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Boudewijns EA, Claessens D, van Schayck OC, Twellaar M, Winkens B, Joore MA, Keijsers LCEM, Krol S, Urlings M, Gidding-Slok AHM. Effectiveness of the Assessment of Burden of Chronic Conditions (ABCC)-tool in patients with asthma, COPD, type 2 diabetes mellitus, and heart failure: A pragmatic clustered quasi-experimental study in the Netherlands. Eur J Gen Pract 2024; 30:2343364. [PMID: 38738695 PMCID: PMC11104697 DOI: 10.1080/13814788.2024.2343364] [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: 05/08/2023] [Accepted: 04/08/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND The Assessment of Burden of Chronic Conditions (ABCC)-tool was developed to optimise chronic care. OBJECTIVES This study aimed to assess the effectiveness of the ABCC-tool in patients with COPD, asthma, type 2 diabetes, and/or heart failure in primary care in the Netherlands. METHODS The study had a pragmatic, clustered, two-armed, quasi-experimental design. The intervention group (41 general practices; 176 patients) used the ABCC-tool during routine consultations and the control group (14 general practices; 61 patients) received usual care. The primary outcome was a change in perceived quality of care (PACIC; Patient Assessment of Chronic Illness Care) after 18 months. Secondary outcomes included change in the PACIC after 6 and 12 months, and in quality of life (EQ-5D-5L; EuroQol-5D-5L), capability well-being (ICECAP-A; ICEpop CAPability measure for Adults), and patients' activation (PAM; Patient Activation Measure) after 6, 12, and 18 months for the total group and conditions separately. RESULTS We observed a significant difference in the PACIC after 6, 12, and 18 months (18 months: 0.388 points; 95%CI: 0.089-0.687; p = 0.011) for the total group and after 6 and 12 months for type 2 diabetes. After 18 months, we observed a significant difference in the PAM for the total group but not at 6 and 12 months, and not for type 2 diabetes. All significant effects were in favour of the intervention group. No significant differences were found for the EQ-5D-5L and the ICECAP-A. CONCLUSION Use of the ABCC-tool has a positive effect on perceived quality of care and patients' activation, which makes the tool ready for use in clinical practice. Healthcare providers (e.g. general practitioners and practice nurses) can use the tool to provide person-centred care.Trial registration number: ClinicalTrials.gov Registry (NCT04127383).
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Affiliation(s)
- Esther A. Boudewijns
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Danny Claessens
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Onno C.P van Schayck
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Mascha Twellaar
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Bjorn Winkens
- Department of Methodology and Statistics, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Manuela A. Joore
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre MUMC+/Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Lotte C. E. M Keijsers
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Stijn Krol
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Mathijs Urlings
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
| | - Annerika H. M Gidding-Slok
- Department of Family Medicine, Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, the Netherlands
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Guedry SE, Langley BO, Schaefer K, Hanes DA. Integrative medicine for hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS): a feasibility study. Disabil Rehabil 2024:1-14. [PMID: 38353245 DOI: 10.1080/09638288.2024.2314713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
PURPOSE Hypermobility spectrum disorders (HSD) and Ehlers-Danlos syndromes (EDS) are multisystem conditions marked by dysfunctional connective tissue. This feasibility study evaluated a 9-week integrative medicine program in this population. METHODS Using a single-arm study design, adults with HSD or EDS were given recommendations for an anti-inflammatory Mediterranean diet and self-management with additional behavioral and psychosocial support. Preliminary data on feasibility based on recruitment and retention, adherence to the diet, mobile app tracking, changes to perceived well-being via health outcomes, and satisfaction with care were obtained. RESULTS Thirteen participants were enrolled within a 4-month timeframe. Eight participants completed the study. Three participants met dietary tracking requirement in at least 4 of 8 intervention weeks and met the macronutrient requirements in at least half of the weeks tracked. No decreases in VAS pain scores after 5 and 9 weeks were noted; however, 62.5% (n = 5) of participants had decreased pain at 9 weeks, compared to baseline. There were significant improvements (p<.05) in six of twelve measurements of satisfaction with care at the end of the intervention. CONCLUSION This study provides a foundation for future research on patient experience and introduces a novel treatment paradigm focused on nutrition and self-management. Trial Registration: National Institutes of Health clinicaltrials.gov; identifier: NCT04734041. IMPLICATIONS FOR REHABILITATION Lifestyle and dietary interventions are relatively safe and well tolerated in the hypermobility spectrum disorder (HSD) and Ehlers-Danlos disorder (EDS) population.Participants in our 9-week integrative medicine program actively engaged in self-management of their condition and showed promising adherence to dietary and tracking requirements.Effective treatment of the intricacies and dynamics of these highly variable and clinically heterogeneous disorders may require a network of healthcare providers, integrative healthcare, as well as behavioral and psychosocial support.Dietary tracking through mobile apps might help promote self-efficacy and adherence to dietary changes.Symptom tracking might be an effective way for patients to track changes to their health and could provide valuable information for health professionals engaged in managing the disorders.
