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Jolidon V, Eicher M, Peytremann-Bridevaux I, Aebi S, Anchisi S, Bettini A, Chalandon Y, Dietrich PY, Duchosal MA, Dürr D, Peters S, von Moos R, Wicki A, Arditi C. Identifying the drivers of overall rating of cancer care: Insights from the second wave of the Swiss Cancer Patient Experiences study. Cancer 2024. [PMID: 39119752 DOI: 10.1002/cncr.35506] [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: 03/15/2024] [Revised: 06/15/2024] [Accepted: 07/03/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Patient experience surveys gather information on various aspects of care via numerous survey items. Identifying the most critical areas of patient experience to prioritize for quality care improvement can be challenging. The objective of this study was to determine which care experience items are the drivers influencing patients' overall rating of cancer care. METHODS Data from 2750 adult patients with cancer from the second wave of the Swiss Cancer Patient Experiences study were analyzed. This cross-sectional survey was conducted in eight Swiss hospitals from September 2021 to February 2022. Stepwise logistic regression examined the relationship between overall care rating and 29 patient experience items covering different patient-centered care dimensions while adjusting for sociodemographic and health variables. RESULTS Overall, patients rated their cancer care experience at 8.9 out of 10. Stepwise regression identified seven drivers contributing to overall care rating. The strongest drivers were "professionals worked well together" (odds ratio [OR], 4.81) and "tests were not repeated" (OR, 2.09) from the coordination and integration dimension, "offered support for symptoms during treatment" (OR, 2.11) from the physical comfort dimension, followed by "hospital staff ensured available home support" (OR, 1.99), "offered to see health professional for concerns" (OR, 1.91), "treatment options were explained" (OR, 1.75), and "involved in treatment decisions as desired" (OR, 1.68). CONCLUSIONS This study evaluated the care experiences of patients with cancer with a comprehensive tool that identified seven key factors independently associated with overall care rating. By concentrating on these areas, hospitals can not only improve the patient care experience but also efficiently allocate resources to quality improvement initiatives.
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Affiliation(s)
- Vladimir Jolidon
- Unisanté, Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
| | - Manuela Eicher
- Institute of Higher Education and Research in Healthcare, Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Isabelle Peytremann-Bridevaux
- Unisanté, Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
| | - Stefan Aebi
- Division of Medical Oncology, Cantonal Hospital, Lucerne and University of Bern, Switzerland
| | - Sandro Anchisi
- Oncology Service, Hospital Center of Valais Romand, Hôpital du Valais, Sion, Switzerland
| | - Adrienne Bettini
- Oncology Service, Fribourg Cantonal Hospital, Fribourg, Switzerland
| | - Yves Chalandon
- Department of Oncology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Pierre-Yves Dietrich
- Department of Oncology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Michel A Duchosal
- Service of Hematology, Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Donat Dürr
- Department of Oncology, Zuger Kantonsspital, Baar, Switzerland
| | - Solange Peters
- Department of Oncology, Lausanne University Hospital, Lausanne, Switzerland
| | - Roger von Moos
- Medical Oncology/Hematology, Cantonal Hospital Graubünden, Chur, Switzerland
| | - Andreas Wicki
- Department of Medical Oncology and Hematology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Chantal Arditi
- Unisanté, Center for Primary Care and Public Health, Department of Epidemiology and Health Systems, University of Lausanne, Lausanne, Switzerland
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Okanlawon Bankole A, Jiwani RB, Avorgbedor F, Wang J, Osokpo OH, Gill SL, Jo Braden C. Exploring illness perceptions of multimorbidity among community-dwelling older adults: a mixed methods study. AGING AND HEALTH RESEARCH 2023; 3:100158. [PMID: 38779434 PMCID: PMC11109937 DOI: 10.1016/j.ahr.2023.100158] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024] Open
Abstract
Background Illness perceptions are individual beliefs or experiences about the nature and treatment of their illness. Although extensive research exists about illness perceptions, little is known about illness perceptions of multimorbidity. Methods The purpose of this parallel-convergent mixed-methods study was to comprehensively explore illness perception of multimorbidity among community dwelling older adults. Data was collected using one-on-one semi-structured interviews (n=17) and the Multimorbidity Illness Perception Scale (MULTIPleS) (n=116). Qualitative data were analyzed using content analysis while quantitative data were analyzed with descriptive and inferential statistics. Both qualitative and quantitative findings were integrated to identify differences in illness perceptions of multimorbidity by participant's socio-demographic and illness-related characteristics. Results Overall, participants were mostly female (71%), self-reported as Hispanic (35%), Black (33%), White (27%), or Asian (5%). From the content analysis of the qualitative data, we described three themes pertaining to Illness perception of multimorbidity which were influenced by both participants' socio-demographic and illness-related characteristics: (1) inter-relationships between conditions (2) consequences and priorities and (3) impact of multimorbidity on wellbeing. While inferential analysis of quantitative data indicated statistically significant differences across only socio-demographic characteristics such as race/ethnicity (causal links, prioritization, summary scale) and educational attainment (prioritization subscale). Mixed analysis of qualitative and quantitative findings confirmed that illness perception of multimorbidity may not differ by the number of chronic conditions. Conclusions Illness perception of multimorbidity may not differ by the number of chronic conditions the participants had. Rather, participants prioritized the impact of multimorbidity on their overall wellbeing, placing less importance on the number of their chronic conditions. Additional studies are needed to further characterize illness perceptions of multimorbidity and develop interventions that extend beyond disease-focused interventions to address holistic needs of older adults with multimorbidity.
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Affiliation(s)
| | - Rozmin B Jiwani
- University of Texas Health Science Center, San Antonio School of Nursing, San Antonio, Texas
| | | | - Jing Wang
- University of New Hampshire, Durham, New Hampshire, USA
| | - Onome H. Osokpo
- University of Pennsylvania, New Courtland Center for Transitions and Health, Philadelphia, PA
| | - Sara L. Gill
- University of Texas Health Science Center, San Antonio School of Nursing, San Antonio, Texas
| | - Carrie Jo Braden
- University of Texas Health Science Center, San Antonio School of Nursing, San Antonio, Texas
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Craig LS, Cunningham-Myrie CA, Theall KP, Gustat J, Hernandez JH, Hotchkiss DR. Multimorbidity patterns and health-related quality of life in Jamaican adults: a cross sectional study exploring potential pathways. Front Med (Lausanne) 2023; 10:1094280. [PMID: 37332764 PMCID: PMC10272613 DOI: 10.3389/fmed.2023.1094280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/09/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Multimorbidity and health-related quality of life (HRQoL) are intimately linked. Multiple chronic conditions may adversely affect physical and mental functioning, while poorer HRQoL may contribute to the worsening course of diseases. Understanding mechanisms through which specific combinations of diseases affect HRQoL outcomes can facilitate identification of factors which are amenable to intervention. Jamaica, a middle-income country with high multimorbidity prevalence, has a health service delivery system dominated by public sector provision via a broad healthcare network. This study aims to examine whether multimorbidity classes differentially impact physical and mental dimensions of HRQoL in Jamaicans and quantify indirect effects on the multimorbidity-HRQoL relationship that are mediated by health system factors pertaining to financial healthcare access and service use. Materials and methods Latent class analysis (LCA) was used to estimate associations between multimorbidity classes and HRQoL outcomes, using latest available data from the nationally representative Jamaica Health and Lifestyle Survey 2007/2008 (N = 2,551). Multimorbidity measurement was based on self-reported presence/absence of 11 non-communicable diseases (NCDs). HRQoL was measured using the 12-item short-form (SF-12) Health Survey. Mediation analyses guided by the counterfactual approach explored indirect effects of insurance coverage and service use on the multimorbidity-HRQoL relationship. Results LCA revealed four profiles, including a Relatively Healthy class (52.7%) characterized by little to no morbidity and three multimorbidity classes characterized by specific patterns of NCDs and labelled Metabolic (30.9%), Vascular-Inflammatory (12.2%), and Respiratory (4.2%). Compared to the Relatively Healthy class, Vascular-Inflammatory class membership was associated with lower physical functioning (β = -5.5; p < 0.001); membership in Vascular-Inflammatory (β = -1.7; p < 0.05), and Respiratory (β = -2.5; p < 0.05) classes was associated with lower mental functioning. Significant mediated effects of health service use, on mental functioning, were observed for Vascular-Inflammatory (p < 0.05) and Respiratory (p < 0.05) classes. Conclusion Specific combinations of diseases differentially impacted HRQoL outcomes in Jamaicans, demonstrating the clinical and epidemiological value of multimorbidity classes for this population, and providing insights that may also be relevant to other settings. To better tailor interventions to support multimorbidity management, additional research is needed to elaborate personal experiences with healthcare and examine how health system factors reinforce or mitigate positive health-seeking behaviours, including timely use of services.
