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Lim WC, Dhesi JK. It Is Time to Prioritize Treatment Burden If We Want to Deliver Truly Patient-Centered Perioperative Care. Anesth Analg 2024:00000539-990000000-00785. [PMID: 38451862 DOI: 10.1213/ane.0000000000006777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Wan Chin Lim
- From the Management and Innovation for Longevity in Elderly Surgical Patients (MILES), Department of Surgery, National University of Singapore
- Quality, Innovation & Improvement and Department of Surgery, Ng Teng Fong General Hospital & Jurong Community Hospital
| | - Jugdeep K Dhesi
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Mangin D, Lamarche L, Templeton JA, Salerno J, Siu H, Trimble J, Ali A, Varughese J, Page A, Etherton-Beer C. Theoretical Underpinnings of a Model to Reduce Polypharmacy and Its Negative Health Effects: Introducing the Team Approach to Polypharmacy Evaluation and Reduction (TAPER). Drugs Aging 2023; 40:857-868. [PMID: 37603255 PMCID: PMC10450010 DOI: 10.1007/s40266-023-01055-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND Polypharmacy, particularly among older adults, is gaining recognition as an important risk to health. The harmful effects on health arise from disease-drug and drug-drug interactions, the cumulative burden of side effects from multiple medications and the burden to the patient. Single-disease clinical guidelines fail to consider the complex reality of optimising treatments for patients with multiple morbidities and medications. Efforts have been made to develop and implement interventions to reduce the risk of harmful effects, with some promising results. However, the theoretical basis (or pre-clinical work) that informed the development of these efforts, although likely undertaken, is unclear, difficult to find or inadequately described in publications. It is critical in interpreting effects and achieving effectiveness to understand the theoretical basis for such interventions. OBJECTIVE Our objective is to outline the theoretical underpinnings of the development of a new polypharmacy intervention: the Team Approach to Polypharmacy Evaluation and Reduction (TAPER). METHODS We examined deprescribing barriers at patient, provider, and system levels and mapped them to the chronic care model to understand the behavioural change requirements for a model to address polypharmacy. RESULTS Using the chronic care model framework for understanding the barriers, we developed a model for addressing polypharmacy. CONCLUSIONS We discuss how TAPER maps to address the specific patient-level, provider-level, and system-level barriers to deprescribing and aligns with three commonly used models and frameworks in medicine (the chronic care model, minimally disruptive medicine, the cumulative complexity model). We also describe how TAPER maps onto primary care principles, ultimately providing a description of the development of TAPER and a conceptualisation of the potential mechanisms by which TAPER reduces polypharmacy and its associated harms.
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Affiliation(s)
- Dee Mangin
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada.
- Department of General Practice, University of Otago, PO Box 4345, Christchurch, 8140, New Zealand.
| | - Larkin Lamarche
- School of Kinesiology and Health Science, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Jeffrey A Templeton
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Jennifer Salerno
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada
| | - Henry Siu
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Johanna Trimble
- Patient Voices Network of BC, 201-750 Pender Street West, Vancouver, BC, V6C 2T8, Canada
| | - Abbas Ali
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Jobin Varughese
- Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, L8P 1H6, Canada
| | - Amy Page
- School of Allied Health, University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
| | - Christopher Etherton-Beer
- Western Australia Centre for Health and Aging, School of Medicine, University of Western Australia, 35 Stirling Highway, Perth, WA, 6009, Australia
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Interventions and management on multimorbidity: An overview of systematic reviews. Ageing Res Rev 2023; 87:101901. [PMID: 36905961 DOI: 10.1016/j.arr.2023.101901] [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: 11/02/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Multimorbidity poses an immense burden on the healthcare systems globally, whereas the management strategies and guidelines for multimorbidity are poorly established. We aim to synthesize current evidence on interventions and management of multimorbidity. METHODS We searched four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews). Systematic reviews (SRs) on interventions or management of multimorbidity were included and evaluated. The methodological quality of each SR was assessed by the AMSTAR-2 tool, and the quality of evidence on the effectiveness of interventions was assessed by the grading of recommendations assessment, development and evaluation (GRADE) system. RESULTS A total of 30 SRs (464 unique underlying studies) were included, including 20 SRs of interventions and 10 SRs summarizing evidence on management of multimorbidity. Four categories of interventions were identified: patient-level interventions, provider-level interventions, organization-level interventions, and combined interventions (combining the aforementioned two or three- level components). The outcomes were categorized into six types: physical conditions/outcomes, mental conditions/outcomes, psychosocial outcomes/general health, healthcare utilization and costs, patients' behaviors, and care process outcomes. Combined interventions (with patient-level and provider-level components) were more effective in promoting physical conditions/outcomes, while patient-level interventions were more effective in promoting mental conditions/outcomes and psychosocial outcomes/general health. As for healthcare utilization and care process outcomes, organization-level and combined interventions (with organization-level components) were more effective. The challenges in the management of multimorbidity at the patient, provider and organizational levels were also summarized. CONCLUSION Combined interventions for multimorbidity at different levels would be favored to promote different types of health outcomes. Challenges exist in the management at the patient, provider, and organization levels. Therefore, a holistic and integrated approach of patient-, provider- and organization- level interventions is required to address the challenges and optimize care of patients with multimorbidity.
