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Brown S, Lhussier M, Dalkin SM, Eaton S. Care Planning: What Works, for Whom, and in What Circumstances? A Rapid Realist Review. QUALITATIVE HEALTH RESEARCH 2018; 28:2250-2266. [PMID: 29676217 DOI: 10.1177/1049732318768807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Care planning has been described as a "better conversation" that helps people with long-term conditions to be in control of planning their care. Each person with long-term conditions faces individual challenges and each health care setting is fundamentally different, so there is a need for empirical testing of the specific mechanisms through which care planning may lead to health improvements. A rapid realist review was conducted to unearth underpinning mechanisms leading to outcomes in particular contexts. These are expressed in the form of realist theories, which are developed and refined through the review process. Fifty-one full text studies were included in the review. Seven program theories were iteratively tested and refined. A detailed description of what care planning is and what it should look like in practice has been achieved in the form of realist theories.
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Affiliation(s)
- Sarah Brown
- 1 Northumbria University, Newcastle upon Tyne, UK
| | | | | | - Simon Eaton
- 2 Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
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O'Donnell M, Alvarez-Iglesias A, McGuire BE, Dinneen SF. The impact of sharing personalised clinical information with people with type 2 diabetes prior to their consultation: A pilot randomised controlled trial. PATIENT EDUCATION AND COUNSELING 2016; 99:591-599. [PMID: 26654869 DOI: 10.1016/j.pec.2015.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Revised: 11/12/2015] [Accepted: 11/14/2015] [Indexed: 06/05/2023]
Abstract
AIM To assess the impact of sharing personalised clinical information with people with type 2 diabetes prior to their out-patient consultation on patient involvement during the consultation, diabetes self-management self-efficacy and glycaemic control. METHODS A pilot three-arm randomised controlled trial. The 'intervention booklet' group received a booklet including personalised clinical information, a 'general information booklet' control group received a booklet with no personalised clinical information and a 'usual care' control group received no written information. RESULTS 136 people took part. The intervention group were significantly more likely to have shown the booklet to a 'significant other', (48% V 23%, p<0.05), brought the booklet with them to the clinic (85% V 35%, p<0.005) and to refer to the booklet during the consultation (45% V 13%, p<0.005). No significant differences in patient involvement during the consultation, diabetes management self-efficacy or glycaemic control were found between the three groups. CONCLUSIONS Although participants found it useful to receive their clinical results, no differences were found in the patient outcomes measured. PRACTICE IMPLICATIONS Further pilot work on the timing of the intervention, who it is targeted at and what outcomes are measured is warranted before proceeding to a full-scale RCT.
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Affiliation(s)
- M O'Donnell
- Discipline of Medicine, NUI Galway, Ireland.
| | | | | | - S F Dinneen
- Discipline of Medicine, NUI Galway, Ireland; Department of Diabetes and Endocrinology, Galway University Hospitals, Ireland
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Gillani SMR, Nevill A, Singh BM. Provision of structured diabetes information encourages activation amongst people with diabetes as measured by diabetes care process attainment: the WICKED Project. Diabet Med 2015; 32:865-71. [PMID: 25764229 DOI: 10.1111/dme.12737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2015] [Indexed: 11/30/2022]
Abstract
BACKGROUND People with diabetes have better outcomes if they actively participate in their care. Patient-focused interventions can be effective in activating patients. Yet there is no known trial to evaluate the impact of the provision of individualized diabetes-specific information on patient activation and diabetes care outcomes. METHODS In a randomized controlled trial, all people (n = 14 559) with diabetes within the local health economy were recruited and cluster randomized into two groups with the active group mailed a structured personalized report containing information on all nine of their diabetes care processes, whereas the control group received standard care. Differences in their Failed Process Score (FPS) were compared at three months. RESULTS At three months, the FPS score (1.25 ± 1.87 vs. 1.35 ± 1.97, P < 0.01) and the change in FPS score (0.48 ± 1.55 vs. 0.42 ± 1.49, P < 0.02) were significantly better in those mailed a structured personalized report. A dichotomized FPS score [good attainment (GA) vs. poorer attainment], was significantly better in those mailed (χ2 = 10.0, P < 0.05) and using a binary logistic regression analysis adjusting for all demographic factors and the baseline FPS, the relative effect of mailing compared with non-mailing on three-month GA category was OR 1.14 (95% CI 1.04-1.25, P < 0.01). CONCLUSIONS Provision of structured and individualized information to people with diabetes can positively influence the level of patient activation, promote better engagement and open the potential to improve other crucial diabetes outcomes.