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Affiliation(s)
- Sara E Guedry
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
| | - Blake O Langley
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
- School of Nursing, University of WA, Seattle, WA, USA
| | - Kerry Schaefer
- Co-investigator, Healthy Living Community Clinic, Portland, OR, USA
| | - Douglas A Hanes
- Helfgott Research Institute, National University of Natural Medicine, Portland, OR, USA
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Zhou C, Tan F, Lai SH, Chen JC, Chen CY, Zhang GF, Dong Y. Patient Assessment of Chronic Illness Care (PACIC) and Its Influence on Patient Compliance With Hypertension: A Cross-Sectional Study. INQUIRY : A JOURNAL OF MEDICAL CARE ORGANIZATION, PROVISION AND FINANCING 2024; 61:469580241277445. [PMID: 39245935 PMCID: PMC11382249 DOI: 10.1177/00469580241277445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2024]
Abstract
The Chronic Care Model (CCM) is a framework that supports the proactive, planned, coordinated and patient-centered care of chronic diseases. The Patient Assessment of Chronic Illness Care (PACIC) scale is a valuable tool for evaluating patients' perspectives on chronic care delivery based on the CCM. Few studies have examined its application in China. This study assesses hypertension care in Chinese patients and explores how PACIC scores relate to patient compliance. A cross-sectional study was conducted in Hangzhou, China, from June to August 2021, including 253 hypertensive patients from 5 county hospitals and 13 primary healthcare centers. The study used the PACIC scale to assess hypertension care delivery and the Compliance of Hypertensive Patients scale (CHPS) to measure patient compliance. Multiple linear regression analyses were used to explore the relationship between demographic characteristics and the total and domain scores of PACIC, as well as the association between CHPS and the domain scores of PACIC. The mean value of overall the PACIC score was 3.12 (out of 5). Problem solving/contextual domain had the highest average score for each item, while follow up/coordination domain had the lowest. Patient activation had negative effects on intention (β = -.18, P < .05), attitude (β = -.21, P < .05), responsibility (β = -.17, P < .05), and the total score of CHPS (β = -.24, P < .01). Delivery system design/decision support was negatively associated with lifestyle (β = -.21, P < .05) and the total score of CHPS (β = -.26, P < .01). Hypertensive patients perceived that they sometimes received hypertension care consistent with the CCM in Chinese primary healthcare settings. A higher level of PACIC score was beneficial for improving hypertensive patient compliance.
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Affiliation(s)
- Chi Zhou
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Fang Tan
- School of Medicine and Health Management, Tongji Medical College,Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Si Hong Lai
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Jing Chun Chen
- School of Public Health, Hangzhou Normal University, Hangzhou, Zhejiang, China
| | - Chao Yi Chen
- School of Medicine and Health Management, Tongji Medical College,Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Gao Feng Zhang
- The People's Hospital of Yuhuan, Yuhuan, Zhejiang, China
| | - Yin Dong
- The People's Hospital of Yuhuan, Yuhuan, Zhejiang, China
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Lukaschek K, Beltz C, Rospleszcz S, Schillok H, Falkai P, Margraf J, Gensichen J. Depressive primary care patients' assessment of received collaborative care. Sci Rep 2023; 13:2329. [PMID: 36759622 PMCID: PMC9911390 DOI: 10.1038/s41598-023-29339-9] [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: 04/30/2022] [Accepted: 02/02/2023] [Indexed: 02/11/2023] Open
Abstract
The "Patient Assessment of Chronic Illness Care" (PACIC) is a tool for evaluating outpatient health service for patients with chronic diseases. Our aim was to analyze the association between PACIC scores of primary care patients with depression and patients' or patients' general practitioners' (GPs) characteristics. In a data set including depressive primary care patients (N = 280) the association of patient characteristics (sex, age, depressive symptom severity, suicidal ideation) with PACIC scores were assessed by linear regression models. The association between GPs' characteristics (type, location of practice; age, qualification of practitioner) and PACIC scores was assessed by linear mixed models with individual practices as random effects. Patient Health Questionnaire (PHQ-9) scores at 12 months follow up and changes in PHQ-9 scores from baseline to follow up were significantly positive associated with higher PACIC scores (beta = 0.67, 95%-CI [0.02, 1.34]). PACIC scores were not associated with patients' sex (p = 0.473) or age (p = 0.531). GP's age was negatively associated with PACIC scores (p = 0.03). In conclusion, in patients with depression, the PACIC is independent from patients' and GPs' characteristics. The PACIC may be appropriate to assess patient-perspective on depression services in primary care.
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Affiliation(s)
- K Lukaschek
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Nussbaumstraße 5, St.-Vinzenz-Haus, 80336, Munich, Germany.
| | - C Beltz
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Nussbaumstraße 5, St.-Vinzenz-Haus, 80336, Munich, Germany
| | - S Rospleszcz
- Department of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.,Institute of Epidemiology, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany
| | - H Schillok
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Nussbaumstraße 5, St.-Vinzenz-Haus, 80336, Munich, Germany.,Graduate Programme "POKAL - Predictors and Outcomes in Primary Care Depression Care" (DFG-GrK 2621), Munich, Germany
| | - P Falkai
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Munich, Germany
| | - J Margraf
- Mental Health Research and Treatment Center, Ruhr-University Bochum, Bochum, Germany
| | - J Gensichen
- Institute of General Practice and Family Medicine, University Hospital, LMU Munich, Nussbaumstraße 5, St.-Vinzenz-Haus, 80336, Munich, Germany
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Kocher A, Simon M, Dwyer AA, Blatter C, Bogdanovic J, Künzler-Heule P, Villiger PM, Dan D, Distler O, Walker UA, Nicca D. Patient Assessment Chronic Illness Care (PACIC) and its associations with quality of life among Swiss patients with systemic sclerosis: a mixed methods study. Orphanet J Rare Dis 2023; 18:7. [PMID: 36624535 PMCID: PMC9828378 DOI: 10.1186/s13023-022-02604-2] [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: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The Chronic Care Model (CCM) is a longstanding and widely adopted model guiding chronic illness management. Little is known about how CCM elements are implemented in rare disease care or how patients' care experiences relate to health-related quality of life (HRQoL). We engaged patients living with systemic sclerosis (SSc) to assess current care according to the CCM from the patient perspective and their HRQoL. METHODS We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional quantitative survey (n = 101) using the Patient Assessment of Chronic Illness Care (PACIC) and Systemic Sclerosis Quality of Life (SScQoL) questionnaires. Next, we used data from individual patient interviews (n = 4) and one patient focus group (n = 4) to further explore care experiences of people living with SSc with a focus on the PACIC dimensions. RESULTS The mean overall PACIC score was 3.0/5.0 (95% CI 2.8-3.2, n = 100), indicating care was 'never' to 'generally not' aligned with the CCM. Lowest PACIC subscale scores related to 'goal setting/tailoring' (mean = 2.5, 95% CI 2.2-2.7) and 'problem solving/contextual counselling' (mean = 2.9, 95% CI 2.7-3.2). No significant correlations were identified between the mean PACIC and SScQoL scores. Interviews revealed patients frequently encounter major shortcomings in care including 'experiencing organized care with limited participation', 'not knowing which strategies are effective or harmful' and 'feeling left alone with disease and psychosocial consequences'. Patients often responded to challenges by 'dealing with the illness in tailored measure', 'taking over complex coordination of care' and 'relying on an accessible and trustworthy team'. CONCLUSIONS The low PACIC mean overall score is comparable to findings in patients with common chronic diseases. Key elements of the CCM have yet to be systematically implemented in Swiss SSc management. Identified gaps in care related to lack of shared decision-making, goal-setting and individual counselling-aspects that are essential for supporting patient self-management skills. Furthermore, there appears to be a lack of complex care coordination tailored to individual patient needs.
