 main categories and 8 subcategories. The main categories including preference for non-pharmacological modalities, preference for symptomatic slow-acting drugs for osteoarthritis (SySADOAs) and preference for vitamins and minerals.
Briefing the patients on the therapeutic goals, participating them in the clinical decision-making process, modifying drug administration patterns through prescribing the minimum effective dosage and substituting alternative therapies whenever possible, consistently monitoring the therapeutic responses and any unexpected complications and use of complementary treatments, makes up strategies that can help improve OA pain management.
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