Determinants associated with deprivation in multimorbid patients in primary care-A cross-sectional study in Switzerland

Understanding the impact of the COVID-19-related lockdown in university workers. Identifying groups through cluster analysis

Objective

To analyse the COVID-19-related lockdown impact on University workers, to identify groups based on this information, and to study the factors associated with each group.

Study design

Cross-sectional study.

Methods

A survey was conducted 3.5 weeks after COVID-19-related lockdown in University workers in Spain. Sociodemographic variables, housing, work, health conditions, levels of anxiety, stress and depression (DASS-21), and social support (MSPSS) were collected. A cluster analysis was performed to identify groups depending on the impact of the lockdown. Differences between groups were tested using Chi-square and Mann-Whitney-U tests, and associated factors with binary logistic regression.

Results

We identified two groups of workers. "G1: Consequences in the daily life routine" was mainly composed of men, Research and Teaching Personnel (RTP) with more stable professional categories, higher income level, and bigger houses than people in G2. Participants in "G2: Concerns for the current and future well-being" presented worse intensity of pain than before the lockdown, more anxiety, depression, stress and less social support than people in G1. ASP (Administration and Services Personnel) had more risk of belonging to G2 than RTP (OR = 5.863). A higher number of people living at home decreased the risk of being in G2 (OR = 0.439). People with lower pain intensity had less risk of being in G2 (OR = 0.014), and this risk decreased as friends support increased (OR = 0.833).

Conclusions

In G1, the consequences were immediately reflected in the stress resulting from changes in their daily work routine. In G2, the concerns were related to their professional future, with worse mental health, greater intensity of pain and less social support.

Becoming a secondary actor of one's own life: A qualitative study of the experiences of informal caregivers in the care of people with chronic pain

INTRODUCTION

The physical limitations experienced by people with chronic pain (CP) produce a greater need for care and assistance, most of which is provided by an informal caregiver (IC). Despite the key role ICs play in the everyday lives of individuals living with CP, knowledge about their experiences and needs is limited. We aimed to address this limitation by exploring the experiences of IC of people with CP.

METHODS

This is a qualitative descriptive study using semistructured interviews. Participants were 12 ICs purposively chosen from the Unit of Pain at the University Hospital in Cádiz. Individual interviews were recorded, transcribed verbatim and analysed following thematic analysis.

RESULTS

We developed one overarching theme 'Becoming a secondary actor of one's own life' and three themes: 1. Key elements that shape a caregiver's experiences; 2. It's the hand that life dealt me; 3. The burden of being a caregiver and coping strategies.

CONCLUSIONS

This study's findings highlight how the CP impacts IC lives. Being an IC for a relative with CP became the most important role in the IC's life, to the point of casting a shadow over their own needs. Besides, participants felt not having other options but to keep going with that role. Yet, the context was essential in shaping the experiences as caregivers and the burden derived from caregiving. In this line, differences related to gender roles were found in the narratives of participant women and men.

PATIENT OR PUBLIC CONTRIBUTION

Participants were purposively chosen from the Unit of Pain at the University Hospital 'Puerta del Mar' who attended the consultation accompanying their relatives. All the eligible participants were approached by the clinician. After this initial approach by the clinician, one of the researchers met the potential participant and they went to a quieter place in a clinical setting for the interview, before which the participant was shown a letter with more comprehensive information about the study and its aim. The participants were left alone to read and think carefully before giving their written informed consent. Participation was voluntary and the subjects received no financial contribution for their time.

Modelling Deprivation Level and Multimorbidity in a Health District

Deprivation is associated with an increased risk of developing chronic health conditions and with worse outcomes in multimorbidity. The goal of our study was to develop an integrated population index of deprivation (IPID) to observe the influence of deprivation on morbidity and the subsequent use of healthcare resources in one health district, using the socioeconomic, clinical and geographical data from its administrative health records. Eight socioeconomic indicators were identified and weighted using the methodology of two-phase principal component analysis, providing an index that allowed each census section to be classified into seven deprivation groups. Secondly, the possible relation between the IPID and the variables for multimorbidity and healthcare resources was analysed using the theory of multiple comparisons. It was observed that places with a greater proportion of healthy people presented lower values of deprivation and that, at lower levels of deprivation, there were fewer hospital admissions. The results show that living in an area with a higher deprivation index is associated with greater consumption of healthcare resources and disease burden. Identifying areas of sociosanitary vulnerability can help to identify health inequalities and allow intervention by clinical practices and healthcare management to reduce them.

Chronic widespread pain in children and adolescents presenting in primary care: prevalence and associated risk factors

ABSTRACT

A significant proportion of children/adolescents report chronic widespread pain (CWP), but little is known about clinically relevant CWP or what factors lead to onset in this population. Objectives were to report the primary care consultation prevalence of CWP and investigate risk factors associated with onset. A validated algorithm for identifying CWP status from primary care electronic healthcare records was applied to a child or adolescent population (aged 8-18 years). The algorithm records patients who have recurrent pain consultations (axial skeleton and upper or lower limbs) or those with a nonspecific generalised pain disorder (eg, fibromyalgia). Prevalence was described, and a nested case-control study was established to identify risk factors associated with CWP onset using logistic regression producing odds ratios (ORs) and 95% confidence intervals (95% CIs). Two hundred seventy-one children or adolescents were identified with CWP, resulting in a 5-year consultation prevalence of 3.19%. Risk factors significantly associated with CWP onset were as follows: mental health (eg, anxiety/neurosis consultations), neurological (eg, headaches), genitourinary (eg, cystitis), gastrointestinal (eg, abdominal pain), and throat problems (eg, sore throats). Children or adolescents with 1 or 2 risk factors (OR 2.15, 95% CI 1.6-2.9) or 3 or more risk factors (OR 9.17, 95% CI 5.9-14.3) were at significantly increased odds of CWP onset compared with those with none. Findings show a significant proportion of the child or adolescent primary care population has CWP. Most risk factors involved pain-related conditions, suggesting potential pathways of pain development. Further work is now needed to better understand the development of CWP in children and adolescents.