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Affiliation(s)
- Agnes Kocher
- Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,Department of Rheumatology and Immunology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Michael Simon
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.5734.50000 0001 0726 5157Department of Nursing, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andrew A. Dwyer
- grid.208226.c0000 0004 0444 7053Boston College, Connell School of Nursing, Chestnut Hill, MA USA ,grid.32224.350000 0004 0386 9924Center for Nursing Research, Massachusetts General Hospital Munn, Boston, MA USA
| | - Catherine Blatter
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Jasmina Bogdanovic
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland
| | - Patrizia Künzler-Heule
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.413349.80000 0001 2294 4705Department of Gastroenterology/Hepatology, Cantonal Hospital St. Gallen, St. Gallen, Switzerland ,grid.413349.80000 0001 2294 4705Department of Nursing, Cantonal Hospital St. Gallen, St. Gallen, Switzerland
| | | | - Diana Dan
- grid.9851.50000 0001 2165 4204Service of Rheumatology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Oliver Distler
- grid.7400.30000 0004 1937 0650Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Ulrich A. Walker
- grid.410567.1Department of Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Dunja Nicca
- grid.6612.30000 0004 1937 0642Department Public Health (DPH), Institute of Nursing Science (INS), Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056 Basel, Switzerland ,grid.7400.30000 0004 1937 0650Department of Global and Public Health, Institute for Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
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Akca N, Saygili M, Ture AK. The relationship between the perception of chronic disease care and health-related quality of life in adults with chronic kidney disease. Chronic Illn 2022; 18:874-888. [PMID: 34569319 DOI: 10.1177/17423953211039792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES In this study, it was aimed to determine the chronic disease care assessments and health-related quality of life (HRQoL) levels in adults with chronic kidney disease (CKD) undergoing hemodialysis and to reveal the relationship between chronic disease care assessment and HRQoL. METHODS A single-center cross-sectional design has been used. Data were collected from 105 adults with CKD, who undergoing hemodialysis. Patient Evaluation Chronic Illness Care (PACIC) scale and Kidney Disease Quality of Life Short Form-36 (KDQOL-36) were used to obtain data. RESULTS The mean scale scores of PACIC were low (2.66 ± 0.891). Although participants achieved high HRQoL scores on the symptoms subdimension of the KDQoL-36 scale, they got low scores on the subdimensions of mental health, physical health, and burden of disease. Participants' HRQoL is affected significantly by gender, age, educational level, working status, income, and presence of comorbidity (especially diabetes), diagnosis time of CKD, and hemodialysis time at the hospital (p < 0.05). A positive and statistically significant relationship was found between PACIC and subdimensions of KDQoL-36 (p < 0.05). DISCUSSION The results can be a guide for improving the quality of chronic disease care in healthcare institutions. To improve this, patients' evaluations on this issue should be taken into account.
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Affiliation(s)
- Nesrin Akca
- 52977Kirikkale University, Faculty of Health Sciences, Department of Health Management, Kirikkale, Turkey
| | - Meltem Saygili
- 52977Kirikkale University, Faculty of Health Sciences, Department of Health Management, Kirikkale, Turkey
| | - Aysun Kandemir Ture
- 52977Kirikkale University, Faculty of Health Sciences, Department of Health Management, Kirikkale, Turkey
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Boecker M, Iglesias K, Peytremann-Bridevaux I. Psychometric evaluation of the Patient Assessment of Chronic Illness Care instrument using Item analysis according to the Rasch model. J Eval Clin Pract 2022; 28:670-679. [PMID: 35195939 DOI: 10.1111/jep.13662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 01/05/2022] [Accepted: 01/10/2022] [Indexed: 11/27/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES The Patient Assessment of Chronic Illness Care (PACIC) instrument assesses patient care in alignment with the chronic care model. The aim of the study was to comprehensively validate the PACIC using the Rasch model. A special focus was placed on the investigation of local dependence (LD), differential item functioning (DIF) and targeting. METHOD This secondary analysis utilized data of 760 patients with a diagnosis of diabetes who had participated in the Swiss CoDiab-VD cohort study. The psychometric properties of the French PACIC-version were evaluated using the Rasch model. DIF was investigated in relation to age, gender, education, year of recruitment into the CoDiab-VD cohort study, type of diabetes and whether patients got an injectable antidiabetic drug or not. RESULTS The initial analysis of the PACIC revealed poor fit to the Rasch model (χ2 -p < 0.001) with response dependency being the most prominent problem. After combining the items into two testlets (testlet 1: Items 1-11; testlet 2: Items 12-20), good overall model fit was found (χ2 -p = 0.77) as well as good reliability (Person Separation Index = 0.85) and targeting. DIF with regard to whether patients got an injectable antidiabetic drug or not was found for testlet 2. However, the size of this DIF was regarded as not being substantial. CONCLUSION The PACIC is a well-targeted, reliable unidimensional instrument to assess patient care in alignment with the chronic care model in patients with diabetes. It is free of substantial DIF. The PACIC-20 sum score can hence be used in clinical practice for individual diagnostic. For evaluation purposes like assessment of change or group evaluations, the usage of the interval-scale level person parameters is recommended as it permits using parametric statistical analyses and provides a more accurate picture about the actual amount of change.
