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Molot J, Sears M, Anisman H. Multiple Chemical Sensitivity: It's time to catch up to the science. Neurosci Biobehav Rev 2023; 151:105227. [PMID: 37172924 DOI: 10.1016/j.neubiorev.2023.105227] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Accepted: 05/06/2023] [Indexed: 05/15/2023]
Abstract
Multiple chemical sensitivity (MCS) is a complex medical condition associated with low dose chemical exposures. MCS is characterized by diverse features and common comorbidities, including fibromyalgia, cough hypersensitivity, asthma, and migraine, and stress/anxiety, with which the syndrome shares numerous neurobiological processes and altered functioning within diverse brain regions. Predictive factors linked to MCS comprise genetic influences, gene-environment interactions, oxidative stress, systemic inflammation, cell dysfunction, and psychosocial influences. The development of MCS may be attributed to the sensitization of transient receptor potential (TRP) receptors, notably TRPV1 and TRPA1. Capsaicin inhalation challenge studies demonstrated that TRPV1 sensitization is manifested in MCS, and functional brain imaging studies revealed that TRPV1 and TRPA1 agonists promote brain-region specific neuronal variations. Unfortunately, MCS has often been inappropriately viewed as stemming exclusively from psychological disturbances, which has fostered patients being stigmatized and ostracized, and often being denied accommodation for their disability. Evidence-based education is essential to provide appropriate support and advocacy. Greater recognition of receptor-mediated biological mechanisms should be incorporated in laws, and regulation of environmental exposures.
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Affiliation(s)
- John Molot
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
| | - Margaret Sears
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
| | - Hymie Anisman
- Family Medicine, University of Ottawa Faculty of Medicine, Ottawa ON Canada; Ottawa Hospital Research Institute, Ottawa, ON, Canada; Department of Neuroscience, Carleton University, Ottawa Canada.
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2
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Doshi K, Henderson SL, Seah DJL, De Silva DA, Lee JJ, Huynh VA, Ozdemir S. Stroke survivors' preferences for post-stroke self-management programs: A discrete choice experiment. J Stroke Cerebrovasc Dis 2023; 32:106993. [PMID: 36669373 DOI: 10.1016/j.jstrokecerebrovasdis.2023.106993] [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: 10/07/2022] [Revised: 01/09/2023] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND AND PURPOSE Self-management programs enhance survival in stroke patients. However, they require patient-centered designs to be effective. The aim of this study was therefore to investigate the type of post-stroke self-management programs that appeal to stroke survivors, and to estimate their willingness to participate in such programs. METHODS A Discrete Choice Experiment was administered to patients who had either a transient ischemic attack (TIA) or stroke within the past 3 years and were cognitively intact (i.e., stroke survivors). Stroke survivors were presented with eight choice tasks and asked to choose between 'No Program' and two hypothetical post-stroke management programs that varied by six attributes: Topics covered by the program; schedule of the program; frequency and duration of the sessions; number of participants; out-of-pocket registration fee for the whole program; and rewards for completing the program. RESULTS The analysis involved 146 stroke survivors. Based on the mixed logit model, the predicted willingness to participate ranged from 53% to 76%. The most popular characteristics in a program were topics on health education and risk management, being scheduled during weekends as four sessions that are each 2 hours long and involve four participants, a registration fee of SGD50 (∼USD36), and SGD500 (∼USD359) reward for program completion. CONCLUSIONS Interest in post-stroke self-management programs was high, with at least half of the sample showing interest in participating in these programs. Program features such as focusing on health education and risk management, charging a low registration fee, and offering incentives helped to increase the demand.
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Affiliation(s)
- Kinjal Doshi
- Department of Psychology, Singapore General Hospital, Singapore.
| | | | | | - Deidre Anne De Silva
- Department of Neurology, National Neuroscience Institute, Singapore General Hospital Campus, Singapore.
| | - Jia Jia Lee
- Signature Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Vinh Anh Huynh
- Signature Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
| | - Semra Ozdemir
- Signature Program in Health Services and Systems Research, Duke-NUS Medical School, Singapore.
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3
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Paukkonen L, Oikarinen A, Kähkönen O, Kaakinen P. Patient activation for self‐management among adult patients with multimorbidity in primary healthcare settings. Health Sci Rep 2022; 5:e735. [PMID: 35873391 PMCID: PMC9297377 DOI: 10.1002/hsr2.735] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aims Methods Results Conclusion
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Affiliation(s)
- Leila Paukkonen
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
- Medical Research Centre Oulu Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
- Medical Research Centre Oulu Finland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
- Medical Research Centre Oulu Finland
| | - Pirjo Kaakinen
- Research Unit of Nursing Science and Health Management University of Oulu Oulu Finland
- Medical Research Centre Oulu Finland
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4
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Marupuru S, Roether A, Guimond AJ, Stanley C, Pesqueira T, Axon DR. A Systematic Review of Clinical Outcomes from Pharmacist Provided Medication Therapy Management (MTM) among Patients with Diabetes, Hypertension, or Dyslipidemia. Healthcare (Basel) 2022; 10:healthcare10071207. [PMID: 35885734 PMCID: PMC9318817 DOI: 10.3390/healthcare10071207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/16/2022] Open
Abstract
This study aimed to compare the clinical outcomes of pharmacist-provided medication therapy management (MTM) services as compared to no MTM services (i.e., standard of care) on outpatient clinical outcomes for patients with diabetes, hypertension, or dyslipidemia. A systematic literature review of PubMed, EMBASE, Cochrane library, International Pharmaceutical Abstracts, PsycINFO, Scopus, CINAHL electronic databases, grey literature, websites, and journals, was conducted from 1 January 2005–20 July 2021. The search field contained a combination of keywords and MeSH terms such as: “medication therapy management”, “pharmacist”, “treatment outcomes”. Studies published in United States, included adults ≥18 years old who received at least one pharmacist-provided MTM consultation and at least one group who received no MTM, and reported pre-specified clinical outcomes for diabetes mellitus, hypertension, or dyslipidemia were included. Of 849 studies identified, eight were included (cohort studies = 6, randomized controlled trials = 2). Clinical outcomes improved with MTM interventions, as evidenced by statistically significant changes in at least one of the three chronic conditions in most studies. Improvements were observed for diabetes outcomes (n = 4 studies), hypertension outcomes (n = 4 studies), and dyslipidemia outcomes (n = 3 studies). Overall, this study indicated that pharmacist delivered MTM services (versus no MTM services) can improve clinical outcomes for patients with diabetes, hypertension, and dyslipidemia.
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5
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Miranda RN, Bhuiya AR, Thraya Z, Hancock-Howard R, Chan BC, Steele Gray C, Wodchis WP, Thavorn K. An Electronic Patient-Reported Outcomes Tool for Older Adults With Complex Chronic Conditions: Cost-Utility Analysis. JMIR Aging 2022; 5:e35075. [PMID: 35442194 PMCID: PMC9069297 DOI: 10.2196/35075] [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: 11/19/2021] [Revised: 02/21/2022] [Accepted: 03/14/2022] [Indexed: 11/13/2022] Open
Abstract
Background eHealth technologies for self-management can improve quality of life, but little is known about whether the benefits gained outweigh their costs. The electronic patient-reported outcome (ePRO) mobile app and portal system supports patients with multiple chronic conditions to collaborate with primary health care providers to set and monitor health-related goals. Objective This study aims to estimate the cost of ePRO and the cost utility of the ePRO intervention compared with usual care provided to patients with multiple chronic conditions and complex needs living in the community, from the perspective of the publicly funded health care payer in Ontario, Canada. Methods We developed a decision tree model to estimate the incremental cost per quality-adjusted life year (QALY) gained for the ePRO tool versus usual care over a time horizon of 15 months. Resource utilization and effectiveness of the ePRO tool were drawn from a randomized clinical trial with 6 family health teams involving 45 participants. Unit costs associated with health care utilization (adjusted to 2020 Canadian dollars) were drawn from literature and publicly available sources. A series of sensitivity analyses were conducted to assess the robustness of the findings. Results The total cost of the ePRO tool was CAD $79,467 (~US $ 63,581; CAD $1733 [~US $1386] per person). Compared with standard care, the ePRO intervention was associated with higher costs (CAD $1710 [~US $1368]) and fewer QALYs (–0.03). The findings were consistent with the clinical evidence, suggesting no statistical difference in health-related quality of life between ePRO and usual care groups. However, the tool would be considered a cost-effective option if it could improve by at least 0.03 QALYs. The probability that the ePRO is cost-effective was 17.3% at a willingness-to-pay (WTP) threshold of CAD $50,000 (~US $40,000)/QALY. Conclusions The ePRO tool is not a cost-effective technology at the commonly used WTP value of CAD $50,000 (~US $40,000)/QALY, but long-term and the societal impacts of ePRO were not included in this analysis. Further research is needed to better understand its impact on long-term outcomes and in real-world settings. The present findings add to the growing evidence about eHealth interventions’ capacity to respond to complex aging populations within finite-resourced health systems. Trial Registration ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954
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Affiliation(s)
- Rafael N Miranda
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Toronto Health Economics and Technology Assessment Collaborative, University Health Network, Toronto, ON, Canada
| | - Aunima R Bhuiya
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Zak Thraya
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Rebecca Hancock-Howard
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Brian Cf Chan
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,KITE - Toronto Rehabilitation Institute, University Health Network, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health, Toronto, ON, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Toronto, ON, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
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6
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Meier C, Maurer J. Buddy or burden? Patterns, perceptions, and experiences of pet ownership among older adults in Switzerland. Eur J Ageing 2022; 19:1201-1212. [PMID: 36692748 PMCID: PMC9729639 DOI: 10.1007/s10433-022-00696-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2022] [Indexed: 01/26/2023] Open
Abstract
While interactions with pets may yield significant emotional, social, and physical benefits, taking care of them can also be demanding and experienced as a burden, especially among persons with physical restrictions or economically disadvantaged individuals. This study investigates pet ownership and corresponding perceptions and experiences in a nationally representative sample of adults aged 55 years and older in Switzerland. We use data from a questionnaire on human-animal interactions from 1832 respondents administered during wave 7 (2017) in the Swiss country study of the Survey of Health, Ageing, and Retirement in Europe. Multivariable associations between pet ownership and pet owners' corresponding perceptions and experiences with respondents' socio-demographic characteristics were estimated using probit and ordered probit models. Slightly more than one-third of adults aged 55 years and older reported owning a pet. Pet owners reported mostly positive experiences with pet ownership, with women showing higher pet bonding levels than men. Moreover, pet ownership was less common among adults aged 75 and older and individuals living in apartments. At the same time, older pet owners aged 75 and above, pet owners living in apartments, and pet owners without a partner reported more positive perceptions and experiences of owning a pet. These findings suggest that promoting pet ownership may help individual well-being and feelings of companionship, especially among women, older adults, and individuals without a partner but also points toward potential selection effects into pet ownership. Financial costs of pet ownership appear to be an important challenge for some older pet owners, notably those with relatively low levels of education and more limited financial resources.