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Affiliation(s)
- Leslie S. Craig
- Department of Medicine, School of Medicine, Tulane University, New Orleans, LA, United States
| | | | - Katherine P. Theall
- Department of Social, Behavioral, and Population Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Jeanette Gustat
- Department of Epidemiology, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Julie H. Hernandez
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - David R. Hotchkiss
- Department of International Health and Sustainable Development, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
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Eyowas FA, Schneider M, Alemu S, Getahun FA. Multimorbidity and adverse longitudinal outcomes among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia. Front Med (Lausanne) 2023; 10:1085888. [PMID: 37250625 PMCID: PMC10213652 DOI: 10.3389/fmed.2023.1085888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Accepted: 04/26/2023] [Indexed: 05/31/2023] Open
Abstract
Background Multimorbidity is becoming more prevalent in low-and middle-income countries (LMICs). However, the evidence base on the burden and its longitudinal outcomes are limited. This study aimed to determine the longitudinal outcomes of patients with multimorbidity among a sample of individuals attending chronic outpatient non communicable diseases (NCDs) care in Bahir Dar, northwest Ethiopia. Methods A facility-based longitudinal study was conducted among 1,123 participants aged 40+ attending care for single NCD (n = 491) or multimorbidity (n = 633). Data were collected both at baseline and after 1 year through standardized interviews and record reviews. Data were analyzed using Stata V.16. Descriptive statistics and longitudinal panel data analyzes were run to describe independent variables and identify factors predicting outcomes. Statistical significance was considered at p-value <0.05. Results The magnitude of multimorbidity has increased from 54.8% at baseline to 56.8% at 1 year. Four percent (n = 44) of patients were diagnosed with one or more NCDs and those having multimorbidity at baseline were more likely than those without multimorbidity to develop new NCDs. In addition, 106 (9.4%) and 22 (2%) individuals, respectively were hospitalized and died during the follow up period. In this study, about one-third of the participants had higher quality of life (QoL), and those having higher high activation status were more likely to be in the higher versus the combined moderate and lower QoL [AOR1 = 2.35, 95%CI: (1.93, 2.87)] and in the combined higher and moderate versus lower level of QoL [AOR2 = 1.53, 95%CI: (1.25, 1.88)]. Conclusion Developing new NCDs is a frequent occurrence and the prevalence of multimorbidity is high. Living with multimorbidity was associated with poor progress, hospitalization and mortality. Patients having a higher activation level were more likely than those with low activation to have better QoL. If health systems are to meet the needs of the people with chronic conditions and multimorbidity, it is essential to understand diseases trajectories and of impact of multimorbidity on QoL, and determinants and individual capacities, and to increase their activation levels for better health improve outcomes through education and activation.
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Affiliation(s)
- Fantu Abebe Eyowas
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Marguerite Schneider
- Alan J. Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - Shitaye Alemu
- School of Medicine, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Fentie Ambaw Getahun
- School of Public Health, College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
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Hernandez S, George T, Dharod A, Feiereisel K, Bundy R, Williams D. The Future of Community Outreach: Using Patient Portals to Provide Voter Resources during the Coronavirus Disease 2019 Pandemic. Appl Clin Inform 2023; 14:300-309. [PMID: 37075802 PMCID: PMC10115515 DOI: 10.1055/s-0043-1764380] [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: 10/03/2022] [Accepted: 01/23/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, there was a concern for the 2020 general election becoming a superspreader event due to in-person voting. OBJECTIVES Our project addressed this concern by disseminating nonpartisan websites detailing safe voter options in the state of North Carolina to prevent community spread of the virus as much as possible. METHODS In this study, patient portals were used to disseminate a Research Electronic Data Capture survey containing embedded links to voter resources including nonpartisan websites discussing voting options. The survey also asked for demographic data and sentiments regarding the resources provided. Quick response (QR) codes with the survey link were also placed in the clinics during the study period. RESULTS The survey was sent to 14,842 patients who had at least one patient encounter in the past 12 months at one of three General Internal Medicine clinics at Atrium Health Wake Forest Baptist. Survey participation through both the patient portals and QR codes was assessed. Patient sentiments toward the voter resources in regard to (1) interest and (2) perceived helpfulness were collected in the survey. In total, 738 (4.99%) patients filled out the survey. Eighty-seven percent of survey respondents reported that the voter resources were helpful. Significantly more black patients than white (29.3 vs. 18.2, p < 0.05) voiced interest in voter resources. There was no statistical significance across gender or reported comorbidities. CONCLUSION Multicultural, underserved, and underinsured patients perceived the most benefit. During public health crises, patient portal messages can be used to bridge information gaps and promote better health outcomes in a timely and effective manner.
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Affiliation(s)
- Sean Hernandez
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Department of General Internal Medicine, Wake Forest Center for Healthcare Innovation (CHI), Winston Salem, North Carolina, United States
- Department of General Internal Medicine, Orlando Health, Orlando, Florida, United States
| | - Tyler George
- Department of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Ajay Dharod
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
- Department of General Internal Medicine, Wake Forest Center for Healthcare Innovation (CHI), Winston Salem, North Carolina, United States
- Department of General Internal Medicine, Wake Forest Center for Biomedical Informatics (WFBMI), Winston Salem, North Carolina, United States
- Department of Implementation Science (IS), Division of Public Health Sciences (PHS), Winston Salem, North Carolina, United States
| | - Kirsten Feiereisel
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Richa Bundy
- Department of General Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
| | - Donna Williams
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, United States
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Bankole AO, Gill SL, McSharry J, White CL, Aniemeke C, Wallington SF, Addo-Mensah DE, Braden CJ. Self-regulatory coping among community dwelling older adults with multiple chronic conditions. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2023; 13:26335565231207538. [PMID: 37867622 PMCID: PMC10588418 DOI: 10.1177/26335565231207538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 09/27/2023] [Indexed: 10/24/2023]
Abstract
Objectives Many older adults with multiple chronic conditions (MCC) frequently experience hospitalizations, functional limitations, and poor quality of life. Outcomes may be improved by promoting self-regulation, which may individuals respond to health threats and manage their health conditions. The aim of this study was to describe self-regulatory coping among older adults with MCC. Methods A qualitative descriptive study using semi-structured interviews and content analysis and guided by the Common-Sense Self-Regulation Model. Seventeen community-dwelling older adults with two or more chronic conditions participated in our study. Results Three themes were developed from the analysis: (1) "I don't think about it unless something happens": coping in the absence of a health event, (2) "doing what I am supposed to do": coping during a health event, and (3) "How do I know if what I did works?": appraisal of coping success. Discussion Self-regulatory coping was influenced by individual beliefs and experiences (illness representations), context, self-efficacy and availability of support and resources to cope with MCC. These findings suggest implications for clinical practice and future self-regulation interventions for older adults with MCC.