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Affiliation(s)
- Maren Boecker
- Institute of Medical Psychology and Medical Sociology, University Hospital of RWTH Aachen University, Aachen, Germany
| | - Katia Iglesias
- School of Health Sciences (HEdS-FR), HES-SO University of Applied Sciences and Arts of Western Switzerland, Fribourg, Switzerland
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Patients' Assessment of Chronic Illness Care (PACIC): Validation and Evaluation of PACIC Scale among Patients with Type 2 Diabetes in Hungary. Int J Integr Care 2022; 22:5. [PMID: 36043029 PMCID: PMC9374014 DOI: 10.5334/ijic.6010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 07/27/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction: The aims of this study were to evaluate the psychometric properties of the Hungarian translation of the PACIC in a sample of patients with type 2 diabetes and to reveal the associations between the mean PACIC scores and the number of chronic diseases, or visits to GPs, and specialist. An exploratory factor analysis (EFA) has also been performed to test the structural validity of the PACIC scale. Methods: The Hungarian version of PACIC was validated using randomly selected patients with type 2 diabetes (N = 684) from licensed GP practices. Results: Floor (1.6%–30.2%) and ceiling effects (11.3–33.6%) were similar of the PACIC scale. The internal consistency of the total scale (Cronbach’s alpha 0.93) was excellent and subscales were good (between 0.73–0.9). The mean scores of each PACIC subscale group were between 2.99–3.53. There was a weak significant correlation between the mean PACIC scores of subscales and the number of GP visits (p < 0.001), and specialist visits (p < 0.001). The EFA identified four factors on the sample (KMO = 0.931). Gender and education showed correlation with some new factors. Conclusion: The psychometric properties of the Hungarian version of PACIC questionnaire showed a reasonable level of validity among patients with type 2 diabetes. Now, this instrument is ready to assess the chronic care of diabetic patients in Hungary.
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Hazazi A, Wilson A. Improving Management of Non-communicable Chronic Diseases in Primary Healthcare Centres in The Saudi Health Care System. Health Serv Insights 2022; 15:11786329221088694. [PMID: 35342294 PMCID: PMC8949774 DOI: 10.1177/11786329221088694] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 02/24/2022] [Indexed: 12/24/2022] Open
Abstract
Evaluation of patient perceptions of quality and adequacy of care is a critical component of continuous improvement in chronic disease care. The purpose of this study was to ascertain how patients with non-communicable diseases (NCDs) assess their routine care in primary care centres in Saudi Arabia and to identify areas for improvement. This cross-sectional study used the PACIC questionnaire to assess the quality of care received by these patients in primary care centres in Saudi Arabia. Data collection took place between May 2019 and July 2019. The questionnaire was self-completed anonymously by 315 patients with NCD attending primary health care centres in Riyadh, Saudi Arabia. The results showed that the average overall PACIC score was 2.97 (SD = 0.65), the mean scores for the subscales ranged from 2.76 (SD = 0.78) for the subscale of goal settings/tailoring to 3.17 (SD = 0.78) for delivery system design/decision support. PACIC scores varied significantly with age, occupation, monthly income, type and duration of chronic illness and educational attainment. In conclusion, patients with NCDs prioritised improvements in organised care that; is comprehensive, focussed on their needs, helps them identify clear goals for their treatments and become more involved in their condition(s) management.
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Affiliation(s)
- Ahmed Hazazi
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
- Department of Public Health, Faculty of Health Sciences, Saudi Electronic University, Riyadh, Saudi Arabia
- Ahmed Hazazi, Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, No. 2W21/Level 2, Charles Perkins Centre D17, Sydney, NSW 2006, Australia.
| | - Andrew Wilson
- Menzies Centre for Health Policy and Economics, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
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Adeoye-Olatunde OA, Pratt N, Kim DD, Schmidt E, Snyder ME. Adaptation and validation of the patient assessment of chronic illness care in United States community pharmacies. BMC Health Serv Res 2022; 22:355. [PMID: 35300662 PMCID: PMC8929461 DOI: 10.1186/s12913-022-07697-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 02/25/2022] [Indexed: 12/04/2022] Open
Abstract
Background
Roles for United States (US)-based community pharmacists in caring for persons with chronic conditions have greatly expanded. The Patient Assessment of Chronic Illness Care (PACIC) was developed to assess patients’ perspectives of care received. However, successful application of this instrument in community pharmacies is uncertain. The objective of this study was to adapt the PACIC for use in community pharmacies (CP-PACIC), assess validity of the CP-PACIC and examine CP-PACIC scale score differences relative to patient characteristics. Methods This cross-sectional study surveyed chronically ill adults in Indiana, US who receive care from pharmacists in community pharmacies. The modified CP-PACIC scale consisted of 20-items, which were rated on a 5-point Likert scale from 0 (none of the time) to 4 (always). The total possible score ranged from 0 – 80. An exploratory factor analysis (EFA) was conducted to assess performance and dimensionality. CP-PACIC validity, including face validity, construct validity (via exploratory factor analysis) and internal consistency were assessed. Relationships between patient characteristics and scale scores were evaluated using appropriate statistical tests. Results Five hundred forty-six respondents’ data were analyzed. EFA revealed a 2-factor solution (termed advanced pharmacy chronic illness care (AP) and traditional pharmacy chronic illness care (TP) subscales) accounting for 64.7% of variance; all 20 items were retained. The total 20-item CP-PACIC scale had a Cronbach’s alpha (internal consistency) of 0.96; with a 12-item AP subscale Cronbach’s alpha of 0.97 and 8-item TP subscale Cronbach’s alpha of 0.89. Median total score was 12.0 [interquartile range = 27.3]. Median CP-PACIC sores varied across many respondent demographics (i.e., survey administration type, age, sex, education, health condition, number of pharmacy services received, community pharmacy type) such as whether respondents participated in one or more pharmacy service or not (29 vs. 10; p < .001). Conclusions Unlike the original 5-subscale (patient activation, delivery system design, goal setting, problem solving, and follow-up/coordination) PACIC, analysis demonstrated a 2-factor (AP, TP) solution for the CP-PACIC scale with good internal consistency. As there are no standardized evaluation tools that exist, community pharmacies could find great value in using this CP-PACIC tool to benchmark performance and inform quality improvement strategies for patient care delivery. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07697-w.
