Validation of the patient assessment of chronic illness care (PACIC) short form scale in heart transplant recipients: the international cross-sectional bright study

Trust in the Transplant Team Associated With the Level of Chronic Illness Management-A Secondary Data Analysis of the International BRIGHT Study

A trustful relationship between transplant patients and their transplant team (interpersonal trust) is essential in order to achieve positive health outcomes and behaviors. We aimed to 1) explore variability of trust in transplant teams; 2) explore the association between the level of chronic illness management and trust; 3) investigate the relationship of trust on behavioral outcomes. A secondary data analysis of the BRIGHT study (ID: NCT01608477; https://clinicaltrials.gov/ct2/show/NCT01608477?id=NCT01608477&rank=1) was conducted, including multicenter data from 36 heart transplant centers from 11 countries across four different continents. A total of 1,397 heart transplant recipients and 100 clinicians were enrolled. Trust significantly varied among the transplant centers. Higher levels of chronic illness management were significantly associated with greater trust in the transplant team (patients: AOR= 1.85, 95% CI = 1.47-2.33, p < 0.001; clinicians: AOR = 1.35, 95% CI = 1.07-1.71, p = 0.012). Consultation time significantly moderated the relationship between chronic illness management levels and trust only when clinicians spent ≥30 min with patients. Trust was significantly associated with better diet adherence (OR = 1.34, 95%CI = 1.01-1.77, p = 0.040). Findings indicate the relevance of trust and chronic illness management in the transplant ecosystem to achieve improved transplant outcomes. Thus, further investment in re-engineering of transplant follow-up toward chronic illness management, and sufficient time for consultations is required.

Patient Assessment Chronic Illness Care (PACIC) and its associations with quality of life among Swiss patients with systemic sclerosis: a mixed methods study

BACKGROUND

The Chronic Care Model (CCM) is a longstanding and widely adopted model guiding chronic illness management. Little is known about how CCM elements are implemented in rare disease care or how patients' care experiences relate to health-related quality of life (HRQoL). We engaged patients living with systemic sclerosis (SSc) to assess current care according to the CCM from the patient perspective and their HRQoL.

METHODS

We employed an explanatory sequential mixed methods design. First, we conducted a cross-sectional quantitative survey (n = 101) using the Patient Assessment of Chronic Illness Care (PACIC) and Systemic Sclerosis Quality of Life (SScQoL) questionnaires. Next, we used data from individual patient interviews (n = 4) and one patient focus group (n = 4) to further explore care experiences of people living with SSc with a focus on the PACIC dimensions.

RESULTS

The mean overall PACIC score was 3.0/5.0 (95% CI 2.8-3.2, n = 100), indicating care was 'never' to 'generally not' aligned with the CCM. Lowest PACIC subscale scores related to 'goal setting/tailoring' (mean = 2.5, 95% CI 2.2-2.7) and 'problem solving/contextual counselling' (mean = 2.9, 95% CI 2.7-3.2). No significant correlations were identified between the mean PACIC and SScQoL scores. Interviews revealed patients frequently encounter major shortcomings in care including 'experiencing organized care with limited participation', 'not knowing which strategies are effective or harmful' and 'feeling left alone with disease and psychosocial consequences'. Patients often responded to challenges by 'dealing with the illness in tailored measure', 'taking over complex coordination of care' and 'relying on an accessible and trustworthy team'.

CONCLUSIONS

The low PACIC mean overall score is comparable to findings in patients with common chronic diseases. Key elements of the CCM have yet to be systematically implemented in Swiss SSc management. Identified gaps in care related to lack of shared decision-making, goal-setting and individual counselling-aspects that are essential for supporting patient self-management skills. Furthermore, there appears to be a lack of complex care coordination tailored to individual patient needs.

The relationship between the perception of chronic disease care and health-related quality of life in adults with chronic kidney disease

OBJECTIVES

In this study, it was aimed to determine the chronic disease care assessments and health-related quality of life (HRQoL) levels in adults with chronic kidney disease (CKD) undergoing hemodialysis and to reveal the relationship between chronic disease care assessment and HRQoL.

METHODS

A single-center cross-sectional design has been used. Data were collected from 105 adults with CKD, who undergoing hemodialysis. Patient Evaluation Chronic Illness Care (PACIC) scale and Kidney Disease Quality of Life Short Form-36 (KDQOL-36) were used to obtain data.

RESULTS

The mean scale scores of PACIC were low (2.66 ± 0.891). Although participants achieved high HRQoL scores on the symptoms subdimension of the KDQoL-36 scale, they got low scores on the subdimensions of mental health, physical health, and burden of disease. Participants' HRQoL is affected significantly by gender, age, educational level, working status, income, and presence of comorbidity (especially diabetes), diagnosis time of CKD, and hemodialysis time at the hospital (p < 0.05). A positive and statistically significant relationship was found between PACIC and subdimensions of KDQoL-36 (p < 0.05).

DISCUSSION

The results can be a guide for improving the quality of chronic disease care in healthcare institutions. To improve this, patients' evaluations on this issue should be taken into account.

