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Stumm J, Peter L, Kuempel L, Erdmann LR, Dierks MT, Heintze C, Döpfmer S. [Do General Practitioners have Experience with Social Care Points? A Berlin-Wide Survey]. DAS GESUNDHEITSWESEN 2023; 85:1010-1015. [PMID: 37028418 PMCID: PMC10653982 DOI: 10.1055/a-2035-9289] [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] [Indexed: 04/09/2023]
Abstract
Primary care for multimorbid patients involves social counseling in addition to medical care. Community care points are established institutions for social counseling at district level in Berlin. A Berlin-wide questionnaire survey examined primary care physicians' knowledge of and experience with community care points. 700 questionnaires were analysed exploratively and descriptively. General practitioners were only partially familiar with the services of community care points (60% barely or not at all). 57% of the general practitioners stated that they already had contact with community care points. General practitioners who had not yet had contact with a community care point recommended other advice centers for social (76%) and care-related advice (79%) to their patients. A majority of general practitioners expressed a wish to get more information about community care points.
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Affiliation(s)
- Judith Stumm
- Institut für Allgemeinmedizin, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt- Universität zu Berlin, and
Institute of Health, Berlin, Germany
| | - Lisa Peter
- Institut für Allgemeinmedizin, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt- Universität zu Berlin, and
Institute of Health, Berlin, Germany
| | - Lisa Kuempel
- Institut für Allgemeinmedizin, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt- Universität zu Berlin, and
Institute of Health, Berlin, Germany
| | - Lara Regina Erdmann
- Institut für Allgemeinmedizin, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt- Universität zu Berlin, and
Institute of Health, Berlin, Germany
| | - Marius Tibor Dierks
- Institut für Allgemeinmedizin, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt- Universität zu Berlin, and
Institute of Health, Berlin, Germany
| | - Christoph Heintze
- Institut für Allgemeinmedizin, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt- Universität zu Berlin, and
Institute of Health, Berlin, Germany
| | - Susanne Döpfmer
- Institut für Allgemeinmedizin, Charité –
Universitätsmedizin Berlin, corporate member of Freie
Universität Berlin, Humboldt- Universität zu Berlin, and
Institute of Health, Berlin, Germany
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Zelenak C, Nagel J, Bersch K, Derendorf L, Doyle F, Friede T, Herbeck Belnap B, Kohlmann S, Skou ST, Velasco CA, Albus C, Asendorf T, Bang CA, Beresnevaite M, Bruun NE, Burg MM, Buhl SF, Gæde PH, Lühmann D, Markser A, Nagy KV, Rafanelli C, Rasmussen S, Søndergaard J, Sørensen J, Stauder A, Stock S, Urbinati S, Riva DD, Wachter R, Walker F, Pedersen SS, Herrmann‐Lingen C. Integrated care for older multimorbid heart failure patients: protocol for the ESCAPE randomized trial and cohort study. ESC Heart Fail 2023; 10:2051-2065. [PMID: 36907651 PMCID: PMC10192276 DOI: 10.1002/ehf2.14294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 12/02/2022] [Accepted: 01/09/2023] [Indexed: 03/13/2023] Open
Abstract
ESCAPE Evaluation of a patient-centred biopsychosocial blended collaborative care pathway for the treatment of multimorbid elderly patients. THERAPEUTIC AREA Healthcare interventions for the management of older patients with multiple morbidities. AIMS Multi-morbidity treatment is an increasing challenge for healthcare systems in ageing societies. This comprehensive cohort study with embedded randomized controlled trial tests an integrated biopsychosocial care model for multimorbid elderly patients. HYPOTHESIS A holistic, patient-centred pro-active 9-month intervention based on the blended collaborative care (BCC) approach and enhanced by information and communication technologies can improve health-related quality of life (HRQoL) and disease outcomes as compared with usual care at 9 months. METHODS Across six European countries, ESCAPE is recruiting patients with heart failure, mental distress/disorder plus ≥2 medical co-morbidities into an observational cohort study. Within the cohort study, 300 patients will be included in a randomized controlled assessor-blinded two-arm parallel group interventional clinical trial (RCT). In the intervention, trained care managers (CMs) regularly support patients and informal carers in managing their multiple health problems. Supervised by a clinical specialist team, CMs remotely support patients in implementing the treatment plan-customized to the patients' individual needs and preferences-into their daily lives and liaise with patients' healthcare providers. An eHealth platform with an integrated patient registry guides the intervention and helps to empower patients and informal carers. HRQoL measured with the EQ-5D-5L as primary endpoint, and secondary outcomes, that is, medical and patient-reported outcomes, healthcare costs, cost-effectiveness, and informal carer burden, will be assessed at 9 and ≥18 months. CONCLUSIONS If proven effective, the ESCAPE BCC intervention can be implemented in routine care for older patients with multiple morbidities across the participating countries and beyond.
