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Sadeghi H, Mohammadi Shahbolaghi F, Hosseini M, Fallahi-Khoshknab M, Ghaedamini Harouni G. Factors associated with self-management in older adults with multiple chronic conditions: a qualitative study. Front Public Health 2024; 12:1412832. [PMID: 39346598 PMCID: PMC11429008 DOI: 10.3389/fpubh.2024.1412832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2024] [Accepted: 08/30/2024] [Indexed: 10/01/2024] Open
Abstract
Background and purpose Recognizing the importance of self-management in older adults with multiple chronic conditions (MCCs) is crucial for their quality of life. This qualitative study explored the factors linked to self-management among older adults with MCCs. Materials and methods The present study was conducted in three stages: an integrated review, qualitative interviews, and Delphi. The search used electronic databases including Web of Science, PubMed, Scopus, Magiran, SID, and Iranmedex. The results of 33 studies that met the inclusion criteria were analyzed using conventional content analysis. A data matrix was formed; and purposeful sampling was conducted among older adults with MCCs, family caregivers, and specialists. The data were collected through semi-structured interviews. Data analysis of 29 interviews was conducted simultaneously with data collection using oriented qualitative content analysis and the Elo and Kyngäs approach. Three rounds of Delphi were conducted via email correspondence with a group of 30 experts to develop and validate the proposed variables. Results The factors that influence self-management can be categorized into various categories. Biological factors, cognitive factors, co-morbidities, socio-economic factors, health-related behaviors, mental health, interactions with healthcare teams, Family relationships, medical facility resources, employee empowerment, health policy development, and cultural influences. Conclusion Self-management in older Iranian adults with MCCs is a complex and multidimensional phenomenon. By identifying the relevant factors, it is possible to design operational plans that promote self-management among the older adult population and are tailored to fit the specific needs of Iranian society.
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Affiliation(s)
- Hajar Sadeghi
- Nursing Department, Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Farahnaz Mohammadi Shahbolaghi
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammadali Hosseini
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Masoud Fallahi-Khoshknab
- Nursing Department, Iranian Research Center on Aging, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Gholamreza Ghaedamini Harouni
- Social Welfare Management Research Center, Social Health Research Institute, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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Liu X, Zhang J, Zhang S, Peng S, Pei M, Dai C, Wang T, Zhang P. Quality of life and associated factors among community-dwelling adults with multimorbidity in Shanghai, China: A cross-sectional study. Nurs Open 2023. [PMID: 37243492 DOI: 10.1002/nop2.1770] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 01/23/2023] [Accepted: 04/16/2023] [Indexed: 05/28/2023] Open
Abstract
AIM To compare the quality of life of patients with and without multimorbidity and investigate potential factors related to the quality of life in patients with multimorbidity. DESIGN A descriptive cross-sectional study. METHODS This study included 1778 residents with chronic diseases, including single disease (1255 people, average age: 60.78 ± 9.42) and multimorbidity (523 people, average age: 64.03 ± 8.91) groups, who were recruited from urban residents of Shanghai through a multistage, stratified, probability proportional to size sampling method. The quality of life was measured using the World Health Organization Quality of Life Questionnaire. The socio-demographic data and psychological states were measured using a self-made structured questionnaire, Self-rating Anxiety Scale, and Self-rating Depression Scale. Differences in demographic characteristics were estimated using Pearson's chi-squared test, and independent t-test or one-way ANOVA followed by S-N-K test was used to compare the mean quality of life. Multiple linear regression analysis was conducted to identify risk factors for multimorbidity. RESULTS There were differences in age, education, income, and BMI between single-disease and multimorbidity groups, but no differences in gender, marriage, and occupation. Multimorbidity had lower quality of life, reflected in all four domains. Multiple linear regression analyses showed that low level of education, low income, number of diseases, depression, and anxiety were negatively related to quality of life in all domains.