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Affiliation(s)
| | - Sara L. Gill
- San Antonio School of Nursing, University of Texas Health Science Center, San Antonio, TX, USA
| | - Jenny McSharry
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Carole L. White
- San Antonio School of Nursing, University of Texas Health Science Center, San Antonio, TX, USA
| | - Chidinma Aniemeke
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Sherrie Flynt Wallington
- School of Nursing and the Milken Institute School of Public Health, George Washington University, Washington, DC, USA
| | | | - Carrie Jo Braden
- San Antonio School of Nursing, University of Texas Health Science Center, San Antonio, TX, USA
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Bezerril MDS, Moreno IM, Ayllón FS, Lira ALBDC, Cogo ALP, Santos VEP. ANÁLISE DO CONCEITO DE PACIENTE EXPERT SEGUNDO O MODELO DE WALKER E AVANT. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0167pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: analisar o conceito de Paciente Expert no modelo de Walker e Avant. Método: análise teórica de conceito realizada em novembro de 2019 em bases de dados nacionais e internacionais com amostra final de 21 estudos, nos quais investigaram-se o país, ano de publicação, área da saúde, participantes, conceito, atributos, antecedentes e consequentes. Os dados quantitativos foram analisados de forma descritiva simples e os qualitativos organizados em figuras. Os conceitos identificados foram processados com apoio do software Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires. Resultados: destacaram-se o Reino Unido (10, 47,6%); o ano de 2015 (04; 19,1%); a enfermagem como área de conhecimento mais evidenciada (05; 23,8%); e pacientes como participantes (18; 72,0%). A respeito dos elementos teóricos, a autogestão do cuidado (04;19,5%) foi o atributo que mais sobressaiu; evidenciaram-se, ainda, o aumento de pessoas com doenças crônicas (10;18,5%) como antecedente, a integração social/comunitária (14;24,5%) em meio aos consequentes, e os vocábulos patient expert, condition e health mediante o processamento dos conceitos apresentados pelos estudos incluídos na amostra final. Conclusão: a análise conceitual permitiu determinar a origem do conceito Paciente Expert, os diferentes campos de atuação desse sujeito, as habilidades desenvolvidas em prol do autocuidado e o seu real significado, o qual é definido como um indivíduo ativo no seu autocuidado com habilidades necessárias para gerenciar sua condição clínica e auxiliar outros em situação semelhante.
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Bezerril MDS, Moreno IM, Ayllón FS, Lira ALBDC, Cogo ALP, Santos VEP. ANALYSIS OF THE EXPERT PATIENT CONCEPT ACCORDING TO WALKER AND AVANT'S MODEL. TEXTO & CONTEXTO ENFERMAGEM 2022. [DOI: 10.1590/1980-265x-tce-2021-0167en] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Objective: to analyze the Expert Patient concept in Walker and Avant's model. Method: theoretical concept analysis conducted in November 2019 on national and international databases with a final sample of 21 studies, in which the following data were investigated: country, year of publication, area of knowledge, participants, concept, attributes, antecedents, and consequences. The quantitative data were analyzed in a simple descriptive way and the qualitative data were organized in figures. The concepts identified were processed with the aid of the Interface de R pour Analyses Multidimensionnelles de Textes et de Questionnaires software program. Results: the United Kingdom (10; 47.6%) stood out, as well as the year 2015 (04; 19.1%), Nursing as the most evidenced area of knowledge (05; 23.8%), and patients as participants (18; 72.0%). With regard to the basic elements, care self-management (04;19.5%) was the most relevant attribute; in addition, the increase in the number of people with chronic diseases (10;18.5%) and social/community integration (14;24.5%) were evidenced as the most important antecedent and consequence, respectively. Additionally, the terms expert patient, condition and health stood out in the processing of the concepts presented in the studies included in the final sample. Conclusion: concept analysis allowed determining the origin of the Expert Patient concept, the different fields of action of this subject, the self-care skills developed and their actual meaning, which is defined as an individual actively engaged in self-care and with the required skills to manage their clinical condition and help others in a similar situation.
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Richmond RS, Connolly M. A delineation of self-management and associated concepts. INTERNATIONAL JOURNAL OF HEALTHCARE MANAGEMENT 2020. [DOI: 10.1080/20479700.2020.1810963] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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10
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Noël PH, Barnard JM, Barry FM, Simon A, Lee ML, Olmos-Ochoa TT, Chawla N, Rose DE, Stockdale SE, Finley EP, Penney LS, Ganz DA. Patient experience of health care system hassles: Dual-system vs single-system users. Health Serv Res 2020; 55:548-555. [PMID: 32380578 DOI: 10.1111/1475-6773.13291] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE To compare health care system problems or "hassles" experienced by Veterans receiving VA health care only versus those receiving dual care from both VA and non-VA community providers. DATA SOURCES We collected survey data in 2017-2018 from 2444 randomly selected Veterans with four or more primary care visits in the prior year at one of 12 VA primary care clinics located in four geographically diverse regions of the United States. STUDY DESIGN We used baseline surveys from the Coordination Toolkit and Coaching quality improvement project to explore Veterans' experience of hassles (dependent variable), source of health care, self-rated physical and mental health, and sociodemographics. DATA COLLECTION Participants responded to mailed surveys by mail, telephone, or online. PRINCIPAL FINDINGS The number of reported hassles ranged from 0 to 16; 79 percent of Veterans reported experiencing one or more hassles. Controlling for sociodemographic characteristics and self-rated physical and mental health, zero-inflated negative binominal regression indicated that dual care users experienced more hassles than VA-only users (adjusted predicted average 5.5 [CI: 5.2, 5.8] vs 4.3 [CI: 4.1, 4.6] hassles [P < .0001]). CONCLUSIONS Anticipated increases in Veterans accessing community-based care may require new strategies to help VA primary care teams optimize care coordination for dual care users.
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Affiliation(s)
- Polly H Noël
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio, Texas.,Department of Family and Community Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Jenny M Barnard
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Frances M Barry
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California.,David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Alissa Simon
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Martin L Lee
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California.,Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Tanya T Olmos-Ochoa
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Neetu Chawla
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California.,Fielding School of Public Health, University of California at Los Angeles, Los Angeles, California
| | - Danielle E Rose
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California
| | - Susan E Stockdale
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California.,Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, California
| | - Erin P Finley
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio, Texas.,Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - Lauren S Penney
- Elizabeth Dole Center of Excellence for Veteran and Caregiver Research, South Texas Veterans Health Care System, San Antonio, Texas.,Department of Medicine, University of Texas Health San Antonio, San Antonio, Texas
| | - David A Ganz
- HSR&D Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Sepulveda, California.,David Geffen School of Medicine, University of California at Los Angeles, Los Angeles, California
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Activating primary care COPD patients with multi-morbidity through tailored self-management support. NPJ Prim Care Respir Med 2020; 30:12. [PMID: 32245961 PMCID: PMC7125179 DOI: 10.1038/s41533-020-0171-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 03/05/2020] [Indexed: 11/09/2022] Open
Abstract
Given the dearth of COPD self-management interventions that specifically acknowledge multi-morbidity in primary care, we aimed to activate COPD patients through personalised self-management support that recognised the implications of co-morbidities. This single-group experimental study included patients aged 40−84 with a spirometry diagnosis of COPD and at least one co-morbidity. A self-management education programme for COPD in the context of multi-morbidity, based on the Health Belief Model, was tailored and delivered to participants by general practice nurses in face-to-face sessions. At 6 months’ follow-up, there was significant improvement in patient activation (p < 0.001), COPD-related quality of life (p = 0.012), COPD knowledge (p < 0.001) and inhaler device technique (p = 0.001), with no significant change in perception of multi-morbidity (p = 0.822) or COPD-related multi-morbidity (0.084). The programme improved patients’ self-efficacy for their COPD as well as overall health behaviour. The findings form an empirical basis for further testing the programme in a large-scale randomised controlled trial.