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Affiliation(s)
- Christine Zelenak
- Department of Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
| | - Jonas Nagel
- Department of Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
| | - Kristina Bersch
- Clinical Trial Unit of the University Medical Center GöttingenGöttingenGermany
| | - Lisa Derendorf
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical EpidemiologyUniversity of CologneCologneGermany
| | - Frank Doyle
- Royal College of Surgeons in IrelandDublinIreland
| | - Tim Friede
- Department of Medical StatisticsUniversity of Göttingen Medical CentreGöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Birgit Herbeck Belnap
- Department of Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
- Center for Behavioral Health, Media, and Technology, Division of General Internal MedicineUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Sebastian Kohlmann
- Clinic for Psychosomatic Medicine and PsychotherapyUniversity Hospital Hamburg EppendorfHamburgGermany
| | - Søren T. Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational TherapyNæstved‐Slagelse‐Ringsted Hospitals, Region ZealandSlagelseDenmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark
| | - Carlos A. Velasco
- Fraunhofer Institute for Applied Information Technology FITSchloss BirlinghovenSankt AugustinGermany
| | - Christian Albus
- Faculty of Medicine and University Hospital of Cologne, Department of Psychosomatics and PsychotherapyUniversity of CologneCologneGermany
| | - Thomas Asendorf
- Clinical Trial Unit of the University Medical Center GöttingenGöttingenGermany
| | | | - Margarita Beresnevaite
- Laboratory of Clinical Cardiology, Institute of CardiologyLithuanian University of Health SciencesKaunasLithuania
| | - Niels Eske Bruun
- Department of CardiologyZealand University HospitalRoskildeDenmark
- Clinical InstitutesCopenhagen and Aalborg UniversitiesCopenhagenDenmark
| | | | - Sussi Friis Buhl
- Research Unit of General Practice, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Peter H. Gæde
- Department of Cardiology and EndocrinologySlagelse HospitalSlagelseDenmark
- Institute of Regional HealthUniversity of Southern DenmarkOdenseDenmark
| | | | - Anna Markser
- Faculty of Medicine and University Hospital of Cologne, Department of Psychosomatics and PsychotherapyUniversity of CologneCologneGermany
| | | | | | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Jan Sørensen
- Healthcare Outcomes Research CentreDublinIreland
| | - Adrienne Stauder
- Institute of Behavioural SciencesSemmelweis UniversityBudapestHungary
| | - Stephanie Stock
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical EpidemiologyUniversity of CologneCologneGermany
| | | | | | | | - Florian Walker
- Clinical Trial Unit of the University Medical Center GöttingenGöttingenGermany
| | - Susanne S. Pedersen
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
- Department of CardiologyOdense University HospitalOdenseDenmark
| | - Christoph Herrmann‐Lingen
- Department of Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
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Schäfer I, Schulze J, Glassen K, Breckner A, Hansen H, Rakebrandt A, Berg J, Blozik E, Szecsenyi J, Lühmann D, Scherer M. Validation of patient- and GP-reported core sets of quality indicators for older adults with multimorbidity in primary care: results of the cross-sectional observational MULTIqual validation study. BMC Med 2023; 21:148. [PMID: 37069536 PMCID: PMC10111827 DOI: 10.1186/s12916-023-02856-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 03/30/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Older adults with multimorbidity represent a growing segment of the population. Metrics to assess quality, safety and effectiveness of care can support policy makers and healthcare providers in addressing patient needs. However, there is a lack of valid measures of quality of care for this population. In the MULTIqual project, 24 general practitioner (GP)-reported and 14 patient-reported quality indicators for the healthcare of older adults with multimorbidity were developed in Germany in a systematic approach. This study aimed to select, validate and pilot core sets of these indicators. METHODS In a cross-sectional observational study, we collected data in general practices (n = 35) and patients