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Affiliation(s)
- Clément Meier
- Faculty of Biology and Medicine (FBM), University of Lausanne, Géopolis, FORS, 1015 Lausanne, Switzerland
| | - Jürgen Maurer
- Present Address: Faculty of Business and Economics (HEC), University of Lausanne, Internef, 1015 Lausanne, Switzerland
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7
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Steele Gray C, Chau E, Tahsin F, Harvey S, Loganathan M, McKinstry B, Mercer SW, Nie JX, Palen TE, Ramsay T, Thavorn K, Upshur R, Wodchis WP. Assessing the Implementation and Effectiveness of the Electronic Patient-Reported Outcome Tool for Older Adults With Complex Care Needs: Mixed Methods Study. J Med Internet Res 2021; 23:e29071. [PMID: 34860675 PMCID: PMC8726765 DOI: 10.2196/29071] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 07/19/2021] [Accepted: 09/12/2021] [Indexed: 12/12/2022] Open
Abstract
Background Goal-oriented care is being adopted to deliver person-centered primary care to older adults with multimorbidity and complex care needs. Although this model holds promise, its implementation remains a challenge. Digital health solutions may enable processes to improve adoption; however, they require evaluation to determine feasibility and impact. Objective This study aims to evaluate the implementation and effectiveness of the electronic Patient-Reported Outcome (ePRO) mobile app and portal system, designed to enable goal-oriented care delivery in interprofessional primary care practices. The research questions driving this study are as follows: Does ePRO improve quality of life and self-management in older adults with complex needs? What mechanisms are likely driving observed outcomes? Methods A multimethod, pragmatic randomized controlled trial using a stepped-wedge design and ethnographic case studies was conducted over a 15-month period in 6 comprehensive primary care practices across Ontario with a target enrollment of 176 patients. The 6 practices were randomized into either early (3-month control period; 12-month intervention) or late (6-month control period; 9-month intervention) groups. The primary outcome measure of interest was the Assessment of Quality of Life-4D (AQoL-4D). Data were collected at baseline and at 3 monthly intervals for the duration of the trial. Ethnographic data included observations and interviews with patients and providers at the midpoint and end of the intervention. Outcome data were analyzed using linear models conducted at the individual level, accounting for cluster effects at the practice level, and ethnographic data were analyzed using qualitative description and framework analysis methods. Results Recruitment challenges resulted in fewer sites and participants than expected; of the 176 target, only 142 (80.6%) patients were identified as eligible to participate because of lower-than-expected provider participation and fewer-than-expected patients willing to participate or perceived as ready to engage in goal-setting. Of the 142 patients approached, 45 (32%) participated. Patients set a variety of goals related to self-management, mental health, social health, and overall well-being. Owing to underpowering, the impact of ePRO on quality of life could not be definitively assessed; however, the intervention group, ePRO plus usual care (mean 15.28, SD 18.60) demonstrated a nonsignificant decrease in quality of life (t24=−1.20; P=.24) when compared with usual care only (mean 21.76, SD 2.17). The ethnographic data reveal a complex implementation process in which the meaningfulness (or coherence) of the technology to individuals’ lives and work acted as a key driver of adoption and tool appraisal. Conclusions This trial experienced many unexpected and significant implementation challenges related to recruitment and engagement. Future studies could be improved through better alignment of the research methods and intervention to the complex and diverse clinical settings, dynamic goal-oriented care process, and readiness of provider and patient participants. Trial Registration ClinicalTrials.gov NCT02917954; https://clinicaltrials.gov/ct2/show/NCT02917954
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Affiliation(s)
- Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenebaum Research Institute, Sinai Health, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Edward Chau
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Farah Tahsin
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Sarah Harvey
- Logibec Inc (QoC Health Inc), Toronto, ON, Canada
| | - Mayura Loganathan
- Ray D Wolfe Department of Family Medicine, Mount Sinai Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Brian McKinstry
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Stewart W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, United Kingdom
| | - Jason Xin Nie
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Ted E Palen
- Institute for Health Research, Kaiser Permanente Colorado, Denver, CO, United States
| | - Tim Ramsay
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Kednapa Thavorn
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Ross Upshur
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenebaum Research Institute, Sinai Health, Toronto, ON, Canada.,Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
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8
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De Maria M, Ferro F, Vellone E, Ausili D, Luciani M, Matarese M. Self-care of patients with multiple chronic conditions and their caregivers during the COVID-19 pandemic: A qualitative descriptive study. J Adv Nurs 2021; 78:1431-1447. [PMID: 34846083 DOI: 10.1111/jan.15115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 09/21/2021] [Accepted: 11/05/2021] [Indexed: 12/23/2022]
Abstract
AIMS Explore the self-care experiences of patients with multiple chronic conditions (MCCs) and caregivers' contributions to patient self-care during COVID-19 pandemic. DESIGN A descriptive qualitative design was used. The COREQ checklist was used for study reporting. METHODS Individual semi-structured interviews were used to collect data from patients with MCCs and caregivers selected from the dataset of an ongoing longitudinal study. Data analysis was performed through deductive thematic analysis. The middle-range theory of self-care of chronic illness, which entails the three dimensions of self-care maintenance, monitoring and management, was used as a theoretical framework to guide data collection and analysis. RESULTS A total of 16 patients and 25 caregivers were interviewed from May to June 2020. The participants were mainly women, with a mean age for patients of 76.25 years and caregivers of 45.76 years; the caregivers were mainly the patients' children (72%). During the pandemic, some patients reported remaining unchanged in their self-care maintenance, monitoring and management behaviours, others intensified their behaviours, and others decreased them. Caregivers played an important role in protecting patients from the risk of contagion COVID-19 and in ensuring patients' self-care of chronic diseases through direct and indirect interventions. CONCLUSIONS Critical events can modify the self-care experiences of chronically ill patients and caregivers' contributions, leading to maintenance, increase or decrease of self-care and contributions to self-care behaviours. IMPACT Patients with MCCs and their caregivers can react in different ways in their performances of self-care and contribution to patients' self-care behaviours when ordinary daily life is disrupted; therefore, nurses should assess such performances during critical events to identify the individuals at risk of reduced self-care and promote the most suitable healthcare services (e.g. eHealth) to implement individualised interventions.
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Affiliation(s)
- Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federico Ferro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Michela Luciani
- Department of Medicine and Surgery, University of Milano Bicocca, Monza, Italy
| | - Maria Matarese
- Research Unit of Nursing Science, Campus Bio-medico University of Rome, Rome, Italy
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9
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Paukkonen L, Oikarinen A, Kähkönen O, Kyngäs H. Adherence to self-management in patients with multimorbidity and associated factors: A cross-sectional study in primary health care. J Clin Nurs 2021; 31:2805-2820. [PMID: 34704303 DOI: 10.1111/jocn.16099] [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: 05/10/2021] [Revised: 08/03/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to explore the adherence to self-management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self-management in terms of the Theory of Adherence of People with Chronic Disease. BACKGROUND Adherence to self-management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients' lives. DESIGN A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. METHODS Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self-administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari's FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi-squared, or corresponding, tests. RESULTS Most patients' responses indicated good or adequate adherence to care regimens and medications. However, adherence to self-management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient-related factors, including demographic and health-related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self-management. CONCLUSIONS Multimorbid patients' adherence to self-management is not an 'all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. RELEVANCE TO CLINICAL PRACTICE The findings highlight needs for an individualised whole-person approach in multimorbid patients' care to provide the required support for good adherence to self-management. Healthcare professionals, especially nurses working in primary health care, are well-positioned to meet this need.
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Affiliation(s)
- Leila Paukkonen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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10
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Iglesias Urrutia CP, Erdem S, Birks YF, Taylor SJC, Richardson G, Bower P, van den Berg B, Manca A. People's preferences for self-management support. Health Serv Res 2021; 57:91-101. [PMID: 33634466 PMCID: PMC8763292 DOI: 10.1111/1475-6773.13635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective To identify and assess the preferences of people with long‐term health conditions toward generalizable characteristics of self‐management support interventions, with the objective to inform the design of more person‐centered support services. Data Sources Primary qualitative and quantitative data collected on a representative sample of individuals with at least one of the fifteen most prevalent long‐term conditions in the UK. Study Design Targeted literature review followed by a series of one‐to‐one qualitative semistructured interviews and a large‐scale discrete choice experiment. Data Collection Digital recording of one‐to‐one qualitative interviews, one‐to‐one cognitive interviews, and a series of online quantitative surveys, including two best‐worst scaling and one discrete choice experiment, with individuals with long‐term conditions. Principal Findings On average, patients preferred a self‐management support intervention that (a) discusses the options available to the patient and make her choose, (b) is individual‐based, (c) face to face (d) with doctor or nurse, (e) at the GP practice, (f) sessions shorter than 1 hour, and (g) occurring annually for two‐third of the sample and monthly for the rest. We found heterogeneity in preferences via three latent classes, with class sizes of 41% (C1), 30% (C2), and 29% (C3). The individuals’ gender [P < 0.05(C1), P < 0.01(C3)], age [P < 0.05(C1), P < 0.05(C2)], type of long‐term condition [P < 0.05(C1), P < 0.01(C3)], and presence of comorbidity [P < 0.01(C1), P < 0.01(C3), P < 0.01(C3)] were able to characterize differences between these latent classes and help understand the heterogeneity of preferences toward the above mentioned features of self‐management support interventions. These findings were then used to profile individuals into different preference groups, for each of whom the most desirable form of self‐management support, one that was more likely to be adopted by the recipient, could be designed. Conclusions We identified several factors that could be used to inform a more nuanced self‐management support service design and provision that take into account the recipient's characteristics and preferences.
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Affiliation(s)
| | - Seda Erdem
- Stirling Management School, University of Stirling, Stirling, UK
| | - Yvonne F Birks
- Social Policy Research Unit, University of York, York, UK
| | - Stephanie J C Taylor
- Barts and The London School of Medicine and Dentistry, Queen Mary University of London (QMUL), London, UK
| | | | - Peter Bower
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Bernard van den Berg
- Department of Health Sciences, VU University Amsterdam, Amsterdam, The Netherlands
| | - Andrea Manca
- Centre for Health Economics, University of York, York, UK
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11
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Burke J, Palmer R, Harrison M. What are the factors that may influence the implementation of self-managed computer therapy for people with long term aphasia following stroke? A qualitative study of speech and language therapists' experiences in the Big CACTUS trial. Disabil Rehabil 2021; 44:3577-3589. [PMID: 33459079 DOI: 10.1080/09638288.2020.1871519] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To explore speech and language therapists' (SLT) experiences of delivering therapy using a computerised self-management approach within a pragmatic trial, in order to identify and understand key factors that may influence the implementation of computerised approaches to rehabilitation for aphasia in routine practice. METHODS Qualitative semi-structured telephone interviews were conducted with eleven SLTs delivering computer therapy in the multisite Big CACTUS trial. The interviews were recorded, transcribed verbatim and analysed using thematic analysis in NVivo11. RESULTS Five themes with implications for implementation emerged: 1) characteristics of the intervention: complexity and adaptability 2) knowledge and beliefs about the intervention: familiarity with computers and the benefits of training; 3) patient needs and the service resource dilemma: "is there anything I can be doing on my computer at home?"; 4) networks and communications; 5) reflecting and evaluating: adaptations for sustainability. CONCLUSIONS Personalisation, feedback and volunteer/assistant support were viewed as benefits of this complex intervention. However, the same benefits required resources including therapist time in learning to use software, procuring it, personalising it, working with volunteers/assistants, and building relationships with IT departments which formed barriers to implementation. The discussion highlights the need to consider integration of computer and face-to-face therapy to support implementation and potentially optimise patient outcomes.IMPLICATIONS FOR REHABILITATIONBenefits of the self-managed computer approach to word finding therapy evaluated in the Big CACTUS trial included the ability to personalise content, to provide feedback, and provide support with volunteers or assistants depending on availability in different clinical contexts to enable repetitive self-managed practice of word finding.Whilst use of computer therapy approaches can facilitate self-management of practice and increased therapy hours in an efficient manner, services need to consider the resources required to implement and support the approach: costs of software and hardware SLT time required to learn to use the software, tailor and personalise it and manage volunteers/assistants.Readiness for successful adoption of computer approaches requires building of relationships and mutual understanding of requirements between SLT and IT departments within an organisation.For time efficiency, it is recommended that SLTs providing self-managed computer therapy approaches pilot the approach with each individual to check patient ability and engagement before fully investing SLT time in personalisation and tailoring of software.