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Affiliation(s)
| | - Naomi Pratt
- Present Affiliation: Meijer Pharmacy, 17000 Mercantile Blvd, Noblesville, IN, 46060, USA.,Purdue University College of Pharmacy, West Lafayette, USA
| | - David D Kim
- Purdue University College of Pharmacy, West Lafayette, USA.,Present Affiliation: Deaconess Health System, Evansville, USA
| | - Evan Schmidt
- Purdue University College of Pharmacy, West Lafayette, USA.,Present Affiliation: Baptist Health Lexington, Lexington, USA
| | - Margie E Snyder
- Department of Pharmacy Practice, Purdue University College of Pharmacy, Indianapolis, USA
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11
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Basri NF, Ramli AS, Mohamad M, Kamaruddin KN. Traditional and complementary medicine (TCM) usage and its association with Patient Assessment of Chronic Illness Care (PACIC) among individuals with metabolic syndrome in primary care. BMC Complement Med Ther 2022; 22:14. [PMID: 35027058 PMCID: PMC8759276 DOI: 10.1186/s12906-021-03493-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 12/07/2021] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Traditional and Complementary Medicine (TCM) is widely used particularly among patients with chronic diseases in primary care. However, evidence is lacking regarding TCM use among patients with Metabolic Syndrome (MetS) and its association with patients’ experience on chronic disease conventional care that they receive. Therefore, this study aims to determine the prevalence and pattern of TCM use, compare the patients’ experience of chronic disease care using the Patient Assessment of Chronic Illness Care - Malay version (PACIC-M) questionnaire between TCM users and non-users and determine the factors associated with TCM use among patients with MetS in primary care.
Methodology
A cross-sectional study was conducted at a university primary care clinic. Patients aged 18 to 80 years old with MetS were recruited. Socio-demographic characteristic, clinical characteristics and information on TCM use and its pattern were recorded in a proforma. Patient’s experience of chronic disease conventional care was measured using PACIC-M questionnaire. The comparison of PACIC-M mean score between TCM users and non-users was measured using independent t-test. The factors associated with TCM use were determined by simple logistic regression (SLogR), followed by multiple logistic regression (MLogR).
Results
Out of 394 participants, 381 (96.7%) were included in the final analysis. Of the 381 participants, 255 (66.9%) were TCM users (95% CI 62.7, 71.7). Only 36.9% of users disclosed about TCM use to their health care providers (HCP). The overall mean PACIC-M score was 2.91 (SD ± 0.04). TCM users had significantly higher mean PACIC-M score compared to non-users (2.98 ± 0.74 vs 2.75 ± 0.72, p = 0.01). The independent factors associated with TCM use were being female (Adj. OR 2.50, 95% CI 1.55, 4.06), having high education level (Adj. OR 2.16, 95% CI 1.37, 3.41) and having high overall PACIC-M mean score (Adj. OR 1.49, 95% CI 1.10, 2.03).
Conclusion
TCM use was highly prevalent in this primary care clinic. However, the disclosure rate of TCM use to HCP was low. Females, those with high education and high PACIC-M mean score were more likely to use TCM. Further research should explore the reasons for their TCM use, despite having good experience in conventional chronic disease care.
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12
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Dupraz J, Zuercher E, Taffé P, Peytremann-Bridevaux I. Ambulatory Healthcare Use Profiles of Patients With Diabetes and Their Association With Quality of Care: A Cross-Sectional Study. Front Endocrinol (Lausanne) 2022; 13:841774. [PMID: 35498410 PMCID: PMC9043606 DOI: 10.3389/fendo.2022.841774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 03/18/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite the growing burden of diabetes worldwide, evidence regarding the optimal models of care to improve the quality of diabetes care remains equivocal. This study aimed to identify profiles of patients with distinct ambulatory care use patterns and to examine the association of these profiles with the quality of diabetes care. METHODS We performed a cross-sectional study of the baseline data of 550 non-institutionalized adults included in a prospective, community-based, cohort study on diabetes care conducted in Switzerland. Clusters of participants with distinct patterns of ambulatory healthcare use were identified using discrete mixture models. To measure the quality of diabetes care, we used both processes of care indicators (eye and foot examination, microalbuminuria screening, blood cholesterol and glycated hemoglobin measurement [HbA1c], influenza immunization, blood pressure measurement, physical activity and diet advice) and outcome indicators (12-Item Short-Form Health Survey [SF-12], Audit of Diabetes-Dependent Quality of Life [ADDQoL], Patient Assessment of Chronic Illness Care [PACIC], Diabetes Self-Efficacy Scale, HbA1c value, and blood pressure <140/90 mmHg). For each profile of ambulatory healthcare use, we calculated adjusted probabilities of receiving processes of care and estimated adjusted outcomes of care using logistic and linear regression models, respectively. RESULTS Four profiles of ambulatory healthcare use were identified: participants with more visits to the general practitioner [GP] than to the diabetologist and receiving concomitant podiatry care ("GP & podiatrist", n=86); participants visiting almost exclusively their GP ("GP only", n=195); participants with a substantially higher use of all ambulatory services ("High users", n=96); and participants reporting more visits to the diabetologist and less visits to the GP than other profiles ("Diabetologist first", n=173). Whereas participants belonging to the "GP only" profile were less likely to report most processes related to the quality of diabetes care, outcomes of care were relatively comparable across all ambulatory healthcare use profiles. CONCLUSIONS Slight differences in quality of diabetes care appear across the four ambulatory healthcare use profiles identified in this study. Overall, however, results suggest that room for improvement exists in all profiles, and further investigation is necessary to determine whether individual characteristics (like diabetes-related factors) and/or healthcare factors contribute to the differences observed between profiles.