aged 65 years and older with three or more chronic conditions (n = 346). One-dimensional core sets for both perspectives were selected by stepwise backward selection based on corrected item-total correlations. We established structural validity, discriminative capacity, feasibility and patient-professional agreement for the selected indicators. Multilevel multivariable linear regression models adjusted for random effects at practice level were calculated to examine construct validity. RESULTS Twelve GP-reported and seven patient-reported indicators were selected, with item-total correlations ranging from 0.332 to 0.576. Fulfilment rates ranged from 24.6 to 89.0%. Between 0 and 12.7% of the values were missing. Seventeen indicators had agreement rates between patients and professionals of 24.1% to 75.9% and one had 90.7% positive and 5.1% negative agreement. Patients who were born abroad (- 1.04, 95% CI = - 2.00/ - 0.08, p = 0.033) and had higher health-related quality of life (- 1.37, 95% CI = - 2.39/ - 0.36, p = 0.008), fewer contacts with their GP (0.14, 95% CI = 0.04/0.23, p = 0.007) and lower willingness to use their GPs as coordinators of their care (0.13, 95% CI = 0.06/0.20, p < 0.001) were more likely to have lower GP-reported healthcare quality scores. Patients who had fewer GP contacts (0.12, 95% CI = 0.04/0.20, p = 0.002) and were less willing to use their GP to coordinate their care (0.16, 95% CI = 0.10/0.21, p < 0.001) were more likely to have lower patient-reported healthcare quality scores. CONCLUSIONS The quality indicator core sets are the first brief measurement tools specifically designed to assess quality of care for patients with multimorbidity. The indicators can facilitate implementation of treatment standards and offer viable alternatives to the current practice of combining disease-related metrics with poor applicability to patients with multimorbidity.
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Affiliation(s)
- Ingmar Schäfer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Josefine Schulze
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Katharina Glassen
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Heike Hansen
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Anja Rakebrandt
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jessica Berg
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Eva Blozik
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Dagmar Lühmann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Claessens F, Castro EM, Jans A, Jacobs L, Seys D, Van Wilder A, Brouwers J, Van der Auwera C, De Ridder D, Vanhaecht K. Patients' and kin's perspective on healthcare quality compared to Lachman's multidimensional quality model: Focus group interviews. PATIENT EDUCATION AND COUNSELING 2022; 105:3151-3159. [PMID: 35843847 DOI: 10.1016/j.pec.2022.07.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES To identify key attributes of healthcare quality relevant to patients and kin and to compare them to Lachman's multidimensional quality model. METHODS Four focus groups with patients and kin were conducted using a semi-structured interview guide and a purposive sampling method. Classical content analysis and constant comparison method were used to focus data analysis on individual and group level. RESULTS Communication with patients, kin and professionals emerged as a new dimension from interview transcripts. Other identified key attributes largely corresponded with Lachman's multidimensional quality model. They were mainly classified in dimensions: 'Partnership and Co-Production', 'Dignity and Respect' and 'Effectiveness'. Technical quality dimensions were linked to organisational aspects of care in terms of staffing levels and time. The dimension 'Eco-friendly' was not addressed by patients or kin. CONCLUSIONS The results enhance the comprehension of healthcare quality and contribute to its academic understanding by validating Lachman's multidimensional quality model from patients' and kin's perspective. The model robustness is increased by including communication as a quality dimension surrounding technical domains and core values. PRACTICE IMPLICATIONS The key attributes can serve as a holistic framework for healthcare organisations to design their quality management system. An instrument can be developed to measure key attributes.