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Affiliation(s)
- Jo Burke
- Community Stroke Service, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Rebecca Palmer
- School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Madeleine Harrison
- Health Sciences School, Division of Nursing and Midwifery, The University of Sheffield, Sheffield, UK
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Dubbin L, Burke N, Fleming M, Thompson-Lastad A, Napoles TM, Yen I, Shim JK. Social Literacy: Nurses' Contribution Toward the Co-Production of Self-Management. Glob Qual Nurs Res 2021; 8:2333393621993451. [PMID: 33628867 PMCID: PMC7882743 DOI: 10.1177/2333393621993451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 01/07/2021] [Accepted: 01/11/2021] [Indexed: 01/23/2023] Open
Abstract
We share findings from a larger ethnographic study of two urban complex care management programs in the Western United States. The data presented stem from in-depth interviews conducted with 17 complex care management RNs and participant observations of home visits. We advance the concept of social literacy as a nursing attribute that comprises an RN's recognition and responses to the varied types of hinderances to self-management with which patients must contend in their lived environment. It is through social literacy that complex care management RNs reconceptualize and understand health literacy to be a product born out of the social circumstances in which patients live and the stratified nature of the health care systems that provide them care. Social literacy provides a broader framework for health literacy-one that is situated within the patient's social context through which complex care management RNs must navigate for self-management goals to be achieved.
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Affiliation(s)
| | - Nancy Burke
- University of California, San Francisco, USA
- University of California, Merced, USA
| | | | | | | | - Irene Yen
- University of California, Merced, USA
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How comfortable are primary care physicians and oncologists prescribing medications for comorbidities in patients with cancer? Res Social Adm Pharm 2020; 16:1087-1094. [DOI: 10.1016/j.sapharm.2019.11.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 11/06/2019] [Accepted: 11/07/2019] [Indexed: 12/21/2022]
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Gobeil-Lavoie AP, Chouinard MC, Danish A, Hudon C. Characteristics of self-management among patients with complex health needs: a thematic analysis review. BMJ Open 2019; 9:e028344. [PMID: 31129599 PMCID: PMC6538095 DOI: 10.1136/bmjopen-2018-028344] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE There is a gap of knowledge among healthcare providers on characteristics of self-management among patients with chronic diseases and complex healthcare needs. Consequently, the objective of this paper was to identify characteristics of self-management among patients with chronic diseases and complex healthcare needs. DESIGN Thematic analysis review of the literature. METHODS We developed search strategies for the MEDLINE and CINAHL databases, covering the January 2000-October 2018 period. All articles in English or French addressing self-management among an adult clientele (18 years and older) with complex healthcare needs (multimorbidity, vulnerability, complexity and frequent use of health services) were included. Studies that addressed self-management of a single disease or that did not have any notion of complexity or vulnerability were excluded. A mixed thematic analysis, deductive and inductive, was performed by three evaluators as described by Mileset al. RESULTS Twenty-one articles were included. Patients with complex healthcare needs present specific features related to self-management that can be exacerbated by deprived socioeconomic conditions. These patients must often prioritise care based on one dominant condition. They are at risk for depression, psychological distress and low self-efficacy, as well as for receiving contradictory information from healthcare providers. However, the knowledge and experiences acquired in the past in relation to their condition may help them improve their self-management skills. CONCLUSIONS This review identifies challenges to self-management for patients with complex healthcare needs, which are exacerbated in contexts of socioeconomic insecurity and proposes strategies to help healthcare providers better adapt their self-management support interventions to meet the specific needs of this vulnerable clientele.
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Affiliation(s)
- Annie-Pier Gobeil-Lavoie
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Alya Danish
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Quebec, Canada
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Hutschemaekers GJM, Zijlstra E, Bree C, Lo Fo Wong S, Lagro‐Janssen A. Similar yet unique: the victim's journey after acute sexual assault and the importance of continuity of care. Scand J Caring Sci 2019; 33:949-958. [DOI: 10.1111/scs.12693] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 03/17/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - Elza Zijlstra
- Department Primary and Community Care Radboud University Medical Centre Nijmegen Nijmegen The Netherlands
| | - Chrissy Bree
- Department Primary and Community Care Radboud University Medical Centre Nijmegen Nijmegen The Netherlands
| | - Sylvie Lo Fo Wong
- Department Primary and Community Care Radboud University Medical Centre Nijmegen Nijmegen The Netherlands
| | - Antoine Lagro‐Janssen
- Department Primary and Community Care Radboud University Medical Centre Nijmegen Nijmegen The Netherlands
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Irfan Khan A, Gill A, Cott C, Hans PK, Steele Gray C. mHealth Tools for the Self-Management of Patients With Multimorbidity in Primary Care Settings: Pilot Study to Explore User Experience. JMIR Mhealth Uhealth 2018; 6:e171. [PMID: 30154073 PMCID: PMC6134226 DOI: 10.2196/mhealth.8593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Revised: 05/20/2018] [Accepted: 06/21/2018] [Indexed: 12/19/2022] Open
Abstract
Background Given the complex and evolving needs of individuals with multimorbidity, the adoption of mHealth tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The electronic patient-reported outcomes (ePRO) tool was codeveloped with patients and providers in an interdisciplinary primary care team in Toronto, Canada, to help facilitate self-management in community-dwelling adults with multiple chronic conditions. Objective The objective of study is to explore the experience and expectations of patients with multimorbidity and their providers around the use of the ePRO tool in supporting self-management efforts. Methods We conducted a 4-week pilot study of the ePRO tool. Patients’ and providers’ experiences and expectations were explored through focus groups that were conducted at the end of the study. In addition, thematic analyses were used to assess the shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Coded data were then mapped onto the Individual and Family Self-Management Theory using the framework method. Results In this pilot study, 12 patients and 6 providers participated. Both patients and providers emphasized the need for a more explicit recognition of self-management context, including greater customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Patients and providers highlighted gaps in the extent to which the tool enables self-management processes, including how limited progress toward self-management goals and the absence of direct provider engagement through the ePRO tool inhibited patients from meeting their self-management goals. Providers highlighted proximal outcomes based on their experience of the tool and specifically, they indicated that the tool offered valuable insights into the broader patient context, which helps to inform the self-management approach and activities they recommend to patients, whereas patients recognized the tool’s potential in helping to improve access to different providers in a team-based primary care setting. Conclusions This study identifies a more explicit recognition of the contextual factors that influence patients’ ability to self-manage and greater adaptability to accommodate patient complexity and provider workflow as next steps in refining the ePRO tool to better support self-management efforts in primary care ahead of its application in a full-scale randomized pragmatic trial.
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Affiliation(s)
- Anum Irfan Khan
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Ashlinder Gill
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Cheryl Cott
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Parminder Kaur Hans
- Bridgepoint Campus, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
| | - Carolyn Steele Gray
- Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Bridgepoint Campus, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, Toronto, ON, Canada
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Steele Gray C, Barnsley J, Gagnon D, Belzile L, Kenealy T, Shaw J, Sheridan N, Wankah Nji P, Wodchis WP. Using information communication technology in models of integrated community-based primary health care: learning from the iCOACH case studies. Implement Sci 2018; 13:87. [PMID: 29940992 PMCID: PMC6019521 DOI: 10.1186/s13012-018-0780-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/11/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Information communication technology (ICT) is a critical enabler of integrated models of community-based primary health care; however, little is known about how existing technologies have been used to support new models of integrated care. To address this gap, we draw on data from an international study of integrated models, exploring how ICT is used to support activities of integrated care and the organizational and environmental barriers and enablers to its adoption. METHODS We take an embedded comparative multiple-case study approach using data from a study of implementation of nine models of integrated community-based primary health care, the Implementing Integrated Care for Older Adults with Complex Health Needs (iCOACH) study. Six cases from Canada, three each in Ontario and Quebec, and three in New Zealand, were studied. As part of the case studies, interviews were conducted with managers and front-line health care providers from February 2015 to March 2017. A qualitative descriptive approach was used to code data from 137 interviews and generate word tables to guide analysis. RESULTS Despite different models and contexts, we found strikingly similar accounts of the types of activities supported through ICT systems in each of the cases. ICT systems were used most frequently to support activities like care coordination by inter-professional teams through information sharing. However, providers were limited in their ability to efficiently share patient data due to data access issues across organizational and professional boundaries and due to system functionality limitations, such as a lack of interoperability. CONCLUSIONS Even in innovative models of care, managers and providers in our cases mainly use technology to enable traditional ways of working. Technology limitations prevent more innovative uses of technology that could support disruption necessary to improve care delivery. We argue the barriers to more innovative use of technology are linked to three factors: (1) information access barriers, (2) limited functionality of available technology, and (3) organizational and provider inertia.
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Affiliation(s)
- Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, 1 Bridgepoint Drive, Toronto, M4M 2B5, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada.
| | - Jan Barnsley
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada
| | - Dominique Gagnon
- Unité d'enseignement et de recherche en sciences du développement humain et social, Université du Québec en Abitibi-Témiscamingue, Val-d'Or, Canada
| | - Louise Belzile
- Gerontology, Université de Sherbrooke, Sherbrooke, Canada
| | - Tim Kenealy
- South Auckland Clinical School, University of Auckland, Auckland, New Zealand
| | - James Shaw
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada
- Institute for Health System Solutions and Virtual Care, Women's College Research Institute, Women's College Hospital, Toronto, Canada
| | - Nicolette Sheridan
- Centre for Nursing and Health Research, School of Nursing, College of Health Te Kura Hauora Tengata, Massey University, Wellington, New Zealand
| | - Paul Wankah Nji
- Sciences de la Santé, Centre de Recherche-Hôpital Charles LeMoyne, Université de Sherbrooke-Campus Longueuil, Longueuil, Canada
| | - Walter P Wodchis
- Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St., Toronto, Ontario, M5T 3M6, Canada
- Implementation and Evaluation Science, Institute for Better Health, Trillium Health Partners, Mississauga, Canada
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Yoon J, Chang E, Rubenstein LV, Park A, Zulman DM, Stockdale S, Ong MK, Atkins D, Schectman G, Asch SM. Impact of Primary Care Intensive Management on High-Risk Veterans' Costs and Utilization: A Randomized Quality Improvement Trial. Ann Intern Med 2018; 168:846-854. [PMID: 29868706 DOI: 10.7326/m17-3039] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Primary care models that offer comprehensive, accessible care to all patients may provide insufficient resources to meet the needs of patients with complex conditions who have the greatest risk for hospitalization. OBJECTIVE To assess whether augmenting usual primary care with team-based intensive management lowers utilization and costs for high-risk patients. DESIGN Randomized quality improvement trial. (ClinicalTrials.gov: NCT03100526). SETTING 5 U.S. Department of Veterans Affairs (VA) medical centers. PATIENTS Primary care patients at high risk for hospitalization who had a recent acute care episode. INTERVENTION Locally tailored intensive management programs providing care coordination, goals assessment, health coaching, medication reconciliation, and home visits through an interdisciplinary team, including a physician or nurse practitioner, a nurse, and psychosocial experts. MEASUREMENTS Utilization and costs (including intensive management program expenses) 12 months before and after randomization. RESULTS 2210 patients were randomly assigned, 1105 to intensive management and 1105 to usual care. Patients had a mean age of 63 years and an average of 7 chronic conditions; 90% were men. Of the patients assigned to intensive management, 487 (44%) received intensive outpatient care (that is, ≥3 encounters in person or by telephone) and 204 (18%) received limited intervention. From the pre- to postrandomization periods, mean inpatient costs decreased more for the intensive management than the usual care group (-$2164 [95% CI, -$7916 to $3587]). Outpatient costs increased more for the intensive management than the usual care group ($2636 [CI, $524 to $4748]), driven by greater use of primary care, home care, telephone care, and telehealth. Mean total costs were similar in the 2 groups before and after randomization. LIMITATIONS Sites took up to several months to contact eligible patients, limiting the time between treatment and outcome assessment. Only VA costs were assessed. CONCLUSION High-risk patients with access to an intensive management program received more outpatient care with no increase in total costs. PRIMARY FUNDING SOURCE Veterans Health Administration Primary Care Services.