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da Silva AWM, Meiners MMMDA, Gallo LG, Oliveira AFDM, Aridja UM, Noronha EF. Assessment of the Perception of People Living With HIV Regarding the Quality of Outpatient Care at a Reference Facility in the Federal District, Brazil. Front Pharmacol 2021; 12:740383. [PMID: 34671259 PMCID: PMC8522475 DOI: 10.3389/fphar.2021.740383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/31/2021] [Indexed: 11/30/2022] Open
Abstract
The effectiveness of antiretroviral treatment has transformed HIV infection into a chronic transmissible condition, requiring health systems to adapt in order to care for people living with HIV. The Chronic Care Model (CCM) is the gold standard for this type of care in many countries. Among its tools, the Patient Assessment of Chronic Illness Care (PACIC) questionnaire gives the patient’s perspective of the care provided. The aim of the present study was to adapt and apply, for the first time, the questionnaire to people living with HIV to determine their perception of the quality of care provided at a reference hospital in the Federal District of Brazil. This is a case study conducted in 2019 at a teaching hospital, with a convenience sample of 30 individuals treated for at least 1 year at the facility. The median PACIC score (3.5 with a range of 1.0–5.0) seems to suggest that the users perceive the outpatient care provided by the hospital as being basic. The “delivery system design/decision support” component was deemed the best (5.0, with a range of 1.0–5.0) and “follow-up/coordination” the worst (1.0, with a range of 1.0–5.0). The results suggest the need to improve the organization of care and make adequate use of community resources, in line with the CCM. The questionnaire makes it possible to determine the strengths and weaknesses of the care provided to people living with HIV and can be used as a planning and monitoring tool to improve management of the condition, with the contribution of the patient, in particular, thereby strengthening self-care.
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Affiliation(s)
| | | | - Luciana Guerra Gallo
- Tropical Medicine, Faculty of Medicine, University of Brasília, Brasília, Brazil
| | | | - Ursila Manga Aridja
- Tropical Medicine, Faculty of Medicine, University of Brasília, Brasília, Brazil
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Nuño-Solínis R, Urtaran-Laresgoiti M, Lázaro E, Ponce S, Orueta JF, Errea Rodríguez M. Inequalities in Health Care Experience of Patients with Chronic Conditions: Results from a Population-Based Study. Healthcare (Basel) 2021; 9:1005. [PMID: 34442142 PMCID: PMC8394123 DOI: 10.3390/healthcare9081005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/02/2021] [Accepted: 08/03/2021] [Indexed: 11/17/2022] Open
Abstract
Patients' experience is an acknowledged key factor for the improvement of healthcare delivery quality. This study aims to explore the differences in healthcare experience among patients with chronic conditions according to individual sociodemographic and health-related variables. A population-based and cross-sectional study was conducted. The sample consisted of 3981 respondents of the Basque Health Survey (out of 8036 total respondents to the individual questionnaire), living in the Basque Country, aged 15 or older, self-reporting at least one chronic condition. Patient experience was assessed with the Instrument for Evaluation of the Experience of Chronic Patients questionnaire, which encompasses three major factors: interactions between patients and professionals oriented to improve outcomes (productive interactions); new ways of patient interaction with the health care system (the new relational model); and the ability of individuals to manage their care and improve their wellbeing based on professional-mediated interventions (self-management). We conducted descriptive and regression analyses. We estimated linear regression models with robust variances that allow testing for differences in experience according to sociodemographic characteristics, the number of comorbidities and the condition (for all chronic or for chronic patients' subgroups). Although no unique inequality patterns by these characteristics can be inferred, females reported worse global results than males and older age was related to poorer experience with the new relational model in health care. Individuals with lower education levels tend to report lower experiences. There is not a clear pattern observed for the type of occupation. Multimorbidity and several specific chronic conditions were associated (positive or negatively) with patients' experience. Health care experience was better in patients with greater quality of life. Understanding the relations among the patients' experience and their sociodemographic and health-related characteristics is an essential issue for health care systems to improve quality of assistance.
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Affiliation(s)
| | - Maider Urtaran-Laresgoiti
- Research Group in Social Determinants of Health and Demographic Change (OPIK), University of the Basque Country (EHU-UPV), 48940 Leioa, Spain;
| | - Esther Lázaro
- Faculty of Health Sciences, Valencian International University, 46002 Valencia, Spain;
| | - Sara Ponce
- International Research Projects Office, University of Deusto, 48007 Bilbao, Spain;
| | - Juan F. Orueta
- Primary Health Care Center of Astrabudua, OSI Uribe, Osakidetza Basque Health Service, 48950 Erandio, Spain;
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15
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Wollny A, Löffler C, Drewelow E, Altiner A, Helbig C, Daubmann A, Wegscheider K, Löscher S, Pentzek M, Wilm S, Feldmeier G, Santos S. Shared decision making and patient-centeredness for patients with poorly controlled type 2 diabetes mellitus in primary care-results of the cluster-randomised controlled DEBATE trial. BMC FAMILY PRACTICE 2021; 22:93. [PMID: 33992088 PMCID: PMC8126132 DOI: 10.1186/s12875-021-01436-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 04/12/2021] [Indexed: 11/23/2022]
Abstract
Background We investigate whether an educational intervention of GPs increases patient-centeredness and perceived shared decision making in the treatment of patients with poorly controlled type 2 diabetes mellitus? Methods We performed a cluster-randomized controlled trial in German primary care. Patients with type 2 diabetes mellitus defined as HbA1c levels ≥ 8.0% (64 mmol/mol) at the time of recruitment (n = 833) from general practitioners (n = 108) were included. Outcome measures included subjective shared decision making (SDM-Q-9; scale from 0 to 45 (high)) and patient-centeredness (PACIC-D; scale from 1 to 5 (high)) as secondary outcomes. Data collection was performed before intervention (baseline, T0), at 6 months (T1), at 12 months (T2), at 18 months (T3), and at 24 months (T4) after baseline. Results Subjective shared decision making decreased in both groups during the course of the study (intervention group: -3.17 between T0 and T4 (95% CI: -4.66, -1.69; p < 0.0001) control group: -2.80 (95% CI: -4.30, -1.30; p = 0.0003)). There were no significant differences between the two groups (-0.37; 95% CI: -2.20, 1.45; p = 0.6847). The intervention's impact on patient-centeredness was minor. Values increased in both groups, but the increase was not statistically significant, nor was the difference between the groups. Conclusions The intervention did not increase patient perceived subjective shared decision making and patient-centeredness in the intervention group as compared to the control group. Effects in both groups might be partially attributed to the Hawthorne-effect. Future trials should focus on patient-based intervention elements to investigate effects on shared decision making and patient-centeredness. Trial registration The trial was registered on March 10th, 2011 at ISRCTN registry under the reference ISRCTN70713571.