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Nwolise C, Corrie P, Fitzpatrick R, Gupta A, Jenkinson C, Middleton M, Matin R. Burden of cancer trial participation: A qualitative sub-study of the INTERIM feasibility RCT. Chronic Illn 2023; 19:81-94. [PMID: 34787471 PMCID: PMC9841458 DOI: 10.1177/17423953211060253] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 10/23/2021] [Indexed: 01/19/2023]
Abstract
OBJECTIVE A qualitative sub-study was carried out within a larger phase II feasibility trial, to identify and describe the burden experienced by advanced melanoma patients participating in a clinical trial and the factors affecting their capacity to cope with the burden. METHODS Semi-structured interviews were conducted with fourteen patients with advanced melanoma recruited from National Health Service hospitals in the United Kingdom. Qualitative analysis was undertaken using a framework analysis approach. Normalisation process theory was applied to the concept of research participation burden in order to interpret and categorise findings. RESULTS Burdens of participation were identified as arising from making sense of the trial and treatment; arranging transport, appointment and prescriptions; enacting management strategies and enduring side effects; reflecting on trial documents and treatment efficacy, and emotional and mental effects of randomisation and treatment side effects. Factors reported as influencing capacity include personal attributes and skills, physical and cognitive abilities and support network. DISCUSSION This is the first study to highlight the substantial burden faced by patients with advanced melanoma in a clinical trial and factors that may lessen or worsen the burden. Consideration of identified burdens during trial design and execution will reduce the burden experienced by research participants.
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Affiliation(s)
- Chidiebere Nwolise
- Health Services Research Unit, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Applied Research
Collaboration Oxford, Oxford, UK
| | - Pippa Corrie
- Cambridge Cancer Centre, Cambridge University Hospitals NHS
Foundation Trust (Addenbrooke's Hospital), Cambridge, UK
| | - Ray Fitzpatrick
- Health Services Research Unit, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
- National Institute for Health Research (NIHR) Applied Research
Collaboration Oxford, Oxford, UK
| | | | - Crispin Jenkinson
- Health Services Research Unit, Nuffield Department of Population
Health, University of Oxford, Oxford, UK
| | - Mark Middleton
- University of Oxford Department of
Oncology, Cancer Research UK Oxford
Centre, Oxford, UK
| | - Rubeta Matin
- Dermatology Department, Churchill Hospital, Oxford, UK
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Gillespie R, Mullan J, Harrison L. Exploring Older Adult Health Literacy in the Day-to-Day Management of Polypharmacy and Making Decisions About Deprescribing: A Mixed Methods Study. Health Lit Res Pract 2023; 7:e14-e25. [PMID: 36629783 PMCID: PMC9833258 DOI: 10.3928/24748307-20221216-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Polypharmacy use in older adults is increasing and sometimes leads to poor health outcomes. The influence of health literacy in managing polypharmacy and making decisions about stopping medication has received limited attention. OBJECTIVE A mixed methods design was used to measure and investigate the influence of health literacy in the management of polypharmacy and decisions about deprescribing. Phase 1 involved two cross-sectional surveys, one with older adults using five or more medications and the other with general practitioners (GPs). METHODS Older adult health literacy was measured using the All Aspects of Health Literacy Scale. Phase 2 employed individual interviews with both older adults and GPs and further explored the reported use of health literacy in practice. SPSS version 24 was used to conduct descriptive statistical analysis of the Phase 1 survey responses and Phase 2 interviews were analyzed using thematic analysis with the assistance of NVivo 12. KEY RESULTS Phase 1 survey responses were received from 85 GPs and 137 older adults. Phase 2 interviews were conducted with 16 GPs and 25 older adults. Phase 1 results indicated that self-reported older adult health literacy was high, and that GPs believed older patients could engage in decisions about deprescribing. Phase 2 findings showed that older adults developed and employed complex health literacy practices to manage medications between consultations; however, few reported using their health literacy skills in consultations with their GPs. GPs noted that older adult involvement in decision-making varied and generally thought that older adults had low health literacy. CONCLUSION Older adults reported using health literacy practices in the management of their sometimes-complex medication regimens. However, the role of health literacy in deprescribing decision-making was limited. The mixed methods approach allowed greater insight into older adult and GP practices that influence the acquisition and use of health literacy. [HLRP: Health Literacy Research and Practice. 2023;7(1):e14-e25.] Plain Language Summary: This report explores health literacy in the use of multiple medications and decisions to stop using medication/s in older age. Older adults reported good heath literacy and practiced many health literacy skills in the management of their medications. However, they did not always report the use of their health literacy skills when discussing their medications with their family doctor.