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Affiliation(s)
- Jean Yoon
- U.S. Department of Veterans Affairs Health Economics Resource Center and Center for Innovation to Implementation, Menlo Park, California, and University of California, San Francisco, School of Medicine, San Francisco, California (J.Y.)
| | - Evelyn Chang
- U.S. Department of Veterans Affairs Center for the Study of Healthcare Innovation, Implementation and Policy, University of California, Los Angeles, and VA Greater Los Angeles Healthcare System, Los Angeles, California (E.C., M.K.O.)
| | - Lisa V Rubenstein
- University of California, Los Angeles, Los Angeles, California, and RAND Corporation, Santa Monica, California (L.V.R.)
| | - Angel Park
- U.S. Department of Veterans Affairs Health Economics Resource Center, Menlo Park, California (A.P.)
| | - Donna M Zulman
- U.S. Department of Veterans Affairs Center for Innovation to Implementation, Menlo Park, California, and Stanford University School of Medicine, Stanford, California (D.M.Z., S.M.A.)
| | - Susan Stockdale
- U.S. Department of Veterans Affairs Center for the Study of Healthcare Innovation, Implementation and Policy and University of California, Los Angeles, Los Angeles, California (S.S.)
| | - Michael K Ong
- U.S. Department of Veterans Affairs Center for the Study of Healthcare Innovation, Implementation and Policy, University of California, Los Angeles, and VA Greater Los Angeles Healthcare System, Los Angeles, California (E.C., M.K.O.)
| | - David Atkins
- U.S. Department of Veterans Affairs Health Services Research and Development, Washington, DC (D.A.)
| | - Gordon Schectman
- U.S. Department of Veterans Affairs Primary Care, Washington, DC (G.S.)
| | - Steven M Asch
- U.S. Department of Veterans Affairs Center for Innovation to Implementation, Menlo Park, California, and Stanford University School of Medicine, Stanford, California (D.M.Z., S.M.A.)
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Slightam CA, Brandt K, Jenchura EC, Lewis ET, Asch SM, Zulman DM. "I had to change so much in my life to live with my new limitations": Multimorbid patients' descriptions of their most bothersome chronic conditions. Chronic Illn 2018; 14:13-24. [PMID: 28449592 DOI: 10.1177/1742395317699448] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objective To characterize diseases that are described as most bothersome by individuals with multiple chronic conditions and to identify themes that characterize their experiences with their most bothersome condition. Methods In a survey of patients at an academic center and a Veterans Affairs hospital, we asked individuals with multiple chronic conditions to identify their most bothersome chronic condition and describe why it is challenging. Standard content analysis methods were used to code responses and identify themes reflecting characteristics of most bothersome conditions. Results The most commonly cited bothersome conditions were chronic pain (52%), diabetes (43%), post-traumatic stress disorder (25%), heart failure (24%), and lung problems (20%). Conditions were described as most bothersome due to: (a) impact on function and quality of life (e.g. active symptoms, activity limitations), (b) health consequences or sequelae (e.g. risk of complications), and (c) challenges associated with treatment or self-management. Patterns of theme dominance varied for conditions with different characteristics. Discussion The conditions that patients with multiple chronic conditions identify as most bothersome vary depending on individuals' diseases and their health-related preferences and priorities. Ascertaining patients' most bothersome conditions and associated challenges, stress, and frustrations may help ensure that management decisions are aligned with patient preferences and priorities.
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Affiliation(s)
- Cindie A Slightam
- 1 Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, USA
| | - Kirsten Brandt
- 2 Division of General Medical Disciplines, Stanford University, USA
| | | | - Eleanor T Lewis
- 1 Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, USA
| | - Steven M Asch
- 1 Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, USA.,2 Division of General Medical Disciplines, Stanford University, USA
| | - Donna M Zulman
- 1 Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System, USA.,2 Division of General Medical Disciplines, Stanford University, USA
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Wittink MN, Walsh P, Yilmaz S, Mendoza M, Street RL, Chapman BP, Duberstein P. Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors? PATIENT EDUCATION AND COUNSELING 2018; 101:214-220. [PMID: 28844522 PMCID: PMC5803466 DOI: 10.1016/j.pec.2017.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/28/2017] [Accepted: 08/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patients with multiple chronic conditions face many stressors (e.g. financial, safety, transportation stressors) that are rarely prioritized for discussion with the primary care provider (PCP). In this pilot randomized controlled trial we examined the effects of a novel technology-based intervention called Customized Care on stressor disclosure. METHODS The main outcomes were stressor disclosure, patient confidence and activation, as assessed by self-report and observational methods (transcribed and coded audio-recordings of the office visit). RESULTS Sixty patients were enrolled. Compared with care as usual, intervention patients were 6 times more likely to disclose stressors to the PCP (OR=6.16, 95% CI [1.53, 24.81], p=0.011) and reported greater stressor disclosure confidence (exp[B]=1.06, 95% CI [1.01, 1.12], p=0.028). No differences were found in patient activation or the length of the office visit. CONCLUSION Customized Care improved the likelihood of stressor disclosure without affecting the length of the PCP visit. PRACTICE IMPLICATIONS Brief technology-based interventions, like Customized Care could be made available through patient portals, or on smart phones, to prime patient-PCP discussion about difficult subjects, thereby improving the patient experience and efficiency of the visit.
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Affiliation(s)
- Marsha N Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA; Department of Family Medicine, University of Rochester Medical Center, Rochester, USA.
| | - Patrick Walsh
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA
| | - Sule Yilmaz
- Warner School for Education, University of Rochester, Rochester, USA
| | - Michael Mendoza
- Department of Family Medicine, University of Rochester Medical Center, Rochester, USA
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, USA; Houston VA Center for Innovation in Quality, Effectiveness and Safety, Houston, USA
| | - Benjamin P Chapman
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA; Department of Family Medicine, University of Rochester Medical Center, Rochester, USA; Department of Medicine, University of Rochester Medical Center, Rochester, USA
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Leijten FR, Struckmann V, van Ginneken E, Czypionka T, Kraus M, Reiss M, Tsiachristas A, Boland M, de Bont A, Bal R, Busse R, Rutten-van Mölken M. The SELFIE framework for integrated care for multi-morbidity: Development and description. Health Policy 2018; 122:12-22. [DOI: 10.1016/j.healthpol.2017.06.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 12/17/2022]
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Struckmann V, Leijten FRM, van Ginneken E, Kraus M, Reiss M, Spranger A, Boland MRS, Czypionka T, Busse R, Rutten-van Mölken M. Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review. Health Policy 2017; 122:23-35. [PMID: 29031933 DOI: 10.1016/j.healthpol.2017.08.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In order to provide adequate care for the growing group of persons with multi-morbidity, innovative integrated care programmes are appearing. The aims of the current scoping review were to i) identify relevant models and elements of integrated care for multi-morbidity and ii) to subsequently identify which of these models and elements are applied in integrated care programmes for multi-morbidity. METHODS A scoping review was conducted in the following scientific databases: Cochrane, Embase, PubMed, PsycInfo, Scopus, Sociological Abstracts, Social Services Abstracts, and Web of Science. A search strategy encompassing a) models, elements and programmes, b) integrated care, and c) multi-morbidity was used to identify both models and elements (aim 1) and implemented programmes of integrated care for multi-morbidity (aim 2). Data extraction was done by two independent reviewers. Besides general information on publications (e.g. publication year, geographical region, study design, and target group), data was extracted on models and elements that publications refer to, as well as which models and elements are applied in recently implemented programmes in the EU and US. RESULTS In the review 11,641 articles were identified. After title and abstract screening, 272 articles remained. Full text screening resulted in the inclusion of 92 articles on models and elements, and 50 articles on programmes, of which 16 were unique programmes in the EU (n=11) and US (n=5). Wagner's Chronic Care Model (CCM) and the Guided Care Model (GCM) were most often referred to (CCM n=31; GCM n=6); the majority of the other models found were only referred to once (aim 1). Both the CCM and GCM focus on integrated care in general and do not explicitly focus on multi-morbidity. Identified elements of integrated care were clustered according to the WHO health system building blocks. Most elements pertained to 'service delivery'. Across all components, the five elements referred to most often are person-centred care, holistic or needs assessment, integration and coordination of care services and/or professionals, collaboration, and self-management (aim 1). Most (n=10) of the 16 identified implemented programmes for multi-morbidity referred to the CCM (aim 2). Of all identified programmes, the elements most often included were self-management, comprehensive assessment, interdisciplinary care or collaboration, person-centred care and electronic information system (aim 2). CONCLUSION Most models and elements found in the literature focus on integrated care in general and do not explicitly focus on multi-morbidity. In line with this, most programmes identified in the literature build on the CCM. A comprehensive framework that better accounts for the complexities resulting from multi-morbidity is needed.
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Affiliation(s)
- Verena Struckmann
- Berlin University of Technology, Department of Health Care Management, Germany.
| | - Fenna R M Leijten
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - Ewout van Ginneken
- WHO Observatory on Health Systems and Policies, Berlin University of Technology, Department of Health Care Management, Germany
| | | | | | - Anne Spranger
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Melinde R S Boland
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | | | - Reinhard Busse
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Maureen Rutten-van Mölken
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, The Netherlands
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van de Pol MHJ, Fluit CRMG, Lagro J, Slaats Y, Olde Rikkert MGM, Lagro-Janssen ALM. Shared decision making with frail older patients: Proposed teaching framework and practice recommendations. GERONTOLOGY & GERIATRICS EDUCATION 2017; 38:482-495. [PMID: 28027017 DOI: 10.1080/02701960.2016.1276014] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This study has two aims: The first aim is to identify core competencies for shared decision making (SDM) with frail older persons, and the second is to determine key elements of a teaching framework, based on the authors' recently developed model for SDM with older patients who are frail. To this end the authors conducted a qualitative inquiry among health professionals (n = 53) and older patients who are frail (n = 16). Participants formulated core competencies and educational needs for SDM with older patients who are frail, which were further explored in the literature. This resulted in practice recommendations and a teaching framework with the following key elements: create a knowledge base for all health professionals, offer practical training, facilitate communication, identify discussion partners, engage patients, and collaborate. The authors' teaching framework for SDM with older patients who are frail may be useful for clinicians, educators, and researchers who aim to promote SDM with older patients who are frail.
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Affiliation(s)
- Marjolein H J van de Pol
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | - Cornelia R M G Fluit
- b Learning Research and Education , Radboudumc Health Academy Nijmegen , Nijmegen , The Netherlands
| | - Joep Lagro
- c Department of Internal Medicine , Haga Teaching Hospital , The Hague , The Netherlands
| | - Yvonne Slaats
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
| | | | - Antoine L M Lagro-Janssen
- a Department of Primary and Community Care , Radboud University Medical Center , Nijmegen , The Netherlands
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Panagioti M, Blakeman T, Hann M, Bower P. Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study. BMJ Open 2017; 7:e013524. [PMID: 28559454 PMCID: PMC5729978 DOI: 10.1136/bmjopen-2016-013524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that patient safety is a serious concern for older patients with long-term conditions. Despite this, there is a lack of research on safety incidents encountered by this patient group. In this study, we sought to examine patient reports of safety incidents and factors associated with reports of safety incidents in older patients with long-term conditions. METHODS The baseline cross-sectional data from a longitudinal cohort study were analysed. Older patients (n=3378 aged 65 years and over) with a long-term condition registered in general practices were included in the study. The main outcome was patient-reported safety incidents including availability and appropriateness of medical tests and prescription of wrong types or doses of medication. Binary univariate and multivariate logistic regression analyses were undertaken to examine factors associated with patient-reported safety incidents. RESULTS Safety incidents were reported by 11% of the patients. Four factors were significantly associated with patient-reported safety incidents in multivariate analyses. The experience of multiple long-term conditions (OR=1.09, 95% CI 1.05 to 1.13), a probable diagnosis of depression (OR=1.36, 95% CI 1.06 to 1.74) and greater relational continuity of care (OR=1.28, 95% CI 1.08 to 1.52) were associated with increased odds for patient-reported safety incidents. Perceived greater support and involvement in self-management was associated with lower odds for patient-reported safety incidents (OR=0.95, 95% CI 0.93 to 0.97). CONCLUSIONS We found that older patients with multimorbidity and depression are more likely to report experiences of patient safety incidents. Improving perceived support and involvement of patients in their care may help prevent patient-reported safety incidents.