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Affiliation(s)
- Xingyue Liu
- Graduate School, Shanghai University of Medicine & Health Sciences, Shanghai, China
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Juhua Zhang
- Department of integrated traditional Chinese and Western Medicine, Shanghai University of Medicine and Health Sciences Affiliated Zhoupu Hospital, Shanghai, China
| | - Shixiang Zhang
- School of Nursing & Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Shuzhi Peng
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Mengyun Pei
- Graduate School, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Chunying Dai
- Department of medicine, Kashgar Vocational and Technical College, Kashgar, China
| | - Tingting Wang
- School of Nursing & Health Management, Shanghai University of Medicine & Health Sciences, Shanghai, China
| | - Peng Zhang
- School of Management, Hainan Medical University, Haikou, China
- School of Clinical Medicine, Shanghai University of Medicine & Health Sciences, Shanghai, China
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The impact of nurse practitioner and physician assistant workforce supply on Medicaid-related emergency department visits and hospitalizations. J Am Assoc Nurse Pract 2021; 33:1190-1197. [PMID: 33534285 DOI: 10.1097/jxx.0000000000000542] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 10/02/2020] [Indexed: 11/25/2022]
Abstract
BACKGROUND New York State (NYS) has approximately 4.7 million Medicaid beneficiaries with 75% having at least one or more chronic conditions. An estimated 10% of Medicaid beneficiaries seek emergency department (ED) services for nonurgent matters. It is unclear if an increased supply of nurse practitioners (NPs) and physician assistants (PAs) impact utilization of ED and subsequent hospitalizations for chronic conditions. PURPOSE To investigate the relationship between NYS workforce supply (physicians, NPs, and PAs) and 1) ED use and 2) in-patient hospitalizations for chronically ill Medicaid beneficiaries. METHODS A cross-sectional study design was employed by calculating total workforce supply per NYS county and the proportion of physicians, NPs, and PAs per total number of Medicaid beneficiaries. We extracted the frequencies of all NYS Medicaid beneficiary chronic condition-related ED visits and in-patient admissions. Medicaid beneficiaries were considered to have a chronic condition if there was a claim indicating that the beneficiary received a service or treatment for this specific condition. We calculated the proportion of ED visits/beneficiary for each chronic disease category and the proportion of category-specific in-patient hospitalizations per the number of beneficiaries with that diagnosis. RESULTS As the NP/beneficiary proportion increased, ED visits for dual and nondual eligible beneficiaries decreased (p = .007; β = -2.218; 95% confidence interval [CI]: -3.79 to -0.644 and p = .04; β = -2.698; 95% CI: -5.268 to -0.127, respectively). IMPLICATIONS FOR PRACTICE Counties with a higher proportion of NPs and PAs had significantly lower numbers of ED visits and hospitalizations for Medicaid beneficiaries.
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Vazquez J, Islam T, Gursky J, Beller J, Correa DJ. Access to Care Matters: Remote Health Care Needs During COVID-19. Telemed J E Health 2020; 27:468-471. [PMID: 33017270 DOI: 10.1089/tmj.2020.0371] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Background: The coronavirus disease 2019 (COVID-19) pandemic is straining health care worldwide with >31 million confirmed cases. Currently, 1 in every 100 U.S. residents and 245,000 in New York City are confirmed positive. The Bronx, with high-risk comorbidities, due in part to socioeconomic factors, has seen disproportionately higher rates of COVID-19-related complications. Poor health care access is exacerbated as in-person visits now pose viral transmission risk. There has been limited discourse regarding widespread disparities underlying transitions to telemedicine. Methods: We review perspectives in recent literature on telemedicine and its potential within neurology. Results: While telemedicine has reduced strain on in-person visits, preliminary reflections highlight implementation successes and challenges. Conclusions: To provide effective care beyond this crisis, fundamental changes in training, technological accessibility, and health care policy are needed. We propose open access to telehealth training, screening of patient's potential technological inequities and socioeconomic insecurities, and advocacy to secure broad long-term access to telehealth care.