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Affiliation(s)
- S M R Gillani
- Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK
| | | | - B M Singh
- Wolverhampton Diabetes Centre, New Cross Hospital, Wolverhampton, UK
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Rodriguez K, Kaselitz E, Wong J, Ligard S, Peck D, Hugo Mena V, Gordillo F, Serlin D, Heisler M. Improving preclinic preparation for patients with chronic conditions in quito, ecuador: a randomized controlled trial. INTERNATIONAL JOURNAL OF FAMILY MEDICINE 2015; 2015:724245. [PMID: 25883805 PMCID: PMC4390100 DOI: 10.1155/2015/724245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Revised: 02/16/2015] [Accepted: 03/01/2015] [Indexed: 06/04/2023]
Abstract
Objectives. As in many settings, patients in community health centers in Ecuador do not complete previsit forms or receive assistance to identify questions and concerns they would like to address in brief clinic visits with physicians. We examined the comparative effectiveness of providing (1) a previsit form to complete; (2) a previsit form along with assistance in completing the form; and (3) usual care. Methods. Parallel, three-arm randomized controlled trial in two health centers serving indigent to low-income communities in Quito, Ecuador, among 199 adult patients who took medications for at least one chronic condition. Outcome measures were self-reported satisfaction with the visit, confidence in asking questions, and extent to which patients' objectives were met. Results. Patients who received assistance in completing a previsit form were more than twice as likely as participants in usual care to report achieving everything they wanted during their visit (AOR 2.2, P = 0.039). There were no differences in any outcomes between the groups who received the previsit form with no assistance and usual care. Conclusions. For high-quality patient-centered primary care, it is important to develop and test innovative and scalable interventions for patients and physicians to make the best use of limited clinic time.
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Affiliation(s)
- K. Rodriguez
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - E. Kaselitz
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, MI 48109, USA
| | - J. Wong
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - S. Ligard
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - D. Peck
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - V. Hugo Mena
- Pontifical Catholic University of Ecuador (PUCE) Medical School, P.O. Box 17012184, Quito, Ecuador
| | - F. Gordillo
- Pontifical Catholic University of Ecuador (PUCE) Medical School, P.O. Box 17012184, Quito, Ecuador
| | - D. Serlin
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
| | - M. Heisler
- University of Michigan Medical School, Ann Arbor, MI 48109, USA
- Center for Clinical Management Research, Ann Arbor Veterans' Affairs (VA) Healthcare System, Ann Arbor, MI 48109, USA
- Department of Health Behavior and Health Education, School of Public Health, University of Michigan, Ann Arbor, MI 48109, USA
- Michigan Center for Diabetes Translational Research (MCDTR), University of Michigan, Ann Arbor VA, Ann Arbor, MI 48109, USA
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Gillani SMR, Singh BM. A simple method for introducing care planning into specialist diabetes clinics. The WICKED project. PRACTICAL DIABETES 2014. [DOI: 10.1002/pdi.1898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- SMR Gillani
- Wolverhampton Diabetes Centre; New Cross Hospital; Wolverhampton UK
| | - BM Singh
- Wolverhampton Diabetes Centre; New Cross Hospital; Wolverhampton UK
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Becker K, Whittam L. A new patient information leaflet for Dermatology outpatients. BMJ QUALITY IMPROVEMENT REPORTS 2014; 3:bmjquality_uu203377.w1925. [PMID: 26734296 PMCID: PMC4645905 DOI: 10.1136/bmjquality.u203377.w1925] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 06/18/2014] [Indexed: 11/29/2022]
Abstract
Lack of provision of information was the single most common cause of poor performance in the 2008/2009 NHS Patient Survey Programme of trusts in the UK. Information leaflets have been shown to improve patient satisfaction with consultations. We introduced a new patient information leaflet about the scheduled consultation in a district hospital's dermatology outpatient clinic. We then assessed in a small study its effect on the patients regarding helpfulness, preparation for and satisfaction with the out-patient consultation. Via the hospital's booking office, leaflets were sent to all patients (n=32) due to attend two outpatient clinics, accompanied by a letter about the survey. After the consultation, patients were given a short anonymous questionnaire to complete. Of the 32 patients, 12 patients did not receive the leaflet, three did not attend their consultation, and two left before they were handed the questionnaire. We gave out 15 questionnaires, and received 15 responses (100%). 46.9% of patients (n=15) answered the questionnaire. Of these 33.3% were new patients (n=5). 86.7% (n=13) found the leaflet helpful and 33% excellent (n=5). 86.7% felt well prepared for the consultation, 40% excellently (n=6). 86.7% were satisfied with the consultation, 73% rated their satisfaction as excellent (n=11). 60% of patients brought a list with their medication (n=9), 80% of the new patients (n=4). 13.3% of patients (n=2) wrote down questions prior to the consultation. Comments suggested the leaflet would be more useful for new patients. Patients scored highly for satisfaction with the consultation, whether or not they had received and information leaflet (we asked n=20 patients without leaflet). This short survey supports the idea that patients find it helpful to receive an information leaflet, and actively prepare by bringing a list of their medication, and thinking of questions.