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Sheppard JP, Tucker KL, Davison WJ, Stevens R, Aekplakorn W, Bosworth HB, Bove A, Earle K, Godwin M, Green BB, Hebert P, Heneghan C, Hill N, Hobbs FDR, Kantola I, Kerry SM, Leiva A, Magid DJ, Mant J, Margolis KL, McKinstry B, McLaughlin MA, McNamara K, Omboni S, Ogedegbe O, Parati G, Varis J, Verberk WJ, Wakefield BJ, McManus RJ. Self-monitoring of Blood Pressure in Patients With Hypertension-Related Multi-morbidity: Systematic Review and Individual Patient Data Meta-analysis. Am J Hypertens 2020; 33:243-251. [PMID: 31730171 PMCID: PMC7162426 DOI: 10.1093/ajh/hpz182] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 11/11/2019] [Accepted: 11/13/2019] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Studies have shown that self-monitoring of blood pressure (BP) is effective when combined with co-interventions, but its efficacy varies in the presence of some co-morbidities. This study examined whether self-monitoring can reduce clinic BP in patients with hypertension-related co-morbidity. METHODS A systematic review was conducted of articles published in Medline, Embase, and the Cochrane Library up to January 2018. Randomized controlled trials of self-monitoring of BP were selected and individual patient data (IPD) were requested. Contributing studies were prospectively categorized by whether they examined a low/high-intensity co-intervention. Change in BP and likelihood of uncontrolled BP at 12 months were examined according to number and type of hypertension-related co-morbidity in a one-stage IPD meta-analysis. RESULTS A total of 22 trials were eligible, 16 of which were able to provide IPD for the primary outcome, including 6,522 (89%) participants with follow-up data. Self-monitoring was associated with reduced clinic systolic BP compared to usual care at 12-month follow-up, regardless of the number of hypertension-related co-morbidities (−3.12 mm Hg, [95% confidence intervals −4.78, −1.46 mm Hg]; P value for interaction with number of morbidities = 0.260). Intense interventions were more effective than low-intensity interventions in patients with obesity (P < 0.001 for all outcomes), and possibly stroke (P < 0.004 for BP control outcome only), but this effect was not observed in patients with coronary heart disease, diabetes, or chronic kidney disease. CONCLUSIONS Self-monitoring lowers BP regardless of the number of hypertension-related co-morbidities, but may only be effective in conditions such obesity or stroke when combined with high-intensity co-interventions.
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Affiliation(s)
- J P Sheppard
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - K L Tucker
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - W J Davison
- Ageing and Stroke Medicine, Norwich Medical School, University of East Anglia, United Kingdom
| | - R Stevens
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - W Aekplakorn
- Department of Community Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University Bangkok, Thailand
| | - H B Bosworth
- Center for Health Services Research in Primary Care, Department of Population Health Sciences, Duke University, Durham, North Carolina, USA
| | - A Bove
- Cardiology, Lewis Katz School of Medicine, Temple University, Philadelphia, Pennsylvania, USA
| | - K Earle
- Thomas Addison Diabetes Unit, St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom
| | - M Godwin
- Family Medicine, Memorial University of Newfoundland, St. John’s, Canada
| | - B B Green
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
| | - P Hebert
- Department of Health Services, University of Washington School of Public Health, Seattle, Washington, USA
| | - C Heneghan
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - N Hill
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - F D R Hobbs
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
| | - I Kantola
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - S M Kerry
- Centre for Primary Care and Public Health, Queen Mary University of London, London, United Kingdom
| | - A Leiva
- Primary Care Research Unit of Mallorca, Baleares Health Services-IbSalut, Mallorca, Spain
| | - D J Magid
- Colorado School of Public Health, University of Colorado, Denver, Colorado, USA
| | - J Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - K L Margolis
- HealthPartners Institute, Minneapolis, Minnesota, USA
| | - B McKinstry
- Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom
| | - M A McLaughlin
- Icahn School of Medicine at Mount Sinai New York, New York, New York, USA
| | - K McNamara
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
- School of Medicine, Deakin University, Geelong, Australia
| | - S Omboni
- Clinical Research Unit, Italian Institute of Telemedicine, Varese, Italy
- Scientific Research Department of Cardiology, Science and Technology Park for Biomedicine, Sechenov First Moscow State Medical University, Moscow, Russian Federation
| | - O Ogedegbe
- Center for Healthful Behavior Change, Division of Health and Behavior, Department of Population Health, Langone School of Medicine, New York University, New York, USA
| | - G Parati
- Istituto Auxologico Italiano, IRCCS, Department of Cardiovascular, Neural and Metabolic Sciences, San Luca Hospital, Milan, Italy
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
| | - J Varis
- Division of Medicine, Turku University Hospital and University of Turku, Turku, Finland
| | - W J Verberk
- Cardiovascular Research Institute Maastricht and Departments of Internal Medicine, Maastricht University, Maastricht, The Netherlands
| | - B J Wakefield
- Department of Veterans (VA) Health Services Research and Development Centre for Comprehensive Access and Delivery Research and Evaluation (CADRE), VA Medical Centre, Iowa City, USA
| | - R J McManus
- Nuffield Department of Primary Care, University of Oxford, Oxford, United Kingdom
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Guilcher SJT, Everall AC, Patel T, Packer TL, Hitzig SL, Lofters AK. Medication adherence for persons with spinal cord injury and dysfunction from the perspectives of healthcare providers: A qualitative study. J Spinal Cord Med 2019; 42:215-225. [PMID: 31573463 PMCID: PMC6781202 DOI: 10.1080/10790268.2019.1637644] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
Context: People with spinal cord injury and dysfunction (SCI/D) often take multiple medications (i.e. polypharmacy) to manage secondary health complications and multiple chronic conditions. Numerous healthcare providers are often involved in clinical care, increasing the risk of fragmented care, problematic polypharmacy, and conflicting health advice. These providers can play a crucial role in assisting patients with medication self-management to improve medication adherence. Design: A qualitative study involving telephone interviews, following a semi-structured guide that explored healthcare providers' conceptualization of factors impacting medication adherence for persons with SCI/D. The interviews were transcribed and analyzed descriptively and interpretively using a constant comparative process with the assistance of data display matrices. Analysis was guided by an ecological model of medication adherence. Setting and participants: Thirty-two healthcare providers from Canada, with varying clinical expertise. Intervention: Not Applicable. Outcome measures: Not Applicable. Results: Providers identified several factors that impact medication adherence for persons with SCI/D, which were grouped into micro (medication and patient-related), meso- (provider-related) and macro- (health system-related) factors. Medication-related factors included side effects, effectiveness, safety, and regimen complexity. Patient-specific factors included medication knowledge, preferences/expectations/goals, severity and type of injury, cognitive function/mental health, time since injury, and caregiver support. Provider-related factors included knowledge/confidence and trust. Health system-related factors included access to healthcare and access to medications. While providers were able to identify several factors influencing medication adherence, micro-level factors were the most frequently discussed. Conclusion: Findings from this study indicate that strategies to optimize medication adherence for persons with SCI/D should be multi-faceted.
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Affiliation(s)
- Sara J. T. Guilcher
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada,Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada,Correspondence to: Sara J. T. Guilcher, Leslie Dan Faculty of Pharmacy, 144 College Street, Toronto, ON, Canada, M5S 3M2; Ph: 416-946-7020.
| | - Amanda C. Everall
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
| | - Tejal Patel
- School of Pharmacy, University of Waterloo, Kitchener, Canada,Department of Family Medicine, DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Tanya L. Packer
- School of Occupational Therapy and Health Administration, Dalhousie University, Halifax, Canada
| | - Sander L. Hitzig
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada,St. John’s Rehab Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, Toronto, Canada,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Aisha K. Lofters
- Department of Family and Community Medicine, St. Michael's Hospital, University of Toronto, Toronto, Canada
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van Eikenhorst L, Taxis K, Rademakers J, Zullig LL, de Gier H, van Dijk L. How are medication related problems managed in primary care? An exploratory study in patients with diabetes and primary care providers. Res Social Adm Pharm 2019; 16:646-653. [PMID: 31427177 DOI: 10.1016/j.sapharm.2019.08.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/31/2019] [Accepted: 08/01/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND Medication self-management is important for patients who are controlling diabetes. Achieving medication self-management goals, may depend on treatment complexity and patients' capacities such as health literacy, knowledge and attitude. OBJECTIVES The aims of this study were to explore how patients with diabetes self-manage their medications, how patients seek support when experiencing problems and how primary healthcare providers identify patients' medication related problems and provide support. METHODS Semi-structured interviews were conducted among patients with diabetes receiving primary care and with their primary healthcare providers - GPs, nurses, pharmacists and technicians - between January and June 2017. A purposive sampling strategy was used to identify and select participants. An interview guide based on the Cycle of Complexity model was developed. Interviews were audiotaped and transcribed verbatim. Transcripts were coded with a combination of deductive and inductive codes. A thematic analysis was performed to identify categories and themes in the data. Findings were compared with the Cycle of Complexity model. RESULTS Twelve patients and 27 healthcare providers were included in the study. From the transcripts 95 codes, 6 categories and 2 major themes were extracted. Patients used practical solutions and gaining knowledge to manage their medication. Their problems were often related to stress and concerns about using medications. A trusted relationship with the healthcare provider was essential for patients to share problems and ask for support. Informal support was sought from family and peer-patients. Healthcare providers perceive problem identification as challenging. They relied on patients coming forward, computer notifications, clinical parameters and gut-feeling. Healthcare providers were able to offer appropriate support if a medication management problem was known. CONCLUSION Patients are confident of finding their way to manage their medications. However, sharing problems with healthcare providers requires a trusted relationship. This is acknowledged by both patients and healthcare providers.