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Affiliation(s)
- Robyn Gillespie
- Address correspondence to Robyn Gillespie, PhD, MPH, BN, via
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Schulze J, Breckner A, Duncan P, Scherer M, Pohontsch NJ, Lühmann D. Adaptation and validation of a German version of the Multimorbidity Treatment Burden Questionnaire. Health Qual Life Outcomes 2022; 20:90. [PMID: 35658972 PMCID: PMC9166496 DOI: 10.1186/s12955-022-01993-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 05/17/2022] [Indexed: 11/10/2022] Open
Abstract
Background Patients with multiple long-term conditions often face a variety of challenges arising from the requirements of their health care. Knowledge of perceived treatment burden is crucial for optimizing treatment. In this study, we aimed to create a German version of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and to evaluate its validity.
Methods The steps to translate the MTBQ included forward/back translation, cognitive interviews (n = 6) and a pilot test (n = 7). Psychometric properties of the scale were assessed in a cross-sectional survey with primary care patients aged 65 and older with at least 3 long-term conditions (n = 344). We examined the distribution of responses, dimensionality, internal reliability and construct validity. Results Cognitive interviewing and piloting led to minor modifications and showed overall good face validity and acceptability. As expected, we observed a positively skewed response distribution for all items. Reliability was acceptable with McDonald’s omega = 0.71. Factor analysis suggested one common factor while model fit indices were inconclusive. Predefined hypotheses regarding the construct validity were supported by negative associations between treatment burden and health-related quality of life, self-rated health, social support, patient activation and medication adherence, and positive associations between treatment burden and number of comorbidities. Treatment burden was found to be higher in female participants (Mdn1 = 6.82, Mdn2 = 4.55; U = 11,729, p = 0.001) and participants with mental health diagnoses (Mdn1 = 9.10, Mdn2 = 4.55; U = 3172, p = 0.024). Conclusions The German MTBQ exhibited good psychometric properties and can be used to assess the perceived treatment burden of patients with multimorbidity. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-022-01993-z.
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Affiliation(s)
- Josefine Schulze
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany.
| | - Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Polly Duncan
- Centre for Academic Primary Care, University of Bristol, Bristol, UK
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Nadine Janis Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
| | - Dagmar Lühmann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany
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Change in treatment burden among people with multimorbidity: a follow-up survey. Br J Gen Pract 2022; 72:e816-e824. [PMID: 36302680 PMCID: PMC9466958 DOI: 10.3399/bjgp.2022.0103] [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: 02/25/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. Little is known about change in treatment burden over time for people with multimorbidity. Aim To quantify change in treatment burden, determine factors associated with this change, and evaluate a revised single-item measure for high treatment burden in older adults with multimorbidity. Design and setting A 2.5-year follow-up of a cross-sectional postal survey via six general practices in Dorset, England. Method GP practices identified participants of the baseline survey. Data on treatment burden (measured using the Multimorbidity Treatment Burden Questionnaire; MTBQ), sociodemographics, clinical variables, health literacy, and financial resource were collected. Change in treatment burden was described, and associations assessed using regression models. Diagnostic test performance metrics evaluated the revised single-item measure relative to the MTBQ. Results In total, 300 participants were recruited (77.3% response rate). Overall, there was a mean increase of 2.6 (standard deviation 11.2) points in treatment burden global score. Ninety-eight (32.7%) and 53 (17.7%) participants experienced an increase and decrease, respectively, in treatment burden category. An increase in treatment burden was associated with having >5 long-term conditions (adjusted β 8.26, 95% confidence interval [CI] = 4.20 to 12.32) and living >10 minutes (versus ≤10 minutes) from the GP (adjusted β 3.88, 95% CI = 1.32 to 6.43), particularly for participants with limited health literacy (mean difference: adjusted β 9.59, 95% CI = 2.17 to 17.00). The single-item measure performed moderately (sensitivity 55.7%; specificity 92.4%. Conclusion Treatment burden changes over time. Improving access to primary care, particularly for those living further away from services, and enhancing health literacy may mitigate increases in burden.