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Affiliation(s)
- Maria Panagioti
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Thomas Blakeman
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Mark Hann
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, UK
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Kirsh SR, Aron DC, Johnson KD, Santurri LE, Stevenson LD, Jones KR, Jagosh J. A realist review of shared medical appointments: How, for whom, and under what circumstances do they work? BMC Health Serv Res 2017; 17:113. [PMID: 28160771 PMCID: PMC5291948 DOI: 10.1186/s12913-017-2064-z] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/31/2017] [Indexed: 12/22/2022] Open
Abstract
Background Shared medical appointments (SMAs) are doctor-patient visits in which groups of patients are seen by one or more health care providers in a concurrent session. There is a growing interest in understanding the potential benefits of SMAs in various contexts to improve clinical outcomes and reduce healthcare costs. This study builds upon the existing evidence base that suggests SMAs are indeed effective. In this study, we explored how they are effective in terms of the underlying mechanisms of action and under what circumstances. Methods Realist review methodology was used to synthesize the literature on SMAs, which included a broad search of 800+ published articles. 71 high quality primary research articles were retained to build a conceptual model of SMAs and 20 of those were selected for an in depth analysis using realist methodology (i.e.,middle-range theories and and context-mechanism-outcome configurations). Results Nine main mechanisms that serve to explain how SMAs work were theorized from the data immersion process and configured in a series of context-mechanism-outcome configurations (CMOs). These are: (1) Group exposure in SMAs combats isolation, which in turn helps to remove doubts about one’s ability to manage illness; (2) Patients learn about disease self-management vicariously by witnessing others’ illness experiences; (3) Patients feel inspired by seeing others who are coping well; (4) Group dynamics lead patients and providers to developing more equitable relationships; (5) Providers feel increased appreciation and rapport toward colleagues leading to increased efficiency; (6) Providers learn from the patients how better to meet their patients’ needs; (7) Adequate time allotment of the SMA leads patients to feel supported; (8) Patients receive professional expertise from the provider in combination with first-hand information from peers, resulting in more robust health knowledge; and (9) Patients have the opportunity to see how the physicians interact with fellow patients, which allows them to get to know the physician and better determine their level of trust. Conclusions Nine overarching mechanisms were configured in CMO configurations and discussed as a set of complementary middle-range programme theories to explain how SMAs work. It is anticipated that this innovative work in theorizing SMAs using realist review methodology will provide policy makers and SMA program planners adequate conceptual grounding to design contextually sensitive SMA programs in a wide variety of settings and advance an SMA research agenda for varied contexts.
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Affiliation(s)
- Susan R Kirsh
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Aron
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA. .,School of Medicine, Case Western Reserve University, Cleveland, OH, USA. .,Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA.
| | - Kimberly D Johnson
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Laura E Santurri
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Katherine R Jones
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Justin Jagosh
- Centre for the Advancement of Realist Evaluation and Synthesis, University of Liverpool, Liverpool, UK
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26
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Ose D, Winkler EC, Berger S, Baudendistel I, Kamradt M, Eckrich F, Szecsenyi J. Complexity of care and strategies of self-management in patients with colorectal cancer. Patient Prefer Adherence 2017; 11:731-742. [PMID: 28435231 PMCID: PMC5391842 DOI: 10.2147/ppa.s127612] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
PURPOSE Given the inherent complexity of cancer care, in which personal, social, and clinical aspects accumulate and interact over time, self-management support need to become more comprehensive. This study has the following two aims: 1) to analyze and describe the complexity of individual patient situations and 2) to analyze and describe already established self-management strategies of patients to handle this complexity. METHODS A qualitative study was conducted. Ten focus groups were performed collecting perspectives of the following three user groups: patients with colorectal cancer (n=12) and representatives from support groups (n=2), physicians (n=17), and other health care professionals (HCPs; n=16). Data were analyzed using qualitative content analysis. RESULTS The results showed that cancer patients are struggling with the complexity of their individual situations characterized by the 1) "complexity of disease", 2) "complexity of care", and 3) "complexity of treatment-related data". To deal with these multifaceted situations, patients have established several individual strategies. These strategies are "proactive demanding" (eg, to get support and guidance or a meaningful dialog with the doctor), "proactive behavior" (eg, preparation of visits), and "proactive data management" (eg, in terms of merging treatment-related data and to disseminate these to their health care providers). CONCLUSION Patients with colorectal cancer have to handle a high complexity of individual situations within treatment and care of their disease. Private and social challenges have a culminating effect. This complexity increases as patients experience a longer duration of treatment and follow-up as patients have to handle a significantly higher amount of data over time. Self-management support should focus more on the individual complexity in a patient's life. This includes assisting patients with strategies that have already been established by themselves (like preparation of visits).
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Affiliation(s)
- Dominik Ose
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
- Department of Population Health, Health System Innovation and Research, University of Utah, Salt Lake City, UT, USA
- Correspondence: Dominik Ose, University of Utah, Department of Population Health Sciences, Health System Innovation and Research, Williams Building, 295 Chipeta Way, Salt Lake City, UT 84108, USA, Tel +1 801 587 2263, Fax +1 801 581 3623, Email
| | - Eva C Winkler
- Program for Ethics and Patient-oriented Care in Oncology, National Centre for Tumour Diseases, University Hospital Heidelberg, Heidelberg, Germany
| | - Sarah Berger
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Ines Baudendistel
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Martina Kamradt
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Felicitas Eckrich
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Wittink MN, Yilmaz S, Walsh P, Chapman B, Duberstein P. Customized Care: An intervention to Improve Communication and health outcomes in multimorbidity. Contemp Clin Trials Commun 2016; 4:214-221. [PMID: 28191546 PMCID: PMC5298860 DOI: 10.1016/j.conctc.2016.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Marsha N. Wittink
- Department of Psychiatry, University of Rochester Medical Center, United States
- Department of Family Medicine, University of Rochester Medical Center, United States
- Corresponding author. Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, 14642, United States.
| | - Sule Yilmaz
- Warner School for Education, University of Rochester, United States
| | - Patrick Walsh
- Department of Psychiatry, University of Rochester Medical Center, United States
- Department of Public Health Sciences, University of Rochester Medical Center, United States
| | - Ben Chapman
- Department of Psychiatry, University of Rochester Medical Center, United States
- Department of Public Health Sciences, University of Rochester Medical Center, United States
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center, United States
- Department of Family Medicine, University of Rochester Medical Center, United States
- Department of Medicine, University of Rochester Medical Center, United States
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28
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Luger TM, Hogan TP, Richardson LM, Cioffari-Bailiff L, Harvey K, Houston TK. Older Veteran Digital Disparities: Examining the Potential for Solutions Within Social Networks. J Med Internet Res 2016; 18:e296. [PMID: 27881361 PMCID: PMC5143468 DOI: 10.2196/jmir.6385] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 09/20/2016] [Accepted: 10/07/2016] [Indexed: 11/13/2022] Open
Abstract
Background Older adults typically have less access to the Internet than other age groups, and older Veterans may use the Internet even less due to economic and geographic reasons. Objective To explore solutions to this problem, our study examined older Veterans’ reported ability to access technology through their close social ties. Methods Data were collected via mail survey from a sample of Veterans aged 65 years and older (N=266). Results Nearly half (44.0%, 117/266) of the sample reported having no Internet access. Yet, among those without current access, older Veterans reported having a median of 5 (IQR 7) close social ties with home Internet access. These older Veterans also reported that they would feel comfortable asking a median of 2 (IQR 4) social ties for help to access the Internet, and that a median of 2 (IQR 4) social ties would directly access the Internet for the older Veteran to help with health management. Conclusions Findings suggest that even older Veterans without current Internet access have at least two social ties with home Internet who could be called upon for technology support. Thus, older Veterans may be willing to call upon these “surrogate seekers” for technology assistance and support in health management. This has implications for the digital divide, technology design, and health care policy.
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Affiliation(s)
| | - Timothy P Hogan
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Lisa Cioffari-Bailiff
- Department of Graduate Nursing, University of Massachusetts Medical School, Worcester, MA, United States
| | | | - Thomas K Houston
- Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA, United States.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, United States
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Sakraida TJ, Weber MT. The Relationship Between Depressive Symptoms and Self-Management Behaviors in Patients With T2DM and Stage 3 CKD. Perspect Psychiatr Care 2016; 52:273-282. [PMID: 26095370 DOI: 10.1111/ppc.12128] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2013] [Revised: 03/31/2015] [Accepted: 04/27/2015] [Indexed: 11/26/2022] Open
Abstract
PURPOSE This study aimed to assess the relationship of depressive symptoms with self-management by adults with type 2 diabetes mellitus and chronic kidney disease. DESIGN AND METHODS Using a descriptive correlational design, participants completed Beck's Depression Inventory (BDI-II) and Summary of Diabetes Self-Care Activities measure. FINDINGS Reported were energy loss, sleep change, and fatigue. Performed less were exercise, physical activity, eating vegetables, and blood checks. Significant correlations were BDI-II total score with feet checking, energy loss with feet checking and exercise, and sleep change with feet soaking. PRACTICE IMPLICATIONS Depressive symptoms were associated to self-management behaviors that require physical energy. Assess for advancing symptoms.
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Affiliation(s)
- Teresa J Sakraida
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA.
| | - Mary T Weber
- University of Colorado Denver College of Nursing, Aurora, Colorado, USA
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30
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Steele Gray C, Wodchis WP, Upshur R, Cott C, McKinstry B, Mercer S, Palen TE, Ramsay T, Thavorn K. Supporting Goal-Oriented Primary Health Care for Seniors with Complex Care Needs Using Mobile Technology: Evaluation and Implementation of the Health System Performance Research Network, Bridgepoint Electronic Patient Reported Outcome Tool. JMIR Res Protoc 2016; 5:e126. [PMID: 27341765 PMCID: PMC4938886 DOI: 10.2196/resprot.5756] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/13/2016] [Accepted: 04/13/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Older adults experiencing multiple chronic illnesses are at high risk of hospitalization and health decline if they are unable to manage the significant challenges posed by their health conditions. Goal-oriented care approaches can provide better care for these complex patients, but clinicians find the process of ascertaining goals "too complex and too-time consuming," and goals are often not agreed upon between complex patients and their providers. The electronic patient reported outcomes (ePRO) mobile app and portal offers an innovative approach to creating and monitoring goal-oriented patient-care plans to improve patient self-management and shared decision-making between patients and health care providers. The ePRO tool also supports proactive patient monitoring by the patient, caregiver(s), and health care provider. It was developed with and for older adults with complex care needs as a means to improve their quality of life. OBJECTIVE Our proposed project will evaluate the use, effectiveness, and value for money of the ePRO tool in a 12-month multicenter, randomized controlled trial in Ontario; targeting individuals 65 or over with two or more chronic conditions that require frequent health care visits to manage their health conditions. METHODS Intervention groups using the ePRO tool will be compared with control groups on measures of quality of life, patient experience, and cost-effectiveness. We will also evaluate the implementation of the tool. RESULTS The proposed project presented in this paper will be funded through the Canadian Institute for Health Research (CIHR) eHealth Innovation Partnerships Program (eHIPP) program (CIHR-348362). The expected completion date of the study is November, 2019. CONCLUSIONS We anticipate our program of work will support improved quality of life and patient self-management, improved patient-centered primary care delivery, and will encourage the adoption of goal-oriented care approaches across primary health care systems. We have partnered with family health teams and quality improvement organizations in Ontario to ensure that our research is practical and that findings are shared widely. We will work with our established international network to develop an implementation framework to support continued adaptation and adoption across Canada and internationally.
