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Kirvalidze M, Boström AM, Liljas A, Doheny M, Hendry A, McCormack B, Fratiglioni L, Ali S, Ebrahimi Z, Elmståhl S, Eriksdotter M, Gläske P, Gustafsson LK, Rundgren ÅH, Hvitfeldt H, Lennartsson C, Hammar LM, Nilsson GH, Nilsson P, Öhlén J, Sandgren A, Söderman A, Swedberg K, Vackerberg N, Vetrano DL, Wijk H, Agerholm J, Calderón-Larrañaga A. Effectiveness of integrated person-centered interventions for older people's care: Review of Swedish experiences and experts' perspective. J Intern Med 2024; 295:804-824. [PMID: 38664991 DOI: 10.1111/joim.13784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/15/2024]
Abstract
Older adults have multiple medical and social care needs, requiring a shift toward an integrated person-centered model of care. Our objective was to describe and summarize Swedish experiences of integrated person-centered care by reviewing studies published between 2000 and 2023, and to identify the main challenges and scientific gaps through expert discussions. Seventy-three publications were identified by searching MEDLINE and contacting experts. Interventions were categorized using two World Health Organization frameworks: (1) Integrated Care for Older People (ICOPE), and (2) Integrated People-Centered Health Services (IPCHS). The included 73 publications were derived from 31 unique and heterogeneous interventions pertaining mainly to the micro- and meso-levels. Among publications measuring mortality, 15% were effective. Subjective health outcomes showed improvement in 24% of publications, morbidity outcomes in 42%, disability outcomes in 48%, and service utilization outcomes in 58%. Workshop discussions in Stockholm (Sweden), March 2023, were recorded, transcribed, and summarized. Experts emphasized: (1) lack of rigorous evaluation methods, (2) need for participatory designs, (3) scarcity of macro-level interventions, and (4) importance of transitioning from person- to people-centered integrated care. These challenges could explain the unexpected weak beneficial effects of the interventions on health outcomes, whereas service utilization outcomes were more positively impacted. Finally, we derived a list of recommendations, including the need to engage care organizations in interventions from their inception and to leverage researchers' scientific expertise. Although this review provides a comprehensive snapshot of interventions in the context of Sweden, the findings offer transferable perspectives on the real-world challenges encountered in this field.
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Affiliation(s)
- Mariam Kirvalidze
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Anne-Marie Boström
- Department of Neurobiology, Care Sciences, and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Research and Development Unit, Stockholms Sjukhem, Stockholm, Sweden
| | - Ann Liljas
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Megan Doheny
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
| | - Anne Hendry
- International Foundation for Integrated Care (IFIC), Glasgow, Scotland, UK
- School of Health and Life Sciences, University of the West of Scotland, Glasgow, Scotland, UK
| | - Brendan McCormack
- Faculty of Medicine and Health, Susan Wakil School of Nursing and Midwifery, Sydney Nursing School, The University of Sydney, Sydney, Australia
| | - Laura Fratiglioni
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Sulin Ali
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Institute for Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Zahra Ebrahimi
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care - GPCC, Gothenburg, Sweden
| | - Sölve Elmståhl
- Department of Clinical Sciences, Division of Geriatric Medicine, Lund University, Lund, Sweden
| | - Maria Eriksdotter
- Theme Inflammation and Aging, Karolinska University Hospital, Stockholm, Sweden
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institutet, Huddinge, Sweden
| | - Pascal Gläske
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
- Institute for Sociology, University of Duisburg-Essen, Duisburg, Germany
| | - Lena-Karin Gustafsson
- School of Health, Care and Social Welfare, Mälardalen University, Eskilstuna, Sweden
| | | | | | - Carin Lennartsson
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Swedish Institute for Social Research (SOFI), Stockholm University, Stockholm, Sweden
| | - Lena Marmstål Hammar
- School of Health, Care and Social Welfare, Mälardalen University, Västerås, Sweden
- School of Health and Welfare, Dalarna University, Falun, Sweden
| | - Gunnar H Nilsson
- Department of Neurobiology, Care Sciences, and Society, Division of Family Medicine and Primary Care, Karolinska Institutet, Huddinge, Sweden
| | - Peter Nilsson
- Myndigheten för vård- och omsorgsanalys, Stockholm, Sweden
| | - Joakim Öhlén
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care - GPCC, Gothenburg, Sweden
- Palliative Care Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Anna Sandgren
- Center for Collaborative Palliative Care, Department of Health and Caring Sciences, Linnaeus University, Växjö, Sweden