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Affiliation(s)
- Fien Claessens
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium.
| | - Eva Marie Castro
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, Regionaal Ziekenhuis Heilig Hart Tienen, Tienen, Belgium
| | - Anneke Jans
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, Sint-Trudo Ziekenhuis, Sint-Truiden, Belgium
| | - Laura Jacobs
- Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Deborah Seys
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Astrid Van Wilder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Jonas Brouwers
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
| | - Charlotte Van der Auwera
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium
| | - Dirk De Ridder
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium
| | - Kris Vanhaecht
- Leuven Institute for Healthcare Policy - Department of Public Health, KU Leuven - University of Leuven, Leuven, Belgium; Department of Quality Management, University Hospitals Leuven, Leuven, Belgium.
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Breckner A, Glassen K, Schulze J, Lühmann D, Schaefer I, Szecsenyi J, Scherer M, Wensing M. Experiences of patients with multimorbidity with primary care and the association with patient activation: a cross-sectional study in Germany. BMJ Open 2022; 12:e059100. [PMID: 35940827 PMCID: PMC9364414 DOI: 10.1136/bmjopen-2021-059100] [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] [Indexed: 12/01/2022] Open
Abstract
OBJECTIVES This study aimed to explore the association between patient activation and patients' experience of care among an elderly multimorbid population in Germany. DESIGN Cross-sectional study. SETTING Primary care practices in two German settings. PARTICIPANTS 346 patients with 3 or more chronic conditions aged 65 years and over from 36 primary care practices. OUTCOME MEASURES Patient activation was measured with the patient activation measure (PAM). To assess patient experiences with primary care, a set of questions concerning domains of primary care were included. Multilevel regression analyses were performed to examine which domains of care were associated with patient activation. RESULTS Out of 1243 invited patients, a total of 346 took part in the study (participation rate 27.8 %). Mean PAM score was 76.1. Across all patients, 3.8% achieved PAM level 1, 7.5% level 2, 27.2% level 3% and 60.7% level 4. PAM scores suggest a highly activated patient group. In the regression analysis, three out ten domains of patients' experiences showed an association with patient activation. The domains 'being involved in decision as much as desired' (B=-8.56, p=0.012) and 'receiving a self-management plan' (B=6.51, p=0.051) were associated with higher patient activation scores. Patients with an up-to-date medication plan had lower patient activation scores (B=-12.01, p=0.041). CONCLUSION Specific domains of primary care were found to be associated with patient activation. To enhance patient activation, primary care physicians may increase involvement of patients in decisions. Future research should examine the causality of these associations. TRIAL REGISTRATION NUMBER DRKS00015718.
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Affiliation(s)
- Amanda Breckner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Katharina Glassen
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Josefine Schulze
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dagmar Lühmann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingmar Schaefer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Schulze J, Breckner A, Duncan P, Scherer M, Pohontsch NJ, Lühmann D. Adaptation and validation of a German version of the Multimorbidity Treatment Burden Questionnaire. Health Qual Life Outcomes 2022; 20:90. [PMID: 35658972 PMCID: PMC9166496 DOI: 10.1186/s12955-022-01993-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients with multiple long-term conditions often face a variety of challenges arising from the requirements of their health care. Knowledge of perceived treatment burden is crucial for optimizing treatment. In this study, we aimed to create a German version of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and to evaluate its validity.
Methods The steps to translate the MTBQ included forward/back translation, cognitive interviews (n = 6) and a pilot test (n = 7). Psychometric properties of the scale were assessed in a cross-sectional survey with primary care patients aged 65 and older with at least 3 long-term conditions (n = 344). We examined the distribution of responses, dimensionality, internal reliability and construct validity. Results Cognitive interviewing and piloting led to minor modifications and showed overall good face validity and acceptability. As expected, we observed a positively skewed response distribution for all items. Reliability was acceptable with McDonald’s omega = 0.71. Factor analysis suggested one common factor while model fit indices were inconclusive. Predefined hypotheses regarding the construct validity were supported by negative associations between treatment burden and health-related quality of life, self-rated health, social support, patient activation and medication adherence, and positive associations between treatment burden and number of comorbidities. Treatment burden was found to be higher in female participants (Mdn1 = 6.82, Mdn2 = 4.55; U = 11,729, p = 0.001) and participants with mental health diagnoses (Mdn1 = 9.10, Mdn2 = 4.55; U = 3172, p = 0.024). Conclusions The German MTBQ exhibited good psychometric properties and can be used to assess the perceived treatment burden of patients with multimorbidity. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01993-z.