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Affiliation(s)
- Carolyn Steele Gray
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Steele Gray C, Gill A, Khan AI, Hans PK, Kuluski K, Cott C. The Electronic Patient Reported Outcome Tool: Testing Usability and Feasibility of a Mobile App and Portal to Support Care for Patients With Complex Chronic Disease and Disability in Primary Care Settings. JMIR Mhealth Uhealth 2016; 4:e58. [PMID: 27256035 PMCID: PMC4911509 DOI: 10.2196/mhealth.5331] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2015] [Revised: 02/05/2016] [Accepted: 02/23/2016] [Indexed: 12/30/2022] Open
Abstract
Background People experiencing complex chronic disease and disability (CCDD) face some of the greatest challenges of any patient population. Primary care providers find it difficult to manage multiple discordant conditions and symptoms and often complex social challenges experienced by these patients. The electronic Patient Reported Outcome (ePRO) tool is designed to overcome some of these challenges by supporting goal-oriented primary care delivery. Using the tool, patients and providers collaboratively develop health care goals on a portal linked to a mobile device to help patients and providers track progress between visits. Objectives This study tested the usability and feasibility of adopting the ePRO tool into a single interdisciplinary primary health care practice in Toronto, Canada. The Fit between Individuals, Fask, and Technology (FITT) framework was used to guide our assessment and explore whether the ePRO tool is: (1) feasible for adoption in interdisciplinary primary health care practices and (2) usable from both the patient and provider perspectives. This usability pilot is part of a broader user-centered design development strategy. Methods A 4-week pilot study was conducted in which patients and providers used the ePRO tool to develop health-related goals, which patients then monitored using a mobile device. Patients and providers collaboratively set goals using the system during an initial visit and had at least 1 follow-up visit at the end of the pilot to discuss progress. Focus groups and interviews were conducted with patients and providers to capture usability and feasibility measures. Data from the ePRO system were extracted to provide information regarding tool usage. Results Six providers and 11 patients participated in the study; 3 patients dropped out mainly owing to health issues. The remaining 8 patients completed 210 monitoring protocols, equal to over 1300 questions, with patients often answering questions daily. Providers and patients accessed the portal on an average of 10 and 1.5 times, respectively. Users found the system easy to use, some patients reporting that the tool helped in their ability to self-manage, catalyzed a sense of responsibility over their care, and improved patient-centered care delivery. Some providers found that the tool helped focus conversations on goal setting. However, the tool did not fit well with provider workflows, monitoring questions were not adequately tailored to individual patient needs, and daily reporting became tedious and time-consuming for patients. Conclusions Although our study suggests relatively low usability and feasibility of the ePRO tool, we are encouraged by the early impact on patient outcomes and generally positive responses from both user groups regarding the potential of the tool to improve care for patients with CCDD. As is consistent with our user-centered design development approach, we have modified the tool based on user feedback, and are now testing the redeveloped tool through an exploratory trial.
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Affiliation(s)
- Carolyn Steele Gray
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
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Predictors of health-related quality of life in people with a complex chronic disease including multimorbidity: a longitudinal cohort study. Qual Life Res 2016; 25:2579-2592. [PMID: 27048497 DOI: 10.1007/s11136-016-1282-x] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/23/2016] [Indexed: 12/21/2022]
Abstract
PURPOSE Factors that predict the health-related quality of life (HRQoL) of people with complex chronic diseases have not been investigated to date. Determining the impact of disease on daily activities is a factor that is particularly important with this group of people. This study examined the influence of a range of predictors (including the impact of chronic diseases on daily activities), on HRQoL in patients with complex chronic diseases over a 12-month period. METHOD A longitudinal cohort study was conducted with outcomes measured at baseline, 3, 6 and 12 months post-baseline. Adults attending an Australian community-based rehabilitation service were included. HRQoL was measured using the SF-36 and corresponding preference-based health utility. Predictor variables included sociodemographic factors, disease factors (e.g. impact of diseases on daily activities), intervention factors, psychosocial factors and HRQoL components that were not included as the dependent variable. Linear mixed-effects regression was used to examine the relationship between predictor variables and HRQoL. RESULTS Data from 351 participants were included. The impact of chronic disease on daily activities was the most frequent significant predictor of HRQoL outcomes. Other significant predictors included the impact of chronic back pain or sciatica on daily activities, the number of comorbidities, general health functioning and psychological distress. CONCLUSION Models of health care for people with complex chronic disease may be enhanced by greater focus on patients' daily activities during assessment and intervention delivery. The range of significant predictors highlights the importance of an interdisciplinary team for managing complex chronic disease or targeted intervention strategies.
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Pain self-management training increases self-efficacy, self-management behaviours and pain and depression outcomes. Eur J Pain 2016; 20:1070-8. [DOI: 10.1002/ejp.830] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/11/2015] [Indexed: 11/07/2022]
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Mehravar F, Mansournia MA, Holakouie-Naieni K, Nasli-Esfahani E, Mansournia N, Almasi-Hashiani A. Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. Epidemiol Health 2016. [DOI: 10.4178/epih.e2016004] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
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Mehravar F, Mansournia MA, Holakouie-Naieni K, Nasli-Esfahani E, Mansournia N, Almasi-Hashiani A. Associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. Epidemiol Health 2016; 38:e2016004. [PMID: 26883737 PMCID: PMC4789607 DOI: 10.4178/epih/e2016004] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/25/2016] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES: Diabetes is a major public health problem that is approaching epidemic proportions globally. Diabetes self-management can reduce complications and mortality in type 2 diabetic patients. The purpose of this study was to examine associations between diabetes self-management and microvascular complications in patients with type 2 diabetes. METHODS: In this cross-sectional study, 562 Iranian patients older than 30 years of age with type 2 diabetes who received treatment at the Diabetes Research Center of the Endocrinology and Metabolism Research Institute of the Tehran University of Medical Sciences were identified. The participants were enrolled and completed questionnaires between January and April 2014. Patients’ diabetes self-management was assessed as an independent variable by using the Diabetes Self-Management Questionnaire translated into Persian. The outcomes were the microvascular complications of diabetes (retinopathy, nephropathy, and neuropathy), identified from the clinical records of each patient. A multiple logistic regression model was used to estimate odds ratios (ORs) and 95% confidence intervals (CIs) between diabetes self-management and the microvascular complications of type 2 diabetes, adjusting for potential confounders. RESULTS: After adjusting for potential confounders, a significant association was found between the diabetes self-management sum scale and neuropathy (adjusted OR, 0.64; 95% CI, 0.45 to 0.92, p=0.01). Additionally, weak evidence was found of an association between the sum scale score of diabetes self-management and nephropathy (adjusted OR, 0.71; 95% CI, 0.47 to 1.05, p=0.09). CONCLUSIONS: Among patients with type 2 diabetes, a lower diabetes self-management score was associated with higher rates of nephropathy and neuropathy.
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Affiliation(s)
- Fatemeh Mehravar
- Clinical Research Development Unit, Imam Hossein Hospital, Shahroud University of Medical Sciences, Shahroud, Iran
| | - Mohammad Ali Mansournia
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Kourosh Holakouie-Naieni
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Ensie Nasli-Esfahani
- Diabetes Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Nasrin Mansournia
- Imam Reza Hospital, AJA University of Medical Sciences, Tehran, Iran
| | - Amir Almasi-Hashiani
- Department of Epidemiology and Reproductive Health, Reproductive Epidemiology Research Center, Royan Institute for Reproductive Biomedicine, Academic Center for Education, Culture and Research, Tehran, Iran
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A systematic review of motivational interviewing in healthcare: the potential of motivational interviewing to address the lifestyle factors relevant to multimorbidity. JOURNAL OF COMORBIDITY 2015; 5:162-174. [PMID: 29090164 PMCID: PMC5636036 DOI: 10.15256/joc.2015.5.55] [Citation(s) in RCA: 58] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/30/2015] [Accepted: 12/08/2015] [Indexed: 01/08/2023]
Abstract
Internationally, health systems face an increasing demand for services from people living with multimorbidity. Multimorbidity is often associated with high levels of treatment burden. Targeting lifestyle factors that impact across multiple conditions may promote quality of life and better health outcomes for people with multimorbidity. Motivational interviewing (MI) has been studied as one approach to supporting lifestyle behaviour change. A systematic review was conducted to assess the effectiveness of MI in healthcare settings and to consider its relevance for multimorbidity. Twelve meta-analyses pertinent to multimorbidity lifestyle factors were identified. As an intervention, MI has been found to have a small-to-medium statistically significant effect across a wide variety of single diseases and for a range of behavioural outcomes. This review highlights the need for specific research into the application of MI to determine if the benefits of MI seen with single diseases are also present in the context of multimorbidity.
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Ward BW. Multiple chronic conditions and labor force outcomes: A population study of U.S. adults. Am J Ind Med 2015; 58:943-54. [PMID: 26103096 DOI: 10.1002/ajim.22439] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Although 1-in-5 adults have multiple (≥ 2) chronic conditions, limited attention has been given to the association between multiple chronic conditions and employment. METHODS Cross-sectional data (2011 National Health Interview Survey) and multivariate regression analyses were used to examine the association among multiple chronic conditions, employment, and labor force outcomes for U.S. adults aged 18-64 years, controlling for covariates. RESULTS Among U.S. adults aged 18-64 years (unweighted, n = 25,458), having multiple chronic conditions reduced employment probability by 11-29%. Some individual chronic conditions decreased employment probability. Among employed adults (unweighted, n = 16,096), having multiple chronic conditions increased the average number of work days missed due to injury/illness in the past year by 3-9 days. CONCLUSIONS Multiple chronic conditions are a barrier to employment and increase the number of work days missed, placing affected individuals at a financial disadvantage. Researchers interested in examining consequences of multiple chronic conditions should give consideration to labor force outcomes.
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Affiliation(s)
- Brian W. Ward
- Division of Health Interview Statistics, National Center for Health Statistics; Centers for Disease Control and Prevention; Hyattsville Maryland
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Junius-Walker U, Wiese B, Klaaßen-Mielke R, Theile G, Müller CA, Hummers-Pradier E. Older patients' perceived burdens of their health problems: a cross-sectional analysis in 74 German general practices. Patient Prefer Adherence 2015; 9:811-20. [PMID: 26124648 PMCID: PMC4476476 DOI: 10.2147/ppa.s81348] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Older patients often experience the burden of multiple health problems. Physicians need to consider them to arrive at a holistic treatment plan. Yet, it has not been systematically investigated as to which personal burdens ensue from certain health conditions. OBJECTIVE The objective of this study is to examine older patients' perceived burden of their health problems. PATIENTS AND METHODS The study presents a cross-sectional analysis in 74 German general practices; 836 patients, 72 years and older (mean 79±4.4), rated the burden of each health problem disclosed by a comprehensive geriatric assessment. Patients rated each burden using three components: importance, emotional impact, and impact on daily activities. Cluster analyses were performed to define patterns in the rating of these components of burden. In a multilevel logistic regression analysis, independent factors that predict high and low burden were explored. RESULTS Patients had a median of eleven health problems and rated the burden of altogether 8,900 health problems. Four clusters provided a good clustering structure. Two clusters describe a high burden, and a further two, a low burden. Patients attributed a high burden to social and psychological health problems (especially being a caregiver: odds ratio [OR] 10.4, 95% confidence interval [CI] 4.4-24.4), to specific symptoms (eg, claudication: OR 2.3, 95% CI 1.3-4.0; pain: OR 2.3, 95% CI 1.6-3.1), and physical disabilities. Patients rated a comparatively low burden for most of their medical findings, for cognitive impairment, and lifestyle issues (eg, hypertension: OR 0.2, 95% CI 0.2-0.3). CONCLUSION The patients experienced a relatively greater burden for physical disabilities, mood, or social issues than for diseases themselves. Physicians should interpret these burdens in the individual context and consider them in their treatment planning.