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Affiliation(s)
- L van Eikenhorst
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, P.O. Box 196, 9700 AD, Groningen, the Netherlands.
| | - K Taxis
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, P.O. Box 196, 9700 AD, Groningen, the Netherlands.
| | - J Rademakers
- Nivel, Netherlands Institute for Health Services Research, Otterstraat 118, 3513 CR, Utrecht, the Netherlands; Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, 6200 MD, Maastricht, the Netherlands.
| | - L L Zullig
- Department of Population Health Sciences, Duke University, 215 Morris Street, Durham, NC, 27701, USA; Center to Accelerate Discovery and Practice Transformation (ADAPT), Durham Veterans Affairs Health Care System, 411 West Chapel Hill Street, Suite 600, Durham, NC, 27701, USA.
| | - H de Gier
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, P.O. Box 196, 9700 AD, Groningen, the Netherlands.
| | - L van Dijk
- University of Groningen, Groningen Research Institute of Pharmacy, PharmacoTherapy, -Epidemiology & -Economics, P.O. Box 196, 9700 AD, Groningen, the Netherlands; Nivel, Netherlands Institute for Health Services Research, Otterstraat 118, 3513 CR, Utrecht, the Netherlands.
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15
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Herzig L, Zeller A, Pasquier J, Streit S, Neuner-Jehle S, Excoffier S, Haller DM. Factors associated with patients' and GPs' assessment of the burden of treatment in multimorbid patients: a cross-sectional study in primary care. BMC FAMILY PRACTICE 2019; 20:88. [PMID: 31253097 PMCID: PMC6598361 DOI: 10.1186/s12875-019-0974-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 06/05/2019] [Indexed: 11/11/2022]
Abstract
Background Multimorbid patients may experience a high burden of treatment. This has a negative impact on treatment adherence, health outcomes and health care costs. The objective of our study was to identify factors associated with the self-perceived burden of treatment of multimorbid patients in primary care and to compare them with factors associated with GPs assessment of this burden. Method A cross sectional study in general practices, 100 GPs in Switzerland and up to 10 multimorbid patients per GP. Patients reported their self-perceived burden of treatment using the Treatment Burden Questionnaire (TBQ, possible score 0–150), whereas GPs evaluated the burden of treatment on a Visual Analog Scale (VAS) from 1 to 9. The study explored medical, social and psychological factors associated with burden of treatment, such as number and type of chronic conditions and drugs, severity of chronic conditions (CIRS score), age, quality of life, deprivation, health literacy. Results The GPs included 888 multimorbid patients. The overall median TBQ was 20 and the median VAS was 4. Both patients’ and GPs’ assessment of the burden of treatment were inversely associated with patients’ age and quality of life. In addition, patients’ assessment of their burden of treatment was associated with a higher deprivation score and lower health literacy, and with having diabetes or atrial fibrillation, whereas GPs’ assessment of this burden was associated with the patient having a greater number of chronic conditions and drugs, and a higher CIRS score. Conclusion Both from patients’ and GPs’ perspectives TB appears to be higher in younger patients. Whereas for patients the burden of treatment is associated with socio-economic and psychological factors, GPs’ assessments of this burden are associated with medical factors. Including socio-economic and psychological factors on patients’ self-perception is likely to improve GPs’ assessments of their patients’ burden of treatment thus favoring patient-centered care. Electronic supplementary material The online version of this article (10.1186/s12875-019-0974-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lilli Herzig
- Department of Family Medicine, General Medicine and Public Health Centre, University of Lausanne, Bugnon 44, 1011, Lausanne, Switzerland. .,, Croisettes 14, 1066, Epalinges, Switzerland.
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Jérôme Pasquier
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - Stefan Neuner-Jehle
- Institute of Primary Care, University and University Hospital of Zurich, Zurich, Switzerland
| | - Sophie Excoffier
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
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16
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Reinke LF, Vig EK, Tartaglione EV, Rise P, Au DH. Symptom Burden and Palliative Care Needs Among High-Risk Veterans With Multimorbidity. J Pain Symptom Manage 2019; 57:880-889. [PMID: 30794938 DOI: 10.1016/j.jpainsymman.2019.02.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Revised: 02/10/2019] [Accepted: 02/12/2019] [Indexed: 12/25/2022]
Abstract
CONTEXT Palliative care research has focused on patients with disease-specific conditions. However, older patients with multimorbidity may have unmet palliative care needs. OBJECTIVES We assessed symptom burden and quality of life among veterans with multimorbidity and sought to determine if their bothersome symptoms were addressed and treated in the primary care setting. We sought to identify specific diagnoses that may account for greater symptom burden. We hypothesized that patients with a higher number of diagnoses would experience greater symptom burden and poorer quality of life. METHODS We identified veterans at high risk of hospitalization or death using a validated prognostic model. We administered cross-sectional surveys via telephone, The Memorial Symptom Assessment Scale-Short Form and Veterans RAND 12, to randomly selected patients in primary care in the VA Health Care System from May to December 2015. We assessed if their most bothersome symptom was addressed and treated during their most recent visit. Regression models identified specific diagnoses accounting for greater symptom burden and patient predictors of high symptom burden and poor quality of life. RESULTS Patients (n = 503) reported (10.6 ± 5.5) active symptoms and poor physical quality of life. Patients reported pain and dyspnea as their most bothersome symptoms (n = 145 [29%] and n = 57 [11%], respectively). Most patients acknowledged their clinicians assessed (n = 348 [74%]) and treated (n = 330 [70%]) their most bothersome symptom. Physical symptoms (78%, P < 0.0001) were more likely to be addressed than psychological symptoms (55%, P < 0.001). Patients diagnosed with obesity or depression experienced greater physical symptom burden. Younger patients reported greater symptom severity than older patients (P < 0.01). Younger patients and those with greater multimorbidities reported lower self-perceived quality of health than older patients and those with fewer multimorbidities (P = 0.01 and P < 0.01, respectively). CONCLUSION Outpatients with multimorbidity have high symptom burden, unaddressed symptoms, poor quality of life, and unmet palliative care needs. Our findings support standardization of comprehensive symptom assessment and management in primary care for veterans with multimorbidities, which may ameliorate symptoms and improve quality of life.