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Affiliation(s)
- Juan Vazquez
- Albert Einstein College of Medicine, Bronx, New York, USA
| | | | - Jonathan Gursky
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.,Department of Neurology, Montefiore Medical Center, Bronx, New York, USA
| | - Jennifer Beller
- Department of Neurology, Montefiore Medical Center, Bronx, New York, USA
| | - Daniel Jose Correa
- Saul R. Korey Department of Neurology, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, New York, USA.,Department of Neurology, Montefiore Medical Center, Bronx, New York, USA
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Newman D, Tong M, Levine E, Kishore S. Prevalence of multiple chronic conditions by U.S. state and territory, 2017. PLoS One 2020; 15:e0232346. [PMID: 32369509 PMCID: PMC7199953 DOI: 10.1371/journal.pone.0232346] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 04/14/2020] [Indexed: 11/18/2022] Open
Abstract
Having multiple (two or more) chronic conditions (MCC) is associated with an increased risk of mortality and functional decline, health resource utilization, and healthcare expenditures. As a result, understanding the prevalence of MCC is increasingly being recognized as a public health imperative. This research describes the prevalence and distribution of adults with MCC across the United States using 2017 data from the Behavioral Risk Factors Surveillance System (BRFSS). Prevalence of MCC was calculated for each U.S. state and territory overall, by sex and by age. Additionally, the most common condition dyads (two condition combinations) and triads (three condition combinations) were assessed for each state. Prevalence of MCC ranged from 37.9% in the District of Columbia to 64.4% in West Virginia. Females had a higher prevalence than males in 47 of 53 states and territories, and MCC prevalence increased with age in every state and territory. Overall prevalence estimates were higher than estimates using data from the National Health Interview Survey (NHIS), especially in the younger population (aged 18–44), due partly to the inclusion of high cholesterol, obesity, and depression as chronic conditions. Analysis of the most prevalent dyads and triads revealed the greatest state-by-state variability in the 18-44-year-old population. Multiple states’ most prevalent dyads and triads for this population included obesity and depression. These findings build an accurate picture of the prevalence of multiple chronic conditions across the United States and will aid public health officials in creating programs targeted to their region.
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Affiliation(s)
- Daniel Newman
- Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- * E-mail:
| | - Michelle Tong
- Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Erica Levine
- Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
| | - Sandeep Kishore
- Arnhold Institute for Global Health at the Icahn School of Medicine at Mount Sinai, New York, New York, United States of America
- Brigham & Women’s Hospital, Harvard Medical School, Boston, Massachusetts, United States of America
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Stone CL. A population-based measure of chronic disease severity for health planning and evaluation in the United States. AIMS Public Health 2020; 7:44-65. [PMID: 32258189 PMCID: PMC7109540 DOI: 10.3934/publichealth.2020006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 01/16/2020] [Indexed: 12/11/2022] Open
Abstract
In the healthcare sector, patients can be categorized into clinical risk groups, which are based, in part, on multiple chronic conditions. Population-based measures of clinical risk groups for population health planning, however, are not available. Using responses of working-age adults (19-64 years old) from the Behavioral Risk Factor Surveillance System for survey years 2015-2017, a population-based measure of chronic disease severity (CDS) was developed as a proxy for clinical risk groups. Four categories of CDS were developed: low, medium-low, medium-high, and high, based on self-reported diagnoses of multiple chronic conditions, weighted by hospitalization costs. Prevalence estimates of CDS were prepared, by population demographics and state characteristics, and CDS association with perceived health-related quality of life (HRQOL) was evaluated. Age-adjusted CDS varied from 72.9% (95% CI: 72.7-73.1%) for low CDS, to 21.0% (95% CI: 20.8-21.2%), 4.4% (95% CI: 4.3-4.5%) and 1.7% (95% CI: 1.6-1.8%) for medium-low, medium-high, and high CDS, respectively. The prevalence of high CDS was significantly greater (p < 0.05) among older adults, those living below the federal poverty level, and those with disabilities. The adjusted odds of fair/poor perceived HRQOL among adults with medium-low or medium-high/high CDS were 2.39 times (95% CI: 2.30-2.48) or 6.53 times (95% CI: 6.22-6.86) higher, respectively, than adults with low CDS. Elevated odds of fair/poor HRQOL with increasing CDS coincided with less prevalence of high CDS among men, minority race/ethnicities, and adults without insurance, suggesting a link between CDS and risk of mortality. Prevalence of high CDS was significantly higher (p < 0.05) in states with lower population density, lower per capita income, and in states that did not adopt the ACA. These results demonstrate the relevance of a single continuous population-based measure of chronic disease severity for health planning at the state, regional, and national levels.