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Walker R, Davison C, Maher AM, Law J, Reilly P, Fordjour G. Introducing personalised care planning into Newham: outcomes of a pilot project. Diabet Med 2012; 29:1074-8. [PMID: 22061431 DOI: 10.1111/j.1464-5491.2011.03523.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM To explore the feasibility and acceptability of implementing a personalised care planning approach for diabetes care in general practice. METHODS A four-stage care planning process was introduced for diabetes annual review, involving patients (1) being made aware of the new process, (2) attending an appointment to gather clinical data, (3) receiving and reviewing their results and (4) attending a care planning consultation. The latter is a collaborative discussion with the health professional about their response to their results, their goals and desired action plan. Health professionals received specialist training in personalised care planning, including practice observations and feedback. RESULTS Sixty-six per cent of patients eligible to participate in the project attended both appointments and received an annual review. Of these, 89% also agreed a personalised care plan. Staff reported greater engagement among patients who had read and understood their results. Fourteen per cent of patients reported that they had not agreed a care plan but would have liked one. Patients reported increased confidence in managing their condition with 75% feeling that their ideas and goals were discussed completely. CONCLUSIONS Introducing personalised care planning to general practice diabetes care is possible and well received. Our model for implementation of personalised care planning, which includes specialist training for practice teams and ongoing support from local colleagues and health organizations, can help to meet national recommendations for the provision of personalised care plans for people with long-term conditions. When implementing personalised care planning, efficient administration is vital and behaviour change is necessary for both staff and patients.
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Affiliation(s)
- R Walker
- Successful Diabetes, Northampton, UK.
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Doherty Y, Eaton S, Turnbull R, Oliver L, Roberts S, Ludbrook S, Lewis-Barned N. Year of Care: the key drivers and theoretical basis for a new approach in diabetes care. PRACTICAL DIABETES 2012. [DOI: 10.1002/pdi.1687] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Vanden Bosch ML, Corser WD, Xie Y, Holmes-Rovner M. Posthospital Heart-Healthy Behaviors in Adults With Comorbid Diabetes. Clin Nurs Res 2011; 21:327-49. [PMID: 21926277 DOI: 10.1177/1054773811422123] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The purpose of these secondary analyses was to examine relationships between patient factors and patient-provider decision-making style (PDM) on heart-healthy behavior changes in 142 adults with diabetes after hospitalization for an acute coronary syndrome (ACS). A clinical trial randomized adults to either control or a telephone coaching intervention. Generalized estimating equations were used to analyze the relationship between patient factors and PDM style on longitudinal postdischarge changes in three heart-healthy behaviors, avoiding high fat foods, weight loss, and increased physical activity. Neither PDM style nor telephone coaching intervention affected heart-healthy behaviors in this population. Although adults with diabetes preferred collaborative patient-provider decision-making, present levels of provider engagement were not sufficient to support behavior change. Results suggest the need for sustained and tailored nursing interventions to facilitate heart-healthy behavior changes in adults with diabetes after ACS hospitalization.
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Affiliation(s)
| | - William D. Corser
- College of Human Medicine, Michigan State University, East Lansing, MI, USA
| | - Yan Xie
- Center for Statistical Training & Consulting, Michigan State University, East Lansing, MI, USA
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