| | - Annika Söderman
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden
| | - Karl Swedberg
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Nicoline Vackerberg
- Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Davide Liborio Vetrano
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
| | - Helle Wijk
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg Centre for Person-Centred Care - GPCC, Gothenburg, Sweden
- Department of Architecture and Civil Engineering, Chalmers University of Technology, Gothenburg, Sweden
- Department of Quality Assurance and Patient Safety, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Janne Agerholm
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Amaia Calderón-Larrañaga
- Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Solna, Sweden
- Stockholm Gerontology Research Center, Stockholm, Sweden
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Blanck E, Pirhonen Nørmark L, Fors A, Ekman I, Ali L, Swedberg K, Gyllensten H. Self-efficacy and healthcare costs in patients with chronic heart failure or chronic obstructive pulmonary disease. ESC Heart Fail 2024; 11:219-228. [PMID: 37940106 PMCID: PMC10804184 DOI: 10.1002/ehf2.14574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 09/22/2023] [Accepted: 10/19/2023] [Indexed: 11/10/2023] Open
Abstract
AIMS This study aims to explore possible associations between self-efficacy and healthcare and drug expenditures (i.e. direct costs) in patients with chronic heart failure (CHF) or chronic obstructive pulmonary disease (COPD) in a study investigating the effects of person-centred care delivered by telephone. METHODS AND RESULTS This exploratory analysis uses data from an open randomized controlled trial conducted between January 2015 and November 2016, providing remote person-centred care by phone to patients with CHF, COPD, or both. Patients hospitalized due to worsening of CHF or COPD were eligible for the study. Randomization was based on a computer-generated list, stratified for age ≥ 75 and diagnosis. At a 6 month follow-up, 118 persons remained in a control group and 103 in an intervention group. The intervention group received person-centred care by phone as an addition to usual care. Trial data were linked to register data on healthcare and drug use. Group-based trajectory modelling was applied to identify trajectories for general self-efficacy and direct costs. Next, associations between self-efficacy trajectories and costs were assessed using regression analysis. Five trajectories were identified for general self-efficacy, of which three indicated different levels of increasing or stable self-efficacy, while two showed a decrease over time in self-efficacy. Three trajectories were identified for costs, indicating a gradient from lower to higher accumulated costs. Increasing or stable self-efficacy was associated with lower direct costs (P = 0.0013). CONCLUSIONS The findings show that an increased or sustained self-efficacy is associated with lower direct costs in patients with CHF or COPD. Person-centred phone contacts used as an add-on to usual care could result in lower direct costs for those with stable or increasing self-efficacy.
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Affiliation(s)
- Elin Blanck
- Institute of Health and Care SciencesSahlgrenska Academy, University of GothenburgBox 457SE‐405 30GothenburgSweden
- University of Gothenburg Centre for Person‐Centred Care (GPCC), Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | | | - Andreas Fors
- Institute of Health and Care SciencesSahlgrenska Academy, University of GothenburgBox 457SE‐405 30GothenburgSweden
- University of Gothenburg Centre for Person‐Centred Care (GPCC), Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health CareGothenburgSweden
| | - Inger Ekman
- Institute of Health and Care SciencesSahlgrenska Academy, University of GothenburgBox 457SE‐405 30GothenburgSweden
- University of Gothenburg Centre for Person‐Centred Care (GPCC), Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Medicine, Geriatrics and Emergency MedicineSahlgrenska University Hospital/ÖstraGothenburgSweden
| | - Lilas Ali
- Institute of Health and Care SciencesSahlgrenska Academy, University of GothenburgBox 457SE‐405 30GothenburgSweden
- University of Gothenburg Centre for Person‐Centred Care (GPCC), Sahlgrenska Academy, University of GothenburgGothenburgSweden
| | - Karl Swedberg
- University of Gothenburg Centre for Person‐Centred Care (GPCC), Sahlgrenska Academy, University of GothenburgGothenburgSweden
- Department of Molecular and Clinical MedicineSahlgrenska AcademyGothenburgSweden
| | - Hanna Gyllensten
- Institute of Health and Care SciencesSahlgrenska Academy, University of GothenburgBox 457SE‐405 30GothenburgSweden
- University of Gothenburg Centre for Person‐Centred Care (GPCC), Sahlgrenska Academy, University of GothenburgGothenburgSweden
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Chica-Pérez A, Dobarrio-Sanz I, Correa-Casado M, Fernández-Sola C, Ruiz-Fernández MD, Hernández-Padilla JM. Spanish version of the self-care self-efficacy scale: A validation study in community-dwelling older adults with chronic multimorbidity. Geriatr Nurs 2023; 53:181-190. [PMID: 37540914 DOI: 10.1016/j.gerinurse.2023.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 07/18/2023] [Accepted: 07/19/2023] [Indexed: 08/06/2023]