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Affiliation(s)
- Josefine Schulze
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany.
| | - Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Polly Duncan
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Nadine Janis Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Dagmar Lühmann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
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Schulze J, Glassen K, Pohontsch NJ, Blozik E, Eißing T, Breckner A, Höflich C, Rakebrandt A, Schäfer I, Szecsenyi J, Scherer M, Lühmann D. Measuring the quality of care for older adults with multimorbidity: Results of the MULTIqual project. THE GERONTOLOGIST 2022; 62:1135-1146. [PMID: 35090014 PMCID: PMC9451020 DOI: 10.1093/geront/gnac013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Providing health care for older adults with multimorbidity is often complex, challenging, and prone to fragmentation. Although clinical decision making should take into account treatment interactions, individual burden, and resources, current approaches to assessing quality of care mostly rely on indicators for single conditions. The aim of this project was to develop a set of generic quality indicators for the management of patients aged 65 and older with multimorbidity that can be used in both health care research and clinical practice. Research Design and Methods Based on the findings of a systematic literature review and eight focus groups with patients with multimorbidity and their family members, we developed candidate indicators. Identified aspects of quality were mapped to core domains of health care to obtain a guiding framework for quality-of-care assessment. Using nominal group technique, indicators were rated by a multidisciplinary expert panel (n = 23) following standardized criteria. Results We derived 47 candidate quality indicators from the literature and 4 additional indicators from the results of the focus groups. The expert panel selected a set of 25 indicators, which can be assigned to the levels of patient factors, patient–provider communication, and context and organizational structures of the conceptual framework. Discussion and Implications We developed a comprehensive indicator set for the management of multimorbidity that can help to highlight areas with potential for improving the quality of care and support application of multimorbidity guidelines. Furthermore, this study may serve as a blueprint for participatory designs in the development of quality indicators.
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Affiliation(s)
- Josefine Schulze
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Glassen
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Nadine Janis Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Blozik
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Tabea Eißing
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Charlotte Höflich
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rakebrandt
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingmar Schäfer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dagmar Lühmann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Breckner A, Roth C, Glassen K, Wensing M. Self-management perspectives of elderly patients with multimorbidity and practitioners - status, challenges and further support needed? BMC FAMILY PRACTICE 2021; 22:238. [PMID: 34836506 PMCID: PMC8624621 DOI: 10.1186/s12875-021-01584-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022]
Abstract
Background Patients with multimorbidity (here defined as three or more chronic conditions) require constant treatment and care. Furthermore, they have to manage their health and diseases in daily life. Offering support to patients’ medical self-management is an important task of primary care. The aim of this study was to explore, what further support is needed from the perspective of patients’ and primary care practitioners. Methods A qualitative study using individual semi-structed interviews with 17 patients with multimorbidity and 7 practitioners (4 primary care physicians and 3 practice assistants) was conducted in Germany. Data were audio-recorded, pseudonymised and transcribed verbatim. Data analysis was performed using qualitative content analysis to structure data into themes and subthemes. All data were managed and organised in MAXQDA. Results The three broad themes: current status, challenges and further support emerged. Patients reported on unfulfilled needs regarding role or emotional management, like coping with loneliness, loss of independence and, changing habits. The importance of social contact was highlighted by patients and practitioners. Patients articulated further support from their primary care practitioners on coping with the disease. Practitioners’ wished for further support in aspects of social participation, public transport, and community resources. Conclusion Challenges regarding self-management of elderly patients with multimorbidity may be addressed by harnessing social support and community initiatives.
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Affiliation(s)
- Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katharina Glassen
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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