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Affiliation(s)
| | - Birgitt Wiese
- Institute of General Practice, Hannover Medical School, Hannover, Germany
| | - Renate Klaaßen-Mielke
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr-University, Bochum, Germany
| | - Gudrun Theile
- Institute of General Practice, Hannover Medical School, Hannover, Germany
- Geriatric Clinic University Hospital, Zurich, Switzerland
| | - Christiane Annette Müller
- Department of General Practice/Family Medicine, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
| | - Eva Hummers-Pradier
- Department of General Practice/Family Medicine, University Medical Center Göttingen, Georg-August-University, Göttingen, Germany
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Beadles CA, Voils CI, Crowley MJ, Farley JF, Maciejewski ML. Continuity of medication management and continuity of care: Conceptual and operational considerations. SAGE Open Med 2014; 2:2050312114559261. [PMID: 26770750 PMCID: PMC4607236 DOI: 10.1177/2050312114559261] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2014] [Accepted: 10/16/2014] [Indexed: 11/30/2022] Open
Abstract
Objective: Continuity of care is considered foundational to high-quality care. Traditional continuity of care constructs may adequately characterize care quality in general populations, but may merit reconceptualization for patients with multiple chronic conditions. Specifically, interactions between multiple chronic condition patients and providers involve complex medication management; therefore care continuity measurement may be more relevant if focused on the provider subset who prescribes essential medications for chronic conditions—a construct we call continuity of medication management. Our objective was to explore conceptual distinctions between continuity of medication management and continuity of care, survey existing evidence in this area, and discuss implications of our findings for future research and intervention development. Methods: In this topical review, we discuss conceptual distinctions between continuity of medication management and continuity of care, review the limited continuity of medication management–related empirical evidence, and discuss implications for future research and interventions. Results: Continuity of medication management represents a potential conceptual and measurement advance by reflecting interpersonal continuity and management continuity, and may provide a means of identifying patients at high-risk of adverse events. Empirical evidence also establishes support for continuity of medication management as a meaningful measure of care continuity. Finally, continuity of medication management may also be a potential target for future intervention to improve care delivery among multiple chronic condition patients. Conclusion: If continuity of medication management is validated in diverse populations, correlated with patient outcomes, and responsive to change, then it may be an important target for improving the health and health care of multiple chronic condition patients.
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Affiliation(s)
- Christopher A Beadles
- Center for Health Services Research in Primary Care (152), Durham VA Medical Center, Durham, NC, USA
| | - Corrine I Voils
- Center for Health Services Research in Primary Care (152), Durham VA Medical Center, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
| | - Matthew J Crowley
- Center for Health Services Research in Primary Care (152), Durham VA Medical Center, Durham, NC, USA; Division of Endocrinology, Department of Medicine, Duke University, Durham, NC, USA
| | - Joel F Farley
- Division of Pharmaceutical Outcomes and Policy, School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Matthew L Maciejewski
- Center for Health Services Research in Primary Care (152), Durham VA Medical Center, Durham, NC, USA; Division of General Internal Medicine, Department of Medicine, Duke University, Durham, NC, USA
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Steele Gray C, Miller D, Kuluski K, Cott C. Tying eHealth Tools to Patient Needs: Exploring the Use of eHealth for Community-Dwelling Patients With Complex Chronic Disease and Disability. JMIR Res Protoc 2014; 3:e67. [PMID: 25428028 PMCID: PMC4260075 DOI: 10.2196/resprot.3500] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2014] [Revised: 09/30/2014] [Accepted: 10/19/2014] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health policy makers have recently shifted attention towards examining high users of health care, in particular patients with complex chronic disease and disability (CCDD) characterized as having multimorbidities and care needs that require ongoing use of services. The adoption of eHealth technologies may be a key strategy in supporting and providing care for these patients; however, these technologies need to address the specific needs of patients with CCDD. This paper describes the first phase of a multiphased patient-centered research project aimed at developing eHealth technology for patients with CCDD. OBJECTIVE As part of the development of new eHealth technologies to support patients with CCDD in primary care settings, we sought to determine the perceived needs of these patients with respect to (1) the kinds of health and health service issues that are important to them, (2) the information that should be collected and how it could be collected in order to help meet their needs, and (3) their views on the challenges/barriers to using eHealth mobile apps to collect the information. METHODS Focus groups were conducted with community-dwelling patients with CCDD and caregivers. An interpretive description research design was used to identify the perceived needs of participants and the information sharing and eHealth technologies that could support those needs. Analysis was conducted concurrently with data collection. Coding of transcripts from four focus groups was conducted by 3 authors. QSR NVivo 10 software was used to manage coding. RESULTS There were 14 total participants in the focus groups. The average age of participants was 64.4 years; 9 participants were female, and 11 were born in Canada. Participants identified a need for open two-way communication and dialogue between themselves and their providers, and better information sharing between providers in order to support continuity and coordination of care. Access issues were mainly around wait times for appointments, challenges with transportation, and costs. A visual depiction of these perceived needs and their relation to each other is included as part of the discussion, which will be used to guide development of our eHealth technologies. Participants recognized the potential for eHealth technologies to support and improve their care but also expressed common concerns regarding their adoption. Specifically, they mentioned privacy and data security, accessibility, the loss of necessary visits, increased social isolation, provider burden, downloading responsibility onto patients for care management, entry errors, training requirements, and potentially confusing interfaces. CONCLUSIONS From the perspective of our participants, there is a significant potential for eHealth tools to support patients with CCDD in community and primary care settings, but we need to be wary of the potential downfalls of adopting eHealth technologies and pay special attention to patient-identified needs and concerns. eHealth tools that support ongoing patient-provider interaction, patient self-management (such as telemonitoring), and provider-provider interactions (through electronic health record integration) could be of most benefit to patients similar to those in our study.
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Affiliation(s)
- Carolyn Steele Gray
- Bridgepoint Collaboratory for Research and Innovation, Bridgepoint Active Healthcare, Toronto, ON, Canada.
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Amante DJ, Hogan TP, Pagoto SL, English TM. A systematic review of electronic portal usage among patients with diabetes. Diabetes Technol Ther 2014; 16:784-93. [PMID: 24999599 DOI: 10.1089/dia.2014.0078] [Citation(s) in RCA: 85] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
The objectives of this review were (1) to examine characteristics associated with enrollment and utilization of portals among patients with diabetes and (2) to identify barriers and facilitators of electronic patient portal enrollment and utilization. PubMed and the Cumulative Index to Nursing and Allied Health Literature (CINAHL) were systematically searched for papers reporting original research using quantitative or qualitative methods on characteristics, barriers, and facilitators associated with portal enrollment and utilization among patients with diabetes in the United States. The search was limited to articles published between February 1, 2005 (the date of the national symposium on personal health records) and January 1, 2014. Sixteen articles were identified. Of these, nine were quantitative, three were qualitative, and four used mixed-methods. Several demographic characteristics, having better-controlled diabetes, and providers who engaged in and encouraged portal use were associated with increased portal enrollment and utilization. Barriers to portal enrollment included a lack of patient (1) capacity, (2) desire, and (3) awareness of portal/portal functions. Barriers to portal utilization included (1) patient capacity, (2) lack of provider and patient buy-in to portal benefits, and (3) negative patient experiences using portals. Facilitators of portal enrollment and utilization were providers and family members recommending and engaging in portal use. Improved usability, increased access, educating patients how to use and benefit from portals, and greater endorsement by providers and family members might increase portal enrollment and utilization. As more providers and hospitals offer portals, addressing barriers and leveraging facilitators may help patients with diabetes achieve potential benefits.
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Affiliation(s)
- Daniel J Amante
- 1 Clinical & Population Health Research Doctoral Program, Graduate School of Biomedical Sciences, University of Massachusetts Medical School , Worcester, Massachusetts
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Burt J, Rick J, Blakeman T, Protheroe J, Roland M, Bower P. Care plans and care planning in long-term conditions: a conceptual model. Prim Health Care Res Dev 2014; 15:342-54. [PMID: 23883621 PMCID: PMC3976966 DOI: 10.1017/s1463423613000327] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
The prevalence and impact of long-term conditions continues to rise. Care planning for people with long-term conditions has been a policy priority for chronic disease management in a number of health-care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between 'care planning' (the process by which health-care professionals and patients discuss, agree and review an action plan to achieve the goals or behaviour change of most relevance and concern to the patient) and a 'care plan' (a written document recording the outcome of a care planning process). We propose a typology of care planning and care plans with three core dimensions: perspective (patient or professional), scope (a focus on goals or on behaviours) and networks (confined to the professional-patient dyad or extending to the entire care network). In addition, we draw on psychological models of mediation and moderation to outline potential mechanisms through which care planning and care plans may lead to improved outcomes for both patients and the wider health-care system. The proposed typology of care planning and care plans offered here, along with the model of the process by which care planning may influence outcomes, provide a useful framework for future policy developments and evaluations. Empirical work is required to explore the degree to which current care planning approaches and care plans can be described according to these dimensions, and the factors that determine which types of patients and professionals use which type of care plans.
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Affiliation(s)
- J Burt
- Corresponding author: Jenni Burt, Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Forvie Site, Robinson Way, Cambridge CB2 0SR. Phone 01223 330596. Fax 01223 762515.
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Bower P, Hann M, Rick J, Rowe K, Burt J, Roland M, Protheroe J, Richardson G, Reeves D. Multimorbidity and delivery of care for long-term conditions in the English National Health Service: baseline data from a cohort study. J Health Serv Res Policy 2014; 18:29-37. [PMID: 24121834 DOI: 10.1177/1355819613492148] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES Many patients with long-term conditions have multiple conditions. Current delivery of care is not designed around their needs and they may face barriers to effective self-management. This study assessed the relationships between multimorbidity, the delivery of care, and self-management. METHODS We surveyed 2439 patients with long-term conditions concerning their experience of the delivery of care and self-management in England in 2011. We assessed multimorbidity in terms of a count of long-term conditions and the presence of 'probable depression'. We explored the relationships between multimorbidity, patient experience of the delivery of care, and self-management RESULTS Neither measure of multimorbidity was a significant predictor of patients' experience of the delivery of care. Patients with multimorbidity reported higher levels of self-management behaviour, while the presence of depression was associated with less positive attitudes towards self-management. CONCLUSIONS The current data do not demonstrate a consistent impact of multimorbidity on patients' experience of care or on self-management. Further research is required to assess those types of multimorbidity that are associated with significant deficits, or to identify other aspects of care that might be problematic in the context of multiple conditions.
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Affiliation(s)
- Peter Bower
- Professor of Health Services Research, NIHR School for Primary Care Research, Centre for Primary Care, University of Manchester, UK
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Bayliss EA, Bonds DE, Boyd CM, Davis MM, Finke B, Fox MH, Glasgow RE, Goodman RA, Heurtin-Roberts S, Lachenmayr S, Lind C, Madigan EA, Meyers DS, Mintz S, Nilsen WJ, Okun S, Ruiz S, Salive ME, Stange KC. Understanding the context of health for persons with multiple chronic conditions: moving from what is the matter to what matters. Ann Fam Med 2014; 12:260-9. [PMID: 24821898 PMCID: PMC4018375 DOI: 10.1370/afm.1643] [Citation(s) in RCA: 119] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 12/24/2013] [Accepted: 01/30/2014] [Indexed: 12/21/2022] Open
Abstract
PURPOSE An isolated focus on 1 disease at a time is insufficient to generate the scientific evidence needed to improve the health of persons living with more than 1 chronic condition. This article explores how to bring context into research efforts to improve the health of persons living with multiple chronic conditions (MCC). METHODS Forty-five experts, including persons with MCC, family and friend caregivers, researchers, policy makers, funders, and clinicians met to critically consider 4 aspects of incorporating context into research on MCC: key contextual factors, needed research, essential research methods for understanding important contextual factors, and necessary partnerships for catalyzing collaborative action in conducting and applying research. RESULTS Key contextual factors involve complementary perspectives across multiple levels: public policy, community, health care systems, family, and person, as well as the cellular and molecular levels where most research currently is focused. Needed research involves moving from a disease focus toward a person-driven, goal-directed research agenda. Relevant research methods are participatory, flexible, multilevel, quantitative and qualitative, conducive to longitudinal dynamic measurement from diverse data sources, sufficiently detailed to consider what works for whom in which situation, and generative of ongoing communities of learning, living and practice. Important partnerships for collaborative action include cooperation among members of the research enterprise, health care providers, community-based support, persons with MCC and their family and friend caregivers, policy makers, and payers, including government, public health, philanthropic organizations, and the business community. CONCLUSION Consistent attention to contextual factors is needed to enhance health research for persons with MCC. Rigorous, integrated, participatory, multimethod approaches to generate new knowledge and diverse partnerships can be used to increase the relevance of research to make health care more sustainable, safe, equitable and effective, to reduce suffering, and to improve quality of life.