Abstract
OBJECTIVE To test the psychometric properties of the Spanish version of the Self-Care Self-Efficacy Scale (SCSES-Sp) in community-dwelling older adults with chronic multimorbidity. METHODS A sample of 1013 community-dwelling older adults with chronic multimorbidity participated in an observational cross-sectional study that was carried out in 3 phases. RESULTS Confirmatory factor analysis showed that the SCSES-Sp has 4 dimensions: "self-efficacy in self-care behaviours based on clinical knowledge", "self-efficacy in self-care maintenance", "self-efficacy in self-care monitoring", and "self-efficacy in self-care management". A panel of independent experts considered the content of the SCSES-Sp valid. Convergent validity analysis showed moderate-strong correlations between all of the SCSES-Sp's dimensions and the reference criteria chosen. Reliability was good for the SCSES-Sp and all its dimensions. Test-retest reliability analysis showed that the SCSES-Sp was temporally stable. CONCLUSIONS The SCSES-Sp is a valid and reliable tool to assess self-efficacy in self-care in Spanish-speaking, community-dwelling older adults with chronic multimorbidity.
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Affiliation(s)
| | - Iria Dobarrio-Sanz
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria 04120, Spain.
| | - Matías Correa-Casado
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria 04120, Spain; Andalusian Health Service District Almeria, Almeria, Spain
| | - Cayetano Fernández-Sola
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria 04120, Spain; Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Santiago 7500000, Chile
| | - María Dolores Ruiz-Fernández
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria 04120, Spain
| | - José Manuel Hernández-Padilla
- Faculty of Health Sciences, Department of Nursing Science, Physiotherapy and Medicine, University of Almeria, Almeria 04120, Spain
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Ebrahimi Z, Barenfeld E, Gyllensten H, Olaya-Contreras P, Fors A, Fredholm E, Fuller JM, Godarzi M, Krantz B, Swedberg K, Ekman I. Integrating health promotion with and for older people - eHealth (IHOPe) - evaluating remote integrated person-centred care : Protocol of a randomised controlled trial with effectiveness, health economic, and process evaluation. BMC Geriatr 2023; 23:174. [PMID: 36973667 PMCID: PMC10044387 DOI: 10.1186/s12877-023-03866-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 03/02/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND Healthcare and welfare systems worldwide are unprepared to accommodate the growing population of older people. Simultaneously, the cost of reactive care for older people is increasing. However, healthcare systems in many countries are reforming towards integrated and person-centred care with a focus on health promotion and proactive actions. The Integrating Health Promotion with and for Older People - eHealth (IHOPe) project aims to describe and evaluate a person-centred e-support intervention that promotes a sustainable partnership between community-dwelling frail older people and health and social care professionals. METHODS The IHOPe project is designed as a randomised controlled trial comparing a control group receiving standard care with an intervention group receiving standard care and add-on person-centred care through telephone support and a digital platform. The primary outcome measure is a composite score of changes in general self-efficacy and the need for unscheduled hospital care. The project is conducted in Gothenburg, Sweden. At least 220 participants aged ≥ 75 years will be included after being screened using a frailty instrument. The study design, intervention components, digital platform, and questionnaires were developed in close collaboration with an advisory group of inter-professional researchers, stakeholders, clinicians, and older representatives. Data will mainly be collected through questionnaires at baseline and 3, 6, and 12 months after inclusion in the study. Recruitment is ongoing and should be completed during 2023. Data will be analysed using quantitative and qualitative methods. The evaluation will include effectiveness, process, and health economics. The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (Dnr 2019-05364, Dnr 2020-03550, Dnr 2021-03255). DISCUSSION The findings will expand our knowledge of remotely integrated person-centred care for frail older people. Thereby, the IHOPe project is expected to fill highlighted knowledge gaps on intervention evaluations including the triad of person-centred, digital, and integrated care elements, as well as economic evaluations of remote health services for frail older people. The study is ongoing, and the results are not completed but if they turn out to be positive, implementation is not limited to time or location. TRIAL REGISTRATION ClinicalTrial.gov: NCT04416815. Registered 07/06/2021.