Patients' Assessment of Chronic Illness Care (PACIC): Validation and Evaluation of PACIC Scale among Patients with Type 2 Diabetes in Hungary

Introduction:

The aims of this study were to evaluate the psychometric properties of the Hungarian translation of the PACIC in a sample of patients with type 2 diabetes and to reveal the associations between the mean PACIC scores and the number of chronic diseases, or visits to GPs, and specialist. An exploratory factor analysis (EFA) has also been performed to test the structural validity of the PACIC scale.

Methods:

The Hungarian version of PACIC was validated using randomly selected patients with type 2 diabetes (N = 684) from licensed GP practices.

Results:

Floor (1.6%–30.2%) and ceiling effects (11.3–33.6%) were similar of the PACIC scale. The internal consistency of the total scale (Cronbach’s alpha 0.93) was excellent and subscales were good (between 0.73–0.9). The mean scores of each PACIC subscale group were between 2.99–3.53. There was a weak significant correlation between the mean PACIC scores of subscales and the number of GP visits (p < 0.001), and specialist visits (p < 0.001). The EFA identified four factors on the sample (KMO = 0.931). Gender and education showed correlation with some new factors.

Conclusion:

The psychometric properties of the Hungarian version of PACIC questionnaire showed a reasonable level of validity among patients with type 2 diabetes. Now, this instrument is ready to assess the chronic care of diabetic patients in Hungary.

Effectiveness of mobile health-based self-management application for posttransplant cares: A systematic review

BACKGROUND AND AIMS

Patients after transplantation need medical management for the rest of their lives, and self-management seems to lead to greater adherence to medical standards, improve early physical changes, and increase patient empowerment. The main objective of this article is to systematic review of the consideration to mobile health applications (m-Health apps) used in transplantation.

METHODS

A systematic search was conducted MEDLINE (through PubMed), Web of Science, Scopus, and Science Direct from inception to November 2020. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) statement was used in this study. Comprehensive research was carried out using a combination of keywords and MeSH terms associated with m-Health, empowerment, self-management, and transplantation. Two independent reviewers screened titles and abstracts, assessed full-text articles, and extracted data from articles that met inclusion criteria. Eligible studies were original research articles that included posttransplant care and mobile phone-based applications to support self-management and self-care. Also, thesis, book chapters, letters to editors, short briefs, reports, technical reports, book reviews, systematic reviews, or meta-analysis were excluded.

RESULTS

We divided all the reviewed articles into four categories, self-management (medication adherence, adherence to medical regimen, and remote monitoring), evaluation, interaction, and interface; 37.5% of the studies were focused on lung transplantation. In 56.25% of the studies, medication adherence was considered because one of the main reasons for the rejection and graft loss is stated medication nonadherence. Also, 62.5% of the studies demonstrated that the use of m-health improved medication adherence and self-management in transplantation.

CONCLUSIONS

The use of m-Health apps interventions to self-management after transplantation has shown promising feasibility and acceptability, and there is modest evidence to support the efficacy of these interventions. We found that m-Health solutions can help the patient in self-management in many ways after transplantation.

[Quality of care in family practice and quality of life from the point of view of older patients with gon- and coxosteoarthritis - results from the MobilE-TRA cohort study]

BACKGROUND

A central role in the care of patients with osteoarthritis has the family practice. The aim of this analysis is to assess the association between the quality of family practice care from the osteoarthritis patients' perspectives and their health-related quality of life, disease-specific symptoms, and physical function.

METHOD

111 patients suffering from cox- and/or gonosteoarthritis at the age of 65 or older had been recruited from family practices in Saxony and Bavaria. The participants received a paper-based questionnaire that assessed their sociodemographic data, the patients' level of depression (PHQ-9), physical activity, health-related quality of life (EQ-5D with EQ-VAS), as well as the quality of care in family practice from the patients' perspectives (PACIC short form). Furthermore, disease-specific symptoms (pain, stiffness) and physical function of patients with osteoarthritis were investigated (WOMAC). The analysis was performed with multiple linear regression models.

RESULTS

A greater extent of depression was associated with stronger pain (beta=0,378; 95% CI [0,180; 0,576]), more stiffness of the joints (beta=0,223; 95% CI [0,135; 0,310]), and worse physical function (beta=1,628; 95% CI [0,908; 2,348]). The analysis also showed that older (beta=-0,901; 95% CI [-1,705; -0,097]), more depressive (beta=-1,654; 95% CI [-2,820; -0,488]) osteoarthritis patients were associated with a lower health-related quality of life. A statistically significant association between the quality of family practice care from the patients' perspectives and their health-related quality of life, disease-specific symptoms, and physical function could not be detected.

CONCLUSIONS

Previous literature provides evidence for an association between the quality of care of patients with a chronic illness and their quality of life or other health outcomes. The results of this research work did not align with these findings. Since depression was associated with decreased health-related quality of life and more severe complaints of patients suffering from osteoarthritis, potential depressive comorbidity should not be disregarded in the health care of this patient group and should be treated if necessary.