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Affiliation(s)
- Elizabeth A. Bayliss
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Denise E. Bonds
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Cynthia M. Boyd
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Melinda M. Davis
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Bruce Finke
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Michael H. Fox
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Russell E. Glasgow
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Richard A. Goodman
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Suzanne Heurtin-Roberts
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Sue Lachenmayr
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Cristin Lind
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Elizabeth A. Madigan
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - David S. Meyers
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Suzanne Mintz
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Wendy J. Nilsen
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Sally Okun
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Sarah Ruiz
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Marcel E. Salive
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
| | - Kurt C. Stange
- Kaiser Permanente, Denver, CO (Bayliss); National Heart, Lung and Blood Institute, Bethesda, MD (Bonds); Johns Hopkins University School of Medicine and Bloomberg School of Public Health, Baltimore, MD (Boyd); Oregon Health & Sciences University, Portland, OR (Davis); Indian Health Services, Nashville, TN, and Baltimore, MD (Finke); Center for Disease Control and Prevention, Atlanta, GA (Fox); National Cancer Institute, National Institutes of Health, Bethesda, MD (Glasgow, Heurtin-Roberts); University of Colorado School of Medicine, Denver, CO (Glasgow); Office of the Assistant Secretary for Health, Department of Health and Human Services and Center for Disease Control and Prevention, Atlanta, GA (Goodman); National Council on Aging, Washington, DC (Lachenmayr, Ruiz); Patient/Caregiver Advocate, Boston, MA (Lind); Karolinska Institute, Stockholm, Sweden (Lind); Case Western Reserve, Cleveland, OH (Madigan, Stange); Agency for Healthcare Research and Quality, Rockville, MD (Meyers); Family Caregiver Advocacy, Kensington, MD (Mintz); Office of Behavioral and Social Sciences Research, National Institutes of Health, Bethesda, MD (Nilsen); PatientsLikeMe, Cambridge, MA (Okun); University of Chicago, Chicago, IL (Ruiz); National Institute on Aging, Bethesda, MD (Salive)
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Carr SM, Paliadelis P, Lhussier M, Forster N, Eaton S, Parmenter G, Death C. Looking after yourself: Clinical understandings of chronic-care self-management strategies in rural and urban contexts of the United Kingdom and Australia. SAGE Open Med 2014; 2:2050312114532636. [PMID: 26770727 PMCID: PMC4607191 DOI: 10.1177/2050312114532636] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 03/28/2014] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES This article reports on the outcomes of two similar projects undertaken during 2011-2012 in Australia (Rural Northern New South Wales) and the United Kingdom (Urban Northern United Kingdom) that sought to identify the strategies that health professionals employ to actively involve patients with chronic conditions in the planning and delivery of their care. In particular, this study explored understandings and contexts of care that impacted on the participants' practices. This study was informed by the global shift to partnership approaches in health policy and the growing imperative to deliver patient or client-centred care. METHODS An ethnomethodological design was used, as ethnomethodology does not dictate a set of research methods or procedures, but rather is congruent with any method that seeks to explore what people do in their routine everyday lives. Focus groups and interviews were employed to explore the strategies used by a range of primary health-care providers, such as general practitioners, nurses, social workers, diabetes educators, dieticians and occupational therapists, to support clients to effectively manage their own chronic conditions. RESULTS Data from both studies were synthesised and analysed thematically, with the themes reflecting the context, similarities and differences of the two studies that the participants felt had either facilitated or blocked their efforts to support their clients to adopt self-care strategies. CONCLUSION Supporting patients/clients to engage in actively self-managing their health-care needs requires changes to clients' and clinicians' traditional perspectives on their roles. The barriers and enablers to supporting clients to manage their own health needs were similar across both locations and included tensions in role identity and functions, the discourse of health-care professionals as 'experts' who deliver care and their level of confidence in being facilitators who 'educate' clients to effectively manage their health-care needs, rather than only the 'providers' of care.
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Affiliation(s)
- Susan Mary Carr
- Faculty of Health, Federation University Australia, Ballarat, VIC, Australia; Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK; Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Penny Paliadelis
- Faculty of Health, Federation University Australia, Ballarat, VIC, Australia
| | - Monique Lhussier
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Natalie Forster
- Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne, UK
| | - Simon Eaton
- Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Catharine Death
- Hunter New England Health District, Armidale, NSW, Australia
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Arbesman M, Mosley LJ. Systematic review of occupation- and activity-based health management and maintenance interventions for community-dwelling older adults. Am J Occup Ther 2013; 66:277-83. [PMID: 22549592 DOI: 10.5014/ajot.2012.003327] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
We describe the results of a systematic review of the literature on occupation- and activity-based health management and maintenance interventions for productive aging. We found moderate to strong evidence that client-centered occupational therapy improved physical functioning and occupational performance related to health management in community-dwelling older adults, as well as in adults with osteoarthritis and macular degeneration. We found moderate evidence that health education programs reduce pain and increase physical activity and that individualized health action plans improve activities of daily living function and participation in physical activities. The evidence that self-management programs result in a decrease in pain and disability and that incorporating cognitive-behavioral principles into physical activity improves long-term participation in exercise was also moderate. Although the evidence for skill-specific training in isolation is limited, effectiveness increases when skill-specific training is combined with health management programs. The implications for practice, education, and research are discussed.
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Affiliation(s)
- Marian Arbesman
- Department of Rehabilitation Science, University at Buffalo, State University of New York, Williamsville, NY, USA.
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Crowley MJ, Powers BJ, Olsen MK, Grubber JM, Koropchak C, Rose CM, Gentry P, Bowlby L, Trujillo G, Maciejewski ML, Bosworth HB. The Cholesterol, Hypertension, And Glucose Education (CHANGE) study: results from a randomized controlled trial in African Americans with diabetes. Am Heart J 2013; 166:179-86. [PMID: 23816038 DOI: 10.1016/j.ahj.2013.04.004] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 04/09/2013] [Indexed: 12/24/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and diabetes account for one-third of the mortality difference between African American and white patients. We evaluated the effect of a CVD risk reduction intervention in African Americans with diabetes. METHODS We randomized 359 African Americans with type 2 diabetes to receive usual care or a nurse telephone intervention. The 12-month intervention provided monthly self-management support and quarterly medication management facilitation. Coprimary outcomes were changes in systolic blood pressure (SBP), hemoglobin A1c (HbA1c), and low-density lipoprotein cholesterol (LDL-C) over 12 months. We estimated between-intervention group differences over time using linear mixed-effects models. The secondary outcome was self-reported medication adherence. RESULTS The sample was 72% female; 49% had low health literacy, and 37% had annual income <$10,000. Model-based estimates for mean baseline SBP, HbA1c, and LDL-C were 136.8 mm Hg (95% CI 135.0-138.6), 8.0% (95% CI 7.8-8.2), and 99.1 mg/dL (95% CI 94.7-103.5), respectively. Intervention patients received 9.9 (SD 3.0) intervention calls on average. Primary providers replied to 76% of nurse medication management facilitation contacts, 18% of these resulted in medication changes. There were no between-group differences over time for SBP (P = .11), HbA1c (P = .66), or LDL-C (P = .79). Intervention patients were more likely than those receiving usual care to report improved medication adherence (odds ratio 4.4, 95% CI 1.8-10.6, P = .0008), but adherent patients did not exhibit relative improvement in primary outcomes. CONCLUSIONS This intervention improved self-reported medication adherence but not CVD risk factor control among African Americans with diabetes. Further research is needed to determine how to maximally impact CVD risk factors in African American patients.
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Affiliation(s)
- Matthew J Crowley
- Center for Health Services Research in Primary Care, Durham VAMC, Durham, NC, USA.
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Robben SHM, Heinen MM, Makai P, Olde Rikkert MGM, Perry M, Schers HJ, Melis RJF. [Reducing fragmentation in the care of frail older people: the successful development and implementation of the Health and Welfare Information Portal]. Tijdschr Gerontol Geriatr 2013; 44:59-71. [PMID: 23494689 DOI: 10.1007/s12439-013-0014-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Our fragmented health care systems are insufficiently equipped to provide frail older people with high quality of care. Therefore, we developed the Health and Welfare Information Portal (ZWIP), an e-health intervention which aims (1) to facilitate self-management by frail older people and informal caregivers and (2) to improve collaboration among professionals. The ZWIP is a personal conference table, accessible through a secure internet connection, for multidisciplinary communication and information exchange for frail older people, their informal caregivers and professionals. After development, the ZWIP was implemented in seven general practices, and this process was evaluated by means of a mixed-methods study. Eventually, 290 frail older people and 169 professionals participated in the ZWIP. Most professionals were positive about its implementation. Facilitators for the implementation were the experienced need for improvement of interprofessional collaboration and the user-friendliness of the ZWIP. Barriers were the low computer-literacy of frail older people, start-up problems, preferring personal contact, and limited use of the ZWIP by other professionals. In sum, this article describes the successful development and implementation of the ZWIP, an e-health intervention which can reduce fragmentation in the care of frail older people.
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Affiliation(s)
- S H M Robben
- Arts in opleiding tot klinisch geriater, Afdeling Klinische Geriatrie, UMC St Radboud, Nijmegen, The Netherlands.
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Robben S, van Kempen J, Heinen M, Zuidema S, Olde Rikkert M, Schers H, Melis R. Preferences for receiving information among frail older adults and their informal caregivers: a qualitative study. Fam Pract 2012; 29:742-7. [PMID: 22532402 DOI: 10.1093/fampra/cms033] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Patient involvement in clinical decision making is increasingly advocated. Although older patients may be more reluctant to become involved, most do appreciate being informed. However, knowledge about their experiences with and preferences for receiving information is limited, and even less is known about these topics for frail older people. OBJECTIVE To explore the experiences of frail older people and informal caregivers with receiving information from health care professionals as well as their preferences for receiving information. METHODS We conducted semi-structured interviews with frail older people (n = 11, 65-90 years) and informal caregivers (n = 11, 55-87 years). Interviews were transcribed verbatim and analysed using a grounded theory approach. RESULTS Frail older people and informal caregivers varied in their information needs and discussed both positive and negative experiences with receiving information. They preferred receiving verbal information from their physician during the consultation; yet would appreciate receiving brief, clearly written information leaflets in addition. They employed several strategies to enhance the information provided, i.e. advocacy, preparing for a consultation and searching their own information. Contextual factors for receiving information, such as having enough time and having a good relationship with professionals involved, were considered of great importance. CONCLUSIONS Participants described a wide range of experiences with and preferences for receiving information. However, even if the information provided would meet all their preferences, this would be of limited significance if not provided within the context of an ongoing trusting relationship with a professional, such as a GP or practice nurse, who genuinely cared for them.
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Affiliation(s)
- Sarah Robben
- Department of Geriatric Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
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A scoping review and thematic classification of patient complexity: offering a unifying framework. JOURNAL OF COMORBIDITY 2012; 2:1-9. [PMID: 29090137 PMCID: PMC5556402 DOI: 10.15256/joc.2012.2.15] [Citation(s) in RCA: 110] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Accepted: 09/04/2012] [Indexed: 11/18/2022]
Abstract
The path to improving healthcare quality for individuals with complex health conditions is complicated by a lack of common understanding of complexity. Modern medicine, together with social and environmental factors, has extended life, leading to a growing population of patients with chronic conditions. In many cases, there are social and psychological factors that impact treatment, health outcomes, and quality of life. This is the face of complexity. Care challenges, burden, and cost have positioned complexity as an important health issue. Complex chronic conditions are now being discussed by clinicians, researchers, and policy-makers around such issues as quantification, payment schemes, transitions, management models, clinical practice, and improved patient experience. We conducted a scoping review of the literature for definitions and descriptions of complexity. We provide an overview of complex chronic conditions, and what is known about complexity, and describe variations in how it is understood. We developed a Complexity Framework from these findings to guide our approach to understanding patient complexity. It is critical to use common vernacular and conceptualization of complexity to improve service and outcomes for patients with complex chronic conditions. Many questions still persist about how to develop this work with a health and social care lens; our framework offers a foundation to structure thinking about complex patients. Further insight into patient complexity can inform treatment models and goals of care, and identify required services and barriers to the management of complexity. Journal of Comorbidity 2012;2:1–9
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