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Affiliation(s)
- Lynn F Reinke
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D; Department of Biobehavioral Nursing and Health Systems, University of Washington, School of Nursing.
| | - Elizabeth K Vig
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D; Geriatric and Palliative Care Medicine Division, University of Washington, School of Medicine
| | - Erica V Tartaglione
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D
| | - Peter Rise
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D
| | - David H Au
- Department of Veterans Affairs, Puget Sound Health Care System, Health Services R&D; Pulmonary and Critical Care Medicine Division, University of Washington, School of Medicine, Seattle, Washington, USA
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17
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Nelson S, Albert JM, Liu Y, Selvaraj D, Curtan S, Ryan K, Pinto A, Ejaz F, Milgrom P, Riedy C. The psychometric properties of a new oral health illness perception measure for adults aged 62 years and older. PLoS One 2019; 14:e0214082. [PMID: 30970021 PMCID: PMC6457485 DOI: 10.1371/journal.pone.0214082] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 03/06/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Based on the Common-Sense Model of Self-Regulation (CSM), a new integrated Illness Perception Questionnaire Revised for Dental Use in Older/Elder Adults (IPQ-RDE) was developed for single and multiple dental conditions. This study describes psychometric properties of the IPQ-RDE for adults 62 years and older. METHODS Participants (n = 198) living in 16 subsidized housing facilities completed the IPQ-RDE and a questionnaire assessing their socio-demographics, frequency of dental visits, perceived condition of teeth/gums, depression, social support, and oral health quality of life (OHQOL). Participants received dental screening for presence/absence of teeth, coronal and root caries, and periodontitis. The 43-item IPQ-RDE was tested for internal (construct, discriminant) and external validity (concurrent, construct, discriminant, predictive) and reliability (internal consistency). RESULTS Confirmatory factor analysis demonstrated that a ten-factor model in accordance with the CSM framework (identity, consequences, control, timeline, illness coherence, treatment burden, prioritization, causal relationship, activity restriction, emotional representations) had good construct validity based on significant factor loadings and acceptable model fit (RMSEA = 0.065, CFI = 0.902). Edentulous participants had significantly higher mean factor scores (inaccurate perception) for overall IPQ-RDE and four constructs indicating concurrent validity. Discriminant validity was suggested by non-relationship with external measures (education, dental visit frequency). Predictive validity was indicated by the negative correlation of most constructs with OHQOL suggesting that inaccurate perception was related to lower quality of life. Internal consistency of eight IPQ-RDE constructs was excellent (Cronbach's alpha > 0.73). CONCLUSIONS The IPQ-RDE is a valid and reliable new measure for assessing older adult's perception of dental conditions. It can be an important tool for oral health behavioral research to restructure older adult's perception of dental conditions, and subsequently prevent tooth loss and improve oral health quality of life.
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Affiliation(s)
- Suchitra Nelson
- Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Jeffrey M. Albert
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Yiying Liu
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - David Selvaraj
- Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Shelley Curtan
- Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Kelli Ryan
- Case Western Reserve University School of Medicine, Cleveland, Ohio, United States of America
| | - Andres Pinto
- Case Western Reserve University School of Dental Medicine, Cleveland, Ohio, United States of America
| | - Farida Ejaz
- Benjamin Rose Institute on Aging, Cleveland, Ohio, United States of America
| | - Peter Milgrom
- University of Washington School of Dentistry, Seattle, Washington, United States of America
| | - Christine Riedy
- Harvard School of Dental Medicine, Boston, Massachusetts, United States of America
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18
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Irfan Khan A, Gill A, Cott C, Hans PK, Steele Gray C. mHealth Tools for the Self-Management of Patients With Multimorbidity in Primary Care Settings: Pilot Study to Explore User Experience. JMIR Mhealth Uhealth 2018; 6:e171. [PMID: 30154073 PMCID: PMC6134226 DOI: 10.2196/mhealth.8593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 05/20/2018] [Accepted: 06/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background Given the complex and evolving needs of individuals with multimorbidity, the adoption of mHealth tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The electronic patient-reported outcomes (ePRO) tool was codeveloped with patients and providers in an interdisciplinary primary care team in Toronto, Canada, to help facilitate self-management in community-dwelling adults with multiple chronic conditions. Objective The objective of study is to explore the experience and expectations of patients with multimorbidity and their providers around the use of the ePRO tool in supporting self-management efforts. Methods We conducted a 4-week pilot study of the ePRO tool. Patients’ and providers’ experiences and expectations were explored through focus groups that were conducted at the end of the study. In addition, thematic analyses were used to assess the shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Coded data were then mapped onto the Individual and Family Self-Management Theory using the framework method. Results In this pilot study, 12 patients and 6 providers participated. Both patients and providers emphasized the need for a more explicit recognition of self-management context, including greater customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Patients and providers highlighted gaps in the extent to which the tool enables self-management processes, including how limited progress toward self-management goals and the absence of direct provider engagement through the ePRO tool inhibited patients from meeting their self-management goals. Providers highlighted proximal outcomes based on their experience of the tool and specifically, they indicated that the tool offered valuable insights into the broader patient context, which helps to inform the self-management approach and activities they recommend to patients, whereas patients recognized the tool’s potential in helping to improve access to different providers in a team-based primary care setting. Conclusions This study identifies a more explicit recognition of the contextual factors that influence patients’ ability to self-manage and greater adaptability to accommodate patient complexity and provider workflow as next steps in refining the ePRO tool to better support self-management efforts in primary care ahead of its application in a full-scale randomized pragmatic trial.
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Affiliation(s)
- Anum Irfan Khan
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ashlinder Gill
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cheryl Cott
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Parminder Kaur Hans
- Bridgepoint Campus, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Bridgepoint Campus, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
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19
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Abbasi A, Ghezeljeh TN, Farahani MA. Effect of the self-management education program on the quality of life in people with chronic heart failure: a randomized controlled trial. Electron Physician 2018; 10:7028-7037. [PMID: 30128093 PMCID: PMC6092147 DOI: 10.19082/7028] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2017] [Accepted: 05/12/2018] [Indexed: 02/03/2023] Open
Abstract
Background Chronic Heart Failure (CHF) is a syndrome that negatively affects a person's Quality of Life (QOL). The efficient self-management education program increases the individual's abilities and skills for following and participating in a long-term healthcare plan. Objective The aim of this study was to determine the effect of the self-management education program on QOL in people with CHF. Methods This randomized controlled trial study was conducted on 60 people with CHF and without sensory-cognitive problem from April-August 2015. They were selected using the convenience sampling method, and were randomly assigned into the intervention and control groups. The control group received the routine education presented to participants at discharge. However, besides the routine education, the intervention group received the self-management education program consisting of three sessions followed for a 3-month period. The Iranian heart failure QOL questionnaire was used for data collection before and after the intervention. The independent-samples and paired-samples t-tests, Chi-square and Fisher exact tests were used for data analysis via the SPSS v.16 software. P<0.05 was considered statistically significant. Results No statistically significant differences were reported between the groups in terms of demographic and clinical characteristics, indicating that they were homogeneous. A statistically significant difference was reported between the two groups after the intervention in terms of the mean changes of total QOL (p<0.001) and its dimensions, including symptoms (p=0.002), social interference (p=0.01), psychological condition (p=0.013), and self-efficacy and knowledge (p<0.001). In addition, an improvement was observed in the total QOL in the intervention group after the education (p<0.001). Conclusions According to the results of this study, the self-management education program can be considered an appropriate strategy for improving the QOL in people suffering from CHF by health care providers. Trial registration The trial was registered at the Iranian Registry of Clinical Trials (http://www.irct.ir) with the IRCT ID: IRCT2015032021521N1. Funding The authors received financial support for the research, authorship, and/or publication of this article from Iran University of Medical Sciences (No: 107/105/94/D, date April 11, 2015).