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Affiliation(s)
- Anja Wollny
- Institute of General Practice, Rostock University Medical Centre, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christin Löffler
- Institute of General Practice, Rostock University Medical Centre, Doberaner Str. 142, 18057, Rostock, Germany.
| | - Eva Drewelow
- Institute of General Practice, Rostock University Medical Centre, Doberaner Str. 142, 18057, Rostock, Germany
| | - Attila Altiner
- Institute of General Practice, Rostock University Medical Centre, Doberaner Str. 142, 18057, Rostock, Germany
| | - Christian Helbig
- Institute of General Practice, Rostock University Medical Centre, Doberaner Str. 142, 18057, Rostock, Germany
| | - Anne Daubmann
- Institute of Medical Biometry and Epidemiology, Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Karl Wegscheider
- Institute of Medical Biometry and Epidemiology, Medical Centre Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Susanne Löscher
- Institute of General Practice (Ifam), Medical Faculty, Centre for Health & Society (Chs), Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Michael Pentzek
- Institute of General Practice (Ifam), Medical Faculty, Centre for Health & Society (Chs), Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Stefan Wilm
- Institute of General Practice (Ifam), Medical Faculty, Centre for Health & Society (Chs), Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
| | - Gregor Feldmeier
- Institute of General Practice, Rostock University Medical Centre, Doberaner Str. 142, 18057, Rostock, Germany
| | - Sara Santos
- Institute of General Practice (Ifam), Medical Faculty, Centre for Health & Society (Chs), Heinrich-Heine University Düsseldorf, Moorenstr. 5, 40225, Düsseldorf, Germany
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16
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Factors Influencing Healthcare Experience of Patients with Self-Declared Diabetes: A Cross-Sectional Population-Based Study in the Basque Country. Healthcare (Basel) 2021; 9:healthcare9050509. [PMID: 33925113 PMCID: PMC8145886 DOI: 10.3390/healthcare9050509] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/22/2021] [Accepted: 04/24/2021] [Indexed: 01/03/2023] Open
Abstract
Background: Diabetes affects more than 400 million people around the world. Few published studies incorporate questionnaires that comprehensively cover every aspect of a patient’s experience of healthcare. This study analyzes potential differences in the healthcare experience for patients with diabetes based on their sociodemographic, economic, and health-related characteristics from a comprehensive viewpoint in an integrated delivery system. Methods: We used data from the 2018 Basque Health Survey, which includes a questionnaire for the measurement of the experiences of patients with chronic problems. We present descriptive and regression analyses to explore differences by sociodemographic, economic, and health-related characteristics of patients’ experiences with different healthcare services. Results: Having diabetes plus other comorbidities significantly decreases the quality of the experience with all healthcare services and decreases the global healthcare experience score. When comorbidities are present, the elderly seem to report better experiences than younger patients. Some differences in experience can be explained by sociodemographic and economic factors. No differences exist between conditions co-occurring with diabetes. Conclusion: Patients with diabetes who also suffer from other conditions report worse experiences than individuals who suffer from diabetes only. No specific conditions explain the differences in care experience.
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Vennedey V, Dust G, Schippel N, Shukri A, Strupp J, Rietz C, Voltz R, Stock S. Patient-centered care during the last year of life: adaptation and validation of the German PACIC short form for bereaved persons as proxies (PACIC-S9-proxy). BMC Palliat Care 2020; 19:177. [PMID: 33234117 PMCID: PMC7687735 DOI: 10.1186/s12904-020-00687-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Accepted: 11/18/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Providing patient-centered care (PCC) during the last year of life (LYOL) can be challenging due to the complexity of the patients' medical, social and psychological needs, especially in case of chronic illnesses. Assessing PCC can be helpful in identifying areas for improvements. Since not all patients can be surveyed, a questionnaire for proxy informants was developed in order to retrospectively assess patient-centeredness in care during the whole LYOL. This study aimed to evaluate the feasibility and validity of an adapted version of the German Patient Assessment of Chronic Illness Care (PACIC) for surveying bereaved persons in order to assess PCC during the decedents' LYOL. METHODS The German PACIC short form (11 items) was adapted to a nine-item version for surveying bereaved persons on the decedent's LYOL (PACIC-S9-Proxy). Items were rated on a five-point Likert scale. The PACIC adaptation and validation was part of a cross-sectional survey in the region of Cologne. Participants were recruited through self-selection and active recruitment by practice partners. Sociodemographic characteristics and missing data were analyzed using descriptive statistics. An exploratory factor analysis was conducted in order to assess the structure of the PACIC-S9-Proxy. Internal consistency was estimated using Cronbach's alpha. RESULTS Of the 351 informants who participated in the survey, 230 (65.52%) considered their decedent to have suffered from chronic illness prior to death. 193 of these informants (83.91%) completed ≥5 items of the questionnaire and were included in the analysis. The least answered item was item (74.09%) was item 4 (encouragement to group & classes for coping). The most frequently answered item (96.89%) was item 2 (satisfaction with care organization). Informants rated the item" Given a copy of their treatment plan" highest (mean 3.96), whereas "encouragement to get to a specific group or class to cope with the condition" (mean 1.74) was rated lowest. Cronbach's alpha was 0.84. A unidimensional structure of the questionnaire was found (Kaiser-Meyer-Olkin 0.86, Bartlett's test for sphericity p < 0.001), with items' factor loadings ranging from 0.46 to 0.82. CONCLUSIONS The nine-item questionnaire can be used as efficient tool for assessing PCC during the LYOL retrospectively and by proxies. TRIAL REGISTRATION The study was registered in the German Clinical Trials Register ( DRKS00011925 ) on 13 June 2017.