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Affiliation(s)
- Zahra Ebrahimi
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
| | - Emmelie Barenfeld
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Hanna Gyllensten
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Patricia Olaya-Contreras
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
| | - Eva Fredholm
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Joanne M Fuller
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mahboubeh Godarzi
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Birgitta Krantz
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karl Swedberg
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Inger Ekman
- Institute of Health and Care Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Melin J, Fors A, Jakobsson S, Krabbe D, Björkman I. Self-Efficacy to Manage Chronic Disease (SEMCD) scale: translation and evaluation of measurement properties for a swedish version. Arch Public Health 2023; 81:2. [PMID: 36600298 DOI: 10.1186/s13690-022-01022-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 12/29/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Reinforcing self-efficacy in patients is important in person-centered care; therefore, reliable and valid measures of a person's self-efficacy is of clinical relevance. A questionnaire suitable for self-efficacy and patient engagement that is not limited to a particular condition is the Self-efficacy to Manage Chronic Disease (SEMCD). This study aims to evaluate the measurement properties of a Swedish translation of the SEMCD with a Rasch analysis. METHODS The translation and cultural adaptation of the SEMCD was performed according to the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) recommendations. Self-reported data was collected from two cohorts: patients with pituitary tumors (n = 86) and patients on sick leave due to common mental disorders (n = 209). Measurement properties were evaluated with a Rasch analysis in RUMM2030. RESULTS The original six-item SEMCD did not fit to a unidimensional scale. Two items, item 5 and item 6, deviated both statistically and conceptually and were removed. A four-item solution, the SEMCD-4 with collapsed thresholds for mid-range response options, showed good targeting and unidimensionality, no item misfit, and a reliability of 0.83. CONCLUSION In a Swedish context with a mix of patients with pituitary tumors or common mental disorders, SEMCD-4 showed satisfactory measurement properties. Thus, SEMCD-4 could be used to identify patient self-efficacy in long-term illnesses. This knowledge about patient self-efficacy may be of importance to tailor person-centered support based on each patient´s resources, needs and goals.
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Affiliation(s)
- Jeanette Melin
- RISE Research Institutes of Sweden, Division Safety and Transport, Measurement Science and Technology, Gothenburg, Sweden.,Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden.,Region Västra Götaland, Research, Education, Development and Innovation, Primary Health Care, Gothenburg, Sweden
| | - Sofie Jakobsson
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden.,Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden
| | - David Krabbe
- Institute of Neuroscience and Physiology, University of Gothenburg, Gothenburg, Sweden.,Neurocare, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ida Björkman
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden. .,Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, 40530, Gothenburg, SE, Sweden.
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Ahlstedt Karlsson S, Henoch I, Olofsson Bagge R, Wallengren C. Person-centred support programme (RESPECT intervention) for women with breast cancer treated with endocrine therapy: a feasibility study. BMJ Open 2022; 12:e060946. [PMID: 36198470 PMCID: PMC9535178 DOI: 10.1136/bmjopen-2022-060946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
OBJECTIVE The peRson-cEntred Support Programme EndoCrine Therapy intervention is a complex intervention encompassing a person-centred support programme for patients with breast cancer being treated with endocrine therapy (ET). The aim of this study was to explore the feasibility of the trial design and patient acceptability of the intervention and outcome measures and to provide data to estimate the parameters required to design the final intervention. DESIGN A controlled before-and-after design following the Consolidated Standards of Reporting Trials 2010 statement for feasibility trials. SETTING A surgical outpatient clinic in Sweden. PARTICIPANTS Forty-one patients (aged 47-85) with breast cancer who were treated with ET. INTERVENTIONS Eligible patients were assigned to the control group or intervention group, which included individual education material, an individualised learning plan and a personalised reminder letter using a person-centred approach. The intervention could be delivered as a telephone or digital follow-up during a 12-week follow-up. OUTCOME MEASURES The aims were to determine the recruitment rate, assess the rate of retention, explore whether the intervention was delivered according to the protocol, assess the preferred form of educational support, rate of education sessions, length per education session and length between each education session, determine the distribution of education materials and assess completion rates of patient-reported instruments, including the General Self-efficacy Scale, the Quality of Care from the Patient's Perspective Questionnaire and the Memorial Symptom Assessment Scale. RESULTS Eighty-six per cent of the patients in the intervention group completed the intervention and questionnaires 3 months after their inclusion. The call attendance was 90%. During the intervention, the contact nurse complied with the intervention protocol. For self-efficacy, symptoms and quality of care, there were no differences in effect size between the control and intervention groups. CONCLUSIONS This intervention seems to be feasible and acceptable among patients.