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Affiliation(s)
- Alireza Abbasi
- MSc of Medical-Surgical Nursing, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Tahereh Najafi Ghezeljeh
- PhD, Associate Professor, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.,Department of Critical Care Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Mansoureh Ashghali Farahani
- Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran.,PhD, Associate Professor, Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
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Ko D, Bratzke LC, Roberts T. Self-management assessment in multiple chronic conditions: A narrative review of literature. Int J Nurs Stud 2018; 83:83-90. [PMID: 29709734 DOI: 10.1016/j.ijnurstu.2018.04.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 02/20/2018] [Accepted: 04/12/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Effective self-management in individuals with multiple chronic conditions is necessary to optimize health outcomes. Self-management in multiple chronic conditions involves an iterative process prioritizing multiple changing needs/conditions. However, self-management in multiple chronic conditions has been assessed with instruments designed to assess self-management of a single chronic illness. The instruments may not address the complexity of self-management in multiple chronic conditions. Thus, this review aimed to examine how self-management has been operationalized in the context of multiple chronic conditions. DESIGN A narrative review method was used. DATA SOURCE The online databases, Pubmed, CINAHL Plus, and PsycInfo, were searched. The search was conducted of the database from January 2006 through November 2017. REVIEW METHODS Peer-reviewed research articles which operationalized self-management in adults with at least two or more chronic illnesses were selected for review. Two reviewers read full text of selected articles and extracted data regarding operational definitions of self-management and instruments used to assess self-management. Operational definitions were categorized to conceptualize how self-management has been assessed. RESULTS A total of seven peer-reviewed research articles were selected for inclusion. This review found that self-management has been assessed through prerequisites of self-management and behaviors involved in self-management. Prerequisites of self-management included attitude, self-efficacy, perceived ability, and knowledge. Behaviors included an individual's engagement in self-management such as health-related behaviors, health service use, and medication adherence. CONCLUSIONS This review revealed that current literature does not operationalize self-management in multiple chronic conditions as a process, indicating incomplete assessments of self-management. To obtain a more comprehensive understanding of self-management in multiple chronic conditions, future studies should consider self-management as an iterative process in addition to prerequisites for self-management and behaviors. Such studies will inform the development of patient-centered self-management interventions for individuals with multiple chronic conditions.
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Affiliation(s)
- Dami Ko
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Madison, WI, 53705, United States.
| | - Lisa C Bratzke
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Madison, WI, 53705, United States.
| | - Tonya Roberts
- School of Nursing, University of Wisconsin-Madison, 701 Highland Ave., Madison, WI, 53705, United States.
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Desborough J, Phillips C, Mills J, Korda R, Bagheri N, Banfield M. Developing a positive patient experience with nurses in general practice: An integrated model of patient satisfaction and enablement. J Adv Nurs 2017; 74:564-578. [DOI: 10.1111/jan.13461] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra, ACT Australia
| | - Christine Phillips
- Australian National University Medical School; Australian National University; Canberra ACT Australia
| | - Jane Mills
- College of Health; Massey University; Palmerston North New Zealand
| | - Rosemary Korda
- National Centre for Epidemiology and Population Health; Research School of Population Health; Australian National University; Canberra ACT Australia
| | - Nasser Bagheri
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra, ACT Australia
| | - Michelle Banfield
- National Institute for Mental Health Research; Research School of Population Health; Australian National University; Canberra ACT Australia
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Panagioti M, Blakeman T, Hann M, Bower P. Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study. BMJ Open 2017; 7:e013524. [PMID: 28559454 PMCID: PMC5729978 DOI: 10.1136/bmjopen-2016-013524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that patient safety is a serious concern for older patients with long-term conditions. Despite this, there is a lack of research on safety incidents encountered by this patient group. In this study, we sought to examine patient reports of safety incidents and factors associated with reports of safety incidents in older patients with long-term conditions. METHODS The baseline cross-sectional data from a longitudinal cohort study were analysed. Older patients (n=3378 aged 65 years and over) with a long-term condition registered in general practices were included in the study. The main outcome was patient-reported safety incidents including availability and appropriateness of medical tests and prescription of wrong types or doses of medication. Binary univariate and multivariate logistic regression analyses were undertaken to examine factors associated with patient-reported safety incidents. RESULTS Safety incidents were reported by 11% of the patients. Four factors were significantly associated with patient-reported safety incidents in multivariate analyses. The experience of multiple long-term conditions (OR=1.09, 95% CI 1.05 to 1.13), a probable diagnosis of depression (OR=1.36, 95% CI 1.06 to 1.74) and greater relational continuity of care (OR=1.28, 95% CI 1.08 to 1.52) were associated with increased odds for patient-reported safety incidents. Perceived greater support and involvement in self-management was associated with lower odds for patient-reported safety incidents (OR=0.95, 95% CI 0.93 to 0.97). CONCLUSIONS We found that older patients with multimorbidity and depression are more likely to report experiences of patient safety incidents. Improving perceived support and involvement of patients in their care may help prevent patient-reported safety incidents.
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Affiliation(s)
- Maria Panagioti
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Thomas Blakeman
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Mark Hann
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, UK
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23
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Munford LA, Sidaway M, Blakemore A, Sutton M, Bower P. Associations of participation in community assets with health-related quality of life and healthcare usage: a cross-sectional study of older people in the community. BMJ Open 2017; 7:e012374. [PMID: 28183807 PMCID: PMC5306503 DOI: 10.1136/bmjopen-2016-012374] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 10/05/2016] [Accepted: 10/12/2016] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Community assets are promoted as a way to improve quality of life and reduce healthcare usage. However, the quantitative impact of participation in community assets on these outcomes is not known. METHODS We examined the association between participation in community assets and health-related quality of life (HRQoL) (EuroQol-5D-5L) and healthcare usage in 3686 individuals aged ≥65 years. We estimated the unadjusted differences in EuroQol-5D-5L scores and healthcare usage between participants and non-participants in community assets and then used multivariate regression to examine scores adjusted for sociodemographic and limiting long-term health conditions. We derived the net benefits of participation using a range of threshold values for a quality-adjusted life year (QALY). RESULTS 50% of individuals reported participation in community assets. Their EuroQol-5D-5L scores were 0.094 (95% CI 0.077 to 0.111) points higher than non-participants. Controlling for sociodemographic characteristics reduced this differential to 0.081 (95% CI 0.064 to 0.098). Further controlling for limiting long-term conditions reduced this effect to 0.039 (95% CI 0.025 to 0.052). Once we adjusted for sociodemographic and limiting long-term conditions, the reductions in healthcare usage and costs associated with community asset participation were not statistically significant. Based on a threshold value of £20 000 per QALY, the net benefits of participation in community assets were £763 (95% CI £478 to £1048) per participant per year. CONCLUSIONS Participation in community assets is associated with substantially higher HRQoL but is not associated with lower healthcare costs. The social value of developing community assets is potentially substantial.
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Affiliation(s)
- Luke A Munford
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Mark Sidaway
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- Salford Royal NHS Foundation Trust, Salford, UK
| | - Amy Blakemore
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Matt Sutton
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Pete Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
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24
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Aron DC. Multimorbidity: an endocrinologist looks at multi-level network disruption and at what gets diabetes? J Eval Clin Pract 2017; 23:225-229. [PMID: 27440485 DOI: 10.1111/jep.12600] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2016] [Accepted: 06/14/2016] [Indexed: 12/11/2022]
Affiliation(s)
- David C Aron
- VA Quality Scholars Program, Louis Stokes Cleveland Department of Veterans Affairs Medical Center, Cleveland, OH, USA.,School of Medicine, and Adjunct Professor of Organizational Behavior, Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA
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25
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Desborough J, Banfield M, Phillips C, Mills J. The process of patient enablement in general practice nurse consultations: a grounded theory study. J Adv Nurs 2016; 73:1085-1096. [DOI: 10.1111/jan.13199] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Jane Desborough
- Department of Health Services Research and Policy; Research School of Population Health; Australian National University; Canberra Australia
| | - Michelle Banfield
- National Institute for Mental Health Research; Australian National University; Canberra Australia
| | - Christine Phillips
- Social Foundations of Medicine; Australian National University Medical School; Australian National University; Canberra Australia
| | - Jane Mills
- School of Health & Biomedical Sciences; RMIT University; Melbourne Victoria Australia
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26
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Blakemore A, Hann M, Howells K, Panagioti M, Sidaway M, Reeves D, Bower P. Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom. BMC Health Serv Res 2016; 16:582. [PMID: 27756341 PMCID: PMC5069882 DOI: 10.1186/s12913-016-1843-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient Activation is defined as the knowledge, skill, and confidence a patient has in managing their health. Higher levels of patient activation are associated with better self-management, better health outcomes, and lower healthcare costs. Understanding the drivers of patient activation can allow better tailoring of patient support and interventions. There are few data on patient activation in UK patients with long-term conditions. METHODS A prospective cohort design was used. Questionnaires were mailed to 12,989 patients over the age of 65 years with at least one long-term condition in Salford, UK. They completed the Patient Activation Measure and self-report measures of: depression, health literacy, social support, health-related quality of life, and impact of multimorbidity. We report descriptive data on baseline activation and change over time, and use multivariate regression to model associations with patient activation at baseline and predictors of change in Activation over 6 months. RESULTS The cohort included 4377 (33.6 %) older people, of whom 4225 were mailed a further questionnaire at 6 months; 3390 returned it complete (80.2 %). At baseline, 15 % self-reported PAM level 1, 16 % level 2, 45 % level 3, and 25 % level 4. Across all patients, depression had the strongest association with patient activation. Other important factors were: older age, being retired, poor health literacy, health-related quality of life, and social support. Total number of self-reported comorbidities and the perceived impact of comorbidities were also important for patients with more than one long-term condition. Patient activation scores were reasonably enduring over time (r = 0.43 between baseline and at six months), although nearly half changed 'levels' of activation over that time. Few variables predicted change in activation over 6 months. CONCLUSIONS This is the first large scale assessment of patient activation in the UK. Our data may be useful in identifying patients who need support with patient activation, and allow interventions (such as health coaching) to be tailored to better support older patients with long-term conditions who have symptoms of depression, poor social support and impaired health literacy. Further analyses of longitudinal studies will be necessary to better understand the causal relationships between patient activation and variables such as depression.