Exploring the ability of self-report measures to identify risk of high treatment burden in chronic disease patients: a cross-sectional study

Background

Effective self-management of chronic health conditions is key to avoiding disease escalation and poor health outcomes, but self-management abilities vary. Adequate patient capacity, in terms of abilities and resources, is needed to effectively manage the treatment burden associated with chronic health conditions. The ability to measure different elements of capacity, as well as treatment burden, may assist to identify those at risk of poor self-management. Our aims were to: 1. Investigate correlations between established self-report tools measuring aspects of patient capacity, and treatment burden; and 2. Explore whether individual questions from the self-report tools will correlate to perceived treatment burden without loss of explanation. This may assist in the development of a clinical screening tool to identify people at risk of high treatment burden.

Methods

A cross-sectional survey in both a postal and online format. Patients reporting one or more chronic diseases completed validated self-report scales assessing social, financial, physical and emotional capacity; quality of life; and perceived treatment burden. Logistic regression analysis was used to explore relationships between different capacity variables, and perceived high treatment burden.

Results

Respondents (n = 183) were mostly female (78%) with a mean age of 60 years. Most participants were multimorbid (94%), with 45% reporting more than five conditions. 51% reported a high treatment burden. Following logistic regression analyses, high perceived treatment burden was correlated with younger age, material deprivation, low self-efficacy and usual activity limitation. These factors accounted for 50.7% of the variance in high perceived treatment burden. Neither disease burden nor specific diagnosis was correlated with treatment burden.

Conclusions

This study supports previous observations that psychosocial factors may be more influential than specific diagnoses for multimorbid patients in managing their treatment workload. A simple capacity measure may be useful to identify those who are likely to struggle with healthcare demands.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-022-12579-1.

Nurse navigators and person-centred care; delivered but not valued?

Positioning the individual at the centre of care (person-centred care [PCC]) is essential to improving outcomes for people living with multiple chronic conditions. However, research also suggests that this is structurally challenging because health systems continue to adopt long-standing, episodic care encounters. One strategy to provide a more cohesive, individualised approach to care is the implementation of the nurse navigator role. Current research shows that although PCC is a focus of navigation, such care may be hindered by the rigid, systematised health services providing siloed specialist care. In this paper, we utilised a case study method to investigate the experiences of a nurse navigator and patient. The nurse navigator and the patient participated in individual interviews, the transcripts of which were analysed using critical discourse analysis. Findings from a larger research project suggest that traditional measures (hospital avoidance, emergency department usage) which work as the service objectives of the nurse navigator service have the potential to stifle the delivery of PCC. The analysis from this case study supports the broader findings and further highlights the need for improved alignment between service objectives and the health and well-being of the individuals utilising the services.

Journey to multimorbidity: longitudinal analysis exploring cardiovascular risk factors and sociodemographic determinants in an urban setting

OBJECTIVE

To study the social determinants and cardiovascular risk factors for multimorbidity and the acquisition sequence of multimorbidity.

DESIGN

Longitudinal study based on anonymised primary care data.

SETTING

General practices in an urban multiethnic borough in London, UK.

PARTICIPANTS

332 353 patients aged ≥18 years.

MAIN OUTCOME MEASURES

Clinical and sociodemographic characteristics of patients with multimorbidity, defined as ≥3 of 12 long-term conditions (LTCs) selected according to high predicted healthcare use. Multilevel logistic regression was used to model social determinants and cardiovascular risk factors. Alluvial plots were constructed to illustrate multimorbidity acquisition sequences according to age, ethnicity and social deprivation.

RESULTS

5597 (1.7%) patients had ≥3 selected LTCs, the 'multimorbidity cohort'. The the most common LTCs were diabetes (63.0%) and chronic pain (CP) (42.8%). Social deprivation and ethnicity were independent determinants of multimorbidity: most compared with the least deprived quintile (adjusted OR (AOR) 1.56 (95% CI 1.41 to 1.72)); South Asian compared with white ethnicity (AOR 1.44 (95% CI 1.29 to 1.61)); and black compared with white ethnicity (AOR 0.86 (95% CI 0.80 to 0.92)). The included cardiovascular risk factors were relatively strong determinants of multimorbidity: hypertension (AOR 5.05 (95% CI 4.69 to 5.44)), moderate obesity (AOR 3.41 (95% CI 3.21 to 3.63)) and smoking (AOR 2.30 (95% CI 2.16 to 2.45)). The most common initial onset conditions were diabetes and depression; diabetes particularly in older and black ethnic groups; and depression particularly in younger, more deprived and white ethnicity groups. CP was less common as an initial condition.

CONCLUSION

Our findings confirm the importance of age, social deprivation and ethnicity as determinants of multimorbidity. Smoking, obesity and hypertension as cardiovascular risk factors were stronger determinants of multimorbidity than deprivation or ethnicity. The acquisition sequence of multimorbidity is patterned by sociodemographic determinants. Understanding onset conditions of multimorbidity and cardiovascular cardiovascular risk factors may lead to the development of interventions to slow the progression of multimorbidity.