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Affiliation(s)
| | - Ingela Henoch
- Institute of Health and Care Sciences, Gothenburg University, Gothenburg, Sweden
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Individually Tailored Remote Physiotherapy Program Improves Participation and Autonomy in Activities of Everyday Life along with Exercise Capacity, Self-Efficacy, and Low-Moderate Physical Activity in Patients with Pulmonary Arterial Hypertension: A Randomized Controlled Study. Medicina (B Aires) 2022; 58:medicina58050662. [PMID: 35630079 PMCID: PMC9147937 DOI: 10.3390/medicina58050662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/09/2022] [Accepted: 05/12/2022] [Indexed: 11/17/2022] Open
Abstract
Background and Objectives: Pulmonary arterial hypertension (PAH) is a rare, chronic, progressive, and life-threatening disease; however, the appropriate target medical treatment today allows patients with PAH not only to survive but also to live a relatively normal life. However, patients face the challenge of adapting and maintaining a good quality of life, thus it is important to consider complex interventions related not only to medical treatment. Methods: This was a prospective, randomized, controlled, single-blind study. Twenty-one (21) patients diagnosed with PAH were included and randomly assigned to training or control group. All participants continued target medical therapy. Furthermore, TG underwent the individually tailored 12-week remote physiotherapy program. As a primary outcome measurement, the Impact on Participation and Autonomy Questionnaire (IPA) was used. Secondary outcome included aerobic capacity (6MWT), accelerometery and general self-efficacy (GSE). Data were collected at baseline, after 12 weeks and at follow-up 6 months after the beginning of the intervention. Results: A significant difference between the groups was found in the follow-up assessment on three of the four IPA subscales analyzed, AO, RF, and AI. The total IPA score decreased significantly in TG after the program, indicating an improved participation. In addition, in TG a significant increase in 6MWT results, daily time in low- or moderate-intensity physical activities, and GSE was observed. Conclusions: In summary, the individually tailored physiotherapy program investigated added to stable target medical therapy in patients with PAH encourages improvement and prevents possible deterioration of perceived participation of patients in activities of their everyday life in the context of one’s health condition in the long term, along with improved exercise capacity and increased time spent in low- or moderate-intensity physical activities. Future studies are needed to develop and evaluate long-term intervention to support patients living with this rare, chronic, and life-threatening disease.