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Affiliation(s)
- Carol L. Stone
- Institute for Families in Society, University of South Carolina, Columbia, SC, USA
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Petarli GB, Cattafesta M, Sant’Anna MM, Bezerra OMDPA, Zandonade E, Salaroli LB. Multimorbidity and complex multimorbidity in Brazilian rural workers. PLoS One 2019; 14:e0225416. [PMID: 31743369 PMCID: PMC6863555 DOI: 10.1371/journal.pone.0225416] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2019] [Accepted: 11/03/2019] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE To estimate the prevalence of multimorbidity and complex multimorbidity in rural workers and their association with sociodemographic characteristics, occupational contact with pesticides, lifestyle and clinical condition. METHODS This is a cross-sectional epidemiological study with 806 farmers from the main agricultural municipality of the state of Espírito Santo/Brazil, conducted from December 2016 to April 2017. Multimorbidity was defined as the presence of two or more chronic diseases in the same individual, while complex multimorbidity was classified as the occurrence of three or more chronic conditions affecting three or more body systems. Socio-demographic data, occupational contact with pesticides, lifestyle data and clinical condition data were collected through a structured questionnaire. Binary logistic regression was conducted to identify risk factors for multimorbidity. RESULTS The prevalence of multimorbidity among farmers was 41.5% (n = 328), and complex multimorbidity was 16.7% (n = 132). More than 77% of farmers had at least one chronic illness. Hypertension, dyslipidemia and depression were the most prevalent morbidities. Being 40 years or older (OR 3.33, 95% CI 2.06-5.39), previous medical diagnosis of pesticide poisoning (OR 1.89, 95% CI 1.03-3.44), high waist circumference (OR 2.82, CI 95% 1.98-4.02) and worse health self-assessment (OR 2.10, 95% CI 1.52-2.91) significantly increased the chances of multimorbidity. The same associations were found for the diagnosis of complex multimorbidity. CONCLUSION We identified a high prevalence of multimorbidity and complex multimorbidity among the evaluated farmers. These results were associated with increased age, abdominal fat, pesticide poisoning, and poor or fair health self-assessment. Public policies are necessary to prevent, control and treat this condition in this population.
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Affiliation(s)
- Glenda Blaser Petarli
- Postgraduate Program in Collective Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Monica Cattafesta
- Postgraduate Program in Collective Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | | | - Olívia Maria de Paula Alves Bezerra
- Department of Family Medicine, Mental and Collective Health, Medical school, Federal University of Ouro Preto, Ouro Preto, Minas Gerais, Brazil
| | - Eliana Zandonade
- Postgraduate Program in Collective Health, Health Sciences Center, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
| | - Luciane Bresciani Salaroli
- Postgraduate program in Nutrition and Health, and Graduate Program in Collective Health, Center for Health Sciences, Federal University of Espírito Santo, Vitória, Espírito Santo, Brazil
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Majumdar UB, Hunt C, Doupe P, Baum AJ, Heller DJ, Levine EL, Kumar R, Futterman R, Hajat C, Kishore SP. Multiple chronic conditions at a major urban health system: a retrospective cross-sectional analysis of frequencies, costs and comorbidity patterns. BMJ Open 2019; 9:e029340. [PMID: 31619421 PMCID: PMC6797368 DOI: 10.1136/bmjopen-2019-029340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To (1) examine the burden of multiple chronic conditions (MCC) in an urban health system, and (2) propose a methodology to identify subpopulations of interest based on diagnosis groups and costs. DESIGN Retrospective cross-sectional study. SETTING Mount Sinai Health System, set in all five boroughs of New York City, USA. PARTICIPANTS 192 085 adult (18+) plan members of capitated Medicaid contracts between the Healthfirst managed care organisation and the Mount Sinai Health System in the years 2012 to 2014. METHODS We classified adults as having 0, 1, 2, 3, 4 or 5+ chronic conditions from a list of 69 chronic conditions. After summarising the demographics, geography and prevalence of MCC within this population, we then described groups of patients (segments) using a novel methodology: we combinatorially defined 18 768 potential segments of patients by a pair of chronic conditions, a sex and an age group, and then ranked segments by (1) frequency, (2) cost and (3) ratios of observed to expected frequencies of co-occurring chronic conditions. We then compiled pairs of conditions that occur more frequently together than otherwise expected. RESULTS 61.5% of the study population suffers from two or more chronic conditions. The most frequent dyad was hypertension and hyperlipidaemia (19%) and the most frequent triad was diabetes, hypertension and hyperlipidaemia (10%). Women aged 50 to 65 with hypertension and hyperlipidaemia were the leading cost segment in the study population. Costs and prevalence of MCC increase with number of conditions and age. The disease dyads associated with the largest observed/expected ratios were pulmonary disease and myocardial infarction. Inter-borough range MCC prevalence was 16%. CONCLUSIONS In this low-income, urban population, MCC is more prevalent (61%) than nationally (42%), motivating further research and intervention in this population. By identifying potential target populations in an interpretable manner, this segmenting methodology has utility for health services analysts.
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Affiliation(s)
- Usnish B Majumdar
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | - Patrick Doupe
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Aaron J Baum
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David J Heller
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Health System Design and Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Erica L Levine
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | | | | | | | - Sandeep P Kishore
- Arnhold Institute for Global Health, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
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