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Affiliation(s)
- Vera Vennedey
- Institute for Health Economics and Clinical Epidemiology, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Gloria Dust
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | - Nicolas Schippel
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
- Institute of Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Arim Shukri
- Institute for Health Economics and Clinical Epidemiology, Gleueler Straße 176-178, 50935 Cologne, Germany
| | - Julia Strupp
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
| | | | - Raymond Voltz
- Department of Palliative Medicine, Medical Faculty, University of Cologne, Cologne, Germany
- Center for Health Services Research Cologne (ZVFK), University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Clinical Trials Center Cologne (ZKS), University of Cologne, Cologne, Germany
| | - Stephanie Stock
- Institute for Health Economics and Clinical Epidemiology, Gleueler Straße 176-178, 50935 Cologne, Germany
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Youssef A, Chaudhary ZK, Wiljer D, Mylopoulos M, Sockalingam S. Mapping Evidence of Patients' Experiences in Integrated Care: A Scoping Review. Gen Hosp Psychiatry 2019; 61:1-9. [PMID: 31479842 DOI: 10.1016/j.genhosppsych.2019.08.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2019] [Revised: 08/12/2019] [Accepted: 08/12/2019] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Despite the established clinical and cost-effectiveness of integrated care (IC) models for patients with comorbid mental and physical illness, little is known about whether these models facilitate a better care experience from the patient's perspective. The authors conducted a scoping review of the literature to explore how IC influences patients' care experiences. METHODS MEDLINE, EMBASE, PSYC INFO CINAHL, AMED, the Cochrane Library, and grey literature were searched to identify relevant articles. Eligible studies were systematically reviewed and analyzed, using thematic analysis approach, to identify patterns, trends, and variation in patient experience within IC settings. RESULTS Search results yielded 5250 unique resources of which 21 primary studies met our eligibility criteria for analysis. Findings from this scoping review revealed variation in patients' experiences in IC settings. IC models enhanced patients' experience by creating theraputic spaces: improving patient access to care, developing collaborative relationships, and personalizing patient care to address individual needs. CONCLUSION Productive interactions with care team were key to improve patient engagement and experience of centeredness in IC settings. Successful implementation of IC demanded purposeful alignment of IC structural components and care processes to create therapeutic spaces that address patient care needs and preferences.
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Affiliation(s)
- Alaa Youssef
- Institute for Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Zarah K Chaudhary
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - David Wiljer
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; University Health Network Centre for Mental Health, Toronto, Ontario, Canada; The Institute for Health Policy, Management and Education, University of Toronto, Toronto, Ontario, Canada
| | - Maria Mylopoulos
- The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Sanjeev Sockalingam
- Institute for Medical Sciences, University of Toronto, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; The Wilson Centre, University Health Network, University of Toronto, Toronto, Ontario, Canada; University Health Network Centre for Mental Health, Toronto, Ontario, Canada; Centre for Addiction and Mental Health, University of Toronto, Toronto, Ontario, Canada.
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Lim MT, Lim YMF, Teh XR, Lee YL, Ismail SA, Sivasampu S. Patient experience on self-management support among primary care patients with diabetes and hypertension. Int J Qual Health Care 2019; 31:37-43. [PMID: 30608582 PMCID: PMC6839370 DOI: 10.1093/intqhc/mzy252] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/20/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To determine the extent of self-management support (SMS) provided to primary care patients with type 2 diabetes (T2D) and hypertension and its associated factors. DESIGN Cross-sectional survey conducted between April and May 2017. SETTING Forty public clinics in Malaysia. PARTICIPANTS A total of 956 adult patients with T2D and/or hypertension were interviewed. MAIN OUTCOME MEASURES Patient experience on SMS was evaluated using a structured questionnaire of the short version Patient Assessment of Chronic Illness Care instrument, PACIC-M11. Linear regression analysis adjusting for complex survey design was used to determine the association of patient and clinic factors with PACIC-M11 scores. RESULTS The overall PACIC-M11 mean was 2.3(SD,0.8) out of maximum of 5. The subscales' mean scores were lowest for patient activation (2.1(SD,1.1)) and highest for delivery system design/decision support (2.9(SD,0.9)). Overall PACIC-M11 score was associated with age, educational level and ethnicity. Higher overall PACIC-M11 ratings was observed with increasing difference between actual and expected consultation duration [β = 0.01; 95% CI (0.001, 0.03)]. Better scores were also observed among patients who would recommend the clinic to friends and family [β = 0.19; 95% CI (0.03, 0.36)], when health providers were able to explain things in ways that were easy to understand [β = 0.34; 95% CI (0.10, 0.59)] and knew about patients' living conditions [β = 0.31; 95% CI (0.15, 0.47)]. CONCLUSIONS Our findings indicated patients received low levels of SMS. PACIC-M11 ratings were associated with age, ethnicity, educational level, difference between actual and expected consultation length, willingness to recommend the clinic and provider communication skills.
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Affiliation(s)
- Ming Tsuey Lim
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health, 3rd Floor, MMA House, 124 Jalan Pahang, Kuala Lumpur, Malaysia
| | - Yvonne Mei Fong Lim
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health, 3rd Floor, MMA House, 124 Jalan Pahang, Kuala Lumpur, Malaysia
| | - Xin Rou Teh
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health, 3rd Floor, MMA House, 124 Jalan Pahang, Kuala Lumpur, Malaysia
| | - Yi Lin Lee
- Clinical Research Ward, Ampang Hospital, Ministry of Health, Jalan Mewah Utara, Pandan Mewah, Ampang, Selangor, Malaysia
| | - Siti Aminah Ismail
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health, 3rd Floor, MMA House, 124 Jalan Pahang, Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Healthcare Statistics Unit, National Clinical Research Centre, Ministry of Health, 3rd Floor, MMA House, 124 Jalan Pahang, Kuala Lumpur, Malaysia
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