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Ali L, Wallström S, Fors A, Barenfeld E, Fredholm E, Fu M, Goudarzi M, Gyllensten H, Lindström Kjellberg I, Swedberg K, Vanfleteren LEGW, Ekman I. Effects of Person-Centered Care Using a Digital Platform and Structured Telephone Support for People With Chronic Obstructive Pulmonary Disease and Chronic Heart Failure: Randomized Controlled Trial. J Med Internet Res 2021; 23:e26794. [PMID: 34898447 PMCID: PMC8713094 DOI: 10.2196/26794] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/15/2021] [Accepted: 10/13/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF) are characterized by severe symptom burden and common acute worsening episodes that often require hospitalization and affect prognosis. Although many studies have shown that person-centered care (PCC) increases self-efficacy in patients with chronic conditions, studies on patients with COPD and CHF treated in primary care and the effects of PCC on the risk of hospitalization in these patients are scarce. OBJECTIVE The aim of this study is to evaluate the effects of PCC through a combined digital platform and telephone support for people with COPD and CHF. METHODS A multicenter randomized trial was conducted from 2018 to 2020. A total of 222 patients were recruited from 9 primary care centers. Patients diagnosed with COPD, CHF, or both and with internet access were eligible. Participants were randomized into either usual care (112/222, 50.5%) or PCC combined with usual care (110/222, 49.5%). The intervention's main component was a personal health plan cocreated by the participants and assigned health care professionals. The health care professionals called the participants in the intervention group and encouraged narration to establish a partnership using PCC communication skills. A digital platform was used as a communication tool. The primary end point, divided into 2 categories (improved and deteriorated or unchanged), was a composite score of change in general self-efficacy and hospitalization or death 6 months after randomization. Data from the intention-to-treat group at 3- and 6-month follow-ups were analyzed. In addition, a per-protocol analysis was conducted on the participants who used the intervention. RESULTS No significant differences were found in composite scores between the groups at the 3- and 6-month follow-ups. However, the per-protocol analysis of the 3-month follow-up revealed a significant difference in composite scores between the study groups (P=.047), although it was not maintained until the end of the 6-month follow-up (P=.24). This effect was driven by a change in general self-efficacy from baseline. CONCLUSIONS PCC using a combined digital platform and structured telephone support seems to be an option to increase the short-term self-efficacy of people with COPD and CHF. This study adds to the knowledge of conceptual innovations in primary care to support patients with COPD and CHF. TRIAL REGISTRATION ClinicalTrials.gov NCT03183817; http://clinicaltrials.gov/ct2/show/NCT03183817.
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Affiliation(s)
- Lilas Ali
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Psychiatric Department, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Sara Wallström
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Andreas Fors
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Region Västra Götaland, Research and Development Primary Health Care, Gothenburg, Sweden
| | - Emmelie Barenfeld
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Department of Occupational Therapy and Physiotherapy, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Fredholm
- The Swedish Heart & Lung Foundation, Stockholm, Sweden
| | - Michael Fu
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mahboubeh Goudarzi
- Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Hanna Gyllensten
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Irma Lindström Kjellberg
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
| | - Karl Swedberg
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lowie E G W Vanfleteren
- Chronic Obstructive Pulmonary Disease Center, Department of Respiratory Medicine and Allergology, Sahlgrenska University Hospital, Gothenburg, Sweden.,Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Inger Ekman
- Sahlgrenska Academy Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Centre for Person-Centred Care, University of Gothenburg, Gothenburg, Sweden
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Ali L, Wallström S, Ekman I, Swedberg K, Fors A. Effects of person-centred care via telephone on self-efficacy in patients with chronic obstructive pulmonary disease: Subgroup analysis of a randomized controlled trial. Nurs Open 2021; 8:927-935. [PMID: 33570304 PMCID: PMC7877134 DOI: 10.1002/nop2.701] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/04/2020] [Indexed: 01/20/2023] Open
Abstract
AIM To evaluate the effects of PCC in the form of structured telephone support on self-reported cardiac self-efficacy in patients with COPD. METHODS We enrolled 105 patients, aged ≥50 years, admitted to hospital and diagnosed with COPD from January 2015 to November 2016. The patients received usual care or PCC via telephone added to usual care. The Swedish Cardiac Self-Efficacy Scale comprising three dimensions (control symptoms, control illness and maintain functioning) was used as outcome measure. Data was collected at baseline, and at 3- and 6-month follow-ups. RESULTS At both the 3- and 6-month follow-ups, the intervention group improved significantly more than the control group in the control illness dimension (p = .012 and p = .032, respectively). No differences were found in the other two dimensions. CONCLUSIONS PCC in the form of structured telephone support increases patients' confidence in managing their illness and may be a feasible strategy to support patients in their homes.
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Affiliation(s)
- Lilas Ali
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
- Psychiatric DepartmentSahlgrenska University HospitalGothenburgSweden
| | - Sara Wallström
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
| | - Inger Ekman
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
| | - Karl Swedberg
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
- Department of Molecular and Clinical MedicineSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
| | - Andreas Fors
- Institute of Health and Care SciencesSahlgrenska AcademyUniversity of GothenburgGothenburgSweden
- Centre for Person‐Centred Care (GPCC)University of GothenburgGothenburgSweden
- Research and Development Primary Health CareRegion Västra GötalandGothenburgSweden
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