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Affiliation(s)
- Amy Blakemore
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Mark Hann
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Kelly Howells
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Maria Panagioti
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Mark Sidaway
- Salford Royal NHS Foundation Trust, Salford Royal Foundation Trust, Stott Lane, Salford, M6 8HD UK
| | - David Reeves
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
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27
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Crowe M, Jordan J, Burrell B, Jones V, Gillon D, Harris S, Wilkinson A. Clinical effectiveness of transdiagnostic health management interventions for older people with multimorbidity: a quantitative systematic review. J Adv Nurs 2016; 72:2315-29. [DOI: 10.1111/jan.13011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/05/2016] [Indexed: 11/27/2022]
Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine; University of Otago; Christchurch New Zealand
- Centre for Postgraduate Nursing; University of Otago; Christchurch New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine; University of Otago; Christchurch New Zealand
| | - Beverley Burrell
- Centre for Postgraduate Nursing; University of Otago; Christchurch New Zealand
| | - Virginia Jones
- Centre for Postgraduate Nursing; University of Otago; Christchurch New Zealand
| | - Deborah Gillon
- Centre for Postgraduate Nursing; University of Otago; Christchurch New Zealand
| | - Shirley Harris
- Centre for Postgraduate Nursing; University of Otago; Christchurch New Zealand
| | - Amanda Wilkinson
- Centre for Postgraduate Nursing; University of Otago; Christchurch New Zealand
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Webster F, Christian J, Mansfield E, Bhattacharyya O, Hawker G, Levinson W, Naglie G, Pham TN, Rose L, Schull M, Sinha S, Stergiopoulos V, Upshur R, Wilson L. Capturing the experiences of patients across multiple complex interventions: a meta-qualitative approach. BMJ Open 2015; 5:e007664. [PMID: 26351182 PMCID: PMC4563230 DOI: 10.1136/bmjopen-2015-007664] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES The perspectives, needs and preferences of individuals with complex health and social needs can be overlooked in the design of healthcare interventions. This study was designed to provide new insights on patient perspectives drawing from the qualitative evaluation of 5 complex healthcare interventions. SETTING Patients and their caregivers were recruited from 5 interventions based in primary, hospital and community care in Ontario, Canada. PARTICIPANTS We included 62 interviews from 44 patients and 18 non-clinical caregivers. INTERVENTION Our team analysed the transcripts from 5 distinct projects. This approach to qualitative meta-evaluation identifies common issues described by a diverse group of patients, therefore providing potential insights into systems issues. OUTCOME MEASURES This study is a secondary analysis of qualitative data; therefore, no outcome measures were identified. RESULTS We identified 5 broad themes that capture the patients' experience and highlight issues that might not be adequately addressed in complex interventions. In our study, we found that: (1) the emergency department is the unavoidable point of care; (2) patients and caregivers are part of complex and variable family systems; (3) non-medical issues mediate patients' experiences of health and healthcare delivery; (4) the unanticipated consequences of complex healthcare interventions are often the most valuable; and (5) patient experiences are shaped by the healthcare discourses on medically complex patients. CONCLUSIONS Our findings suggest that key assumptions about patients that inform intervention design need to be made explicit in order to build capacity to better understand and support patients with multiple chronic diseases. Across many health systems internationally, multiple models are being implemented simultaneously that may have shared features and target similar patients, and a qualitative meta-evaluation approach, thus offers an opportunity for cumulative learning at a system level in addition to informing intervention design and modification.
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Affiliation(s)
- Fiona Webster
- Department of Family and CommunityMedicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Onil Bhattacharyya
- Department of Family and CommunityMedicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Gillian Hawker
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Levinson
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Naglie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thuy-Nga Pham
- Department of Family and CommunityMedicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- South East Toronto Family Health Team, Toronto East General Hospital, Toronto, Ontario, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, Toronto, Ontario, Canada
| | - Michael Schull
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Health System Planning & Evaluation Research Program, Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Samir Sinha
- Health System Planning & Evaluation Research Program, Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ross Upshur
- Department of Family and CommunityMedicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Health, Bridgepoint Collaboratory for Research and Innovation, Toronto, Ontario, Canada
| | - Lynn Wilson
- Department of Family and CommunityMedicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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Adeniji C, Kenning C, Coventry PA, Bower P. What are the core predictors of 'hassles' among patients with multimorbidity in primary care? A cross sectional study. BMC Health Serv Res 2015; 15:255. [PMID: 26137932 PMCID: PMC4489210 DOI: 10.1186/s12913-015-0927-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Accepted: 06/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background A limitation of service delivery in primary care in the United Kingdom is that services are often organised to manage discrete long-term conditions, using guidelines related to single conditions, and managed in clinics organised around single conditions. However, many older patients have more than one condition (so called multimorbidity). Qualitative research suggests that these patients experience ‘hassles’ in their care, including multiple appointments, poor co-ordination, and conflicting recommendations. However, there is limited quantitative evidence on the ‘hassles’ that patients with multimorbidity experience, or factors predicting ‘hassles’ in patients with multimorbidity. Methods We conducted a cross sectional study, mailing questionnaires to 1460 patients with multimorbidity identified from the disease registers of four general practices in the UK. Patients were asked to complete a range of self-report measures including measures of multimorbidity, measures of their experience of multimorbidity and service delivery. Data were analysed using regression modelling to assess the factors predicting ‘hassles’ in patients with multimorbidity. Results In total 33 % (n = 486) of patients responded to the baseline survey. The ‘hassles’ most often reported by patients related to lack of information about conditions and treatment options, poor communication among health professionals, and poor access to specialist care. There was a significant relationship between numbers of conditions, and reports of ‘hassles’. In multivariate analysis, 5 variables predicted more ‘hassles’: more long-term conditions, symptoms of anxiety and depression, younger age, being in paid employment, and not having a discussion with their GP in the last 12 months. Conclusion Hassles are frequently reported by patients with multimorbidity in primary care. A priority for future research should be on the development of new models of care that better cater for these patients. This research highlights core hassles that need to be addressed, and the patient groups that are most at risk, which may aid in the design of these new models.
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Affiliation(s)
- Charles Adeniji
- *NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Williamson Building, Manchester, M13 9PL, UK. .,NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
| | - Cassandra Kenning
- NIHR Collaboration for Applied Health Research and Care, Greater Manchester (GM-CLAHRC), Manchester Academic Health Science Centre (MAHSC), University of Manchester, Williamson Building, Manchester, M13 9PL, UK.
| | - Peter A Coventry
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
| | - Peter Bower
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
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