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Hardman R, Begg S, Spelten E. Exploring the ability of self-report measures to identify risk of high treatment burden in chronic disease patients: a cross-sectional study. BMC Public Health 2022; 22:163. [PMID: 35073896 PMCID: PMC8785389 DOI: 10.1186/s12889-022-12579-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 01/13/2022] [Indexed: 09/03/2023] Open
Abstract
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.
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Hounkpatin HO, Roderick P, Morris JE, Harris S, Watson F, Dambha-Miller H, Roberts H, Walsh B, Smith D, Fraser SDS. Change in treatment burden among people with multimorbidity: Protocol of a follow up survey and development of efficient measurement tools for primary care. PLoS One 2021; 16:e0260228. [PMID: 34843541 PMCID: PMC8629211 DOI: 10.1371/journal.pone.0260228] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 11/04/2021] [Indexed: 11/30/2022] Open
Abstract
Background Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. It is likely treatment burden changes over time as circumstances change for patients and health services. However, there are a lack of population-level studies of treatment burden change and factors associated with this change over time. Furthermore, there are currently no practical screening tools for treatment burden in time-pressured clinical settings or at population level. Methods and analysis This is a three-year follow-up of a cross-sectional survey of 723 people with multimorbidity (defined as three or more long-term conditions; LTCs) registered at GP practices in in Dorset, England. The survey will repeat collection of information on treatment burden (using the 10-item Multimorbidity Treatment Burden Questionnaire (MTBQ) and a novel single-item screening tool), sociodemographics, medications, LTCs, health literacy and financial resource, as at baseline. Descriptive statistics will be used to compare change in treatment burden since the baseline survey in 2019 and associations of treatment burden change will be assessed using regression methods. Diagnostic test accuracy metrics will be used to evaluate the single-item treatment burden screening tool using the MTBQ as the gold-standard. Routine primary care data (including demographics, medications, LTCs, and healthcare usage data) will be extracted from medical records for consenting participants. A forward-stepwise, likelihood-ratio logistic regression model building approach will be employed in order to assess the utility of routine data metrics in quantifying treatment burden in comparison to self-reported treatment burden using the MTBQ. Impact To the authors’ knowledge, this will be the first study investigating longitudinal aspects of treatment burden. Findings will improve understanding of the extent to which treatment burden changes over time for people with multimorbidity and factors contributing to this change, as well as allowing better identification of people at risk of high treatment burden.
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Affiliation(s)
- Hilda O. Hounkpatin
- School of Primary Care, Population Sciences, and Medical Education, University of Southampton, Southampton, United Kingdom
- * E-mail:
| | - Paul Roderick
- School of Primary Care, Population Sciences, and Medical Education, University of Southampton, Southampton, United Kingdom
| | - James E. Morris
- School of Primary Care, Population Sciences, and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Scott Harris
- School of Primary Care, Population Sciences, and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Forbes Watson
- NHS Dorset Clinical Commissioning Group, Dorset, United Kingdom
| | - Hajira Dambha-Miller
- School of Primary Care, Population Sciences, and Medical Education, University of Southampton, Southampton, United Kingdom
| | - Helen Roberts
- Human Development and Health, University of Southampton, Southampton, United Kingdom
- Geriatric Medicine, University Hospitals Southampton, Southampton, United Kingdom
| | - Bronagh Walsh
- Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Dianna Smith
- Geography and Environmental Science, University of Southampton, Southampton, United Kingdom
| | - Simon D. S. Fraser
- School of Primary Care, Population Sciences, and Medical Education, University of Southampton, Southampton, United Kingdom
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Tan QY, Cox NJ, Lim SER, Coutts L, Fraser SDS, Roberts HC, Ibrahim K. The Experiences of Treatment Burden in People with Parkinson's Disease and Their Caregivers: A Systematic Review of Qualitative Studies. JOURNAL OF PARKINSONS DISEASE 2021; 11:1597-1617. [PMID: 34334419 DOI: 10.3233/jpd-212612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BackgroundHigh treatment burden is associated with poor adherence, wasted resources, poor quality of life and poor health outcomes. Identifying factors that impact treatment burden in Parkinson's disease can offer insights into strategies to mitigate them.ObjectiveTo explore the experiences of treatment burden among people with Parkinson's disease (PwP) and their caregivers.MethodsA systematic review of studies published from year 2006 was conducted. Qualitative and mixed-method studies with a qualitative component that relate to usual care in Parkinson's disease were included. Quantitative studies and grey literature were excluded. Data synthesis was conducted using framework synthesis.Results1757 articles were screened, and 39 articles included. Understanding treatment burden in PwP and caregivers was not the primary aim in any of the included studies. The main issues of treatment burden in Parkinson's disease are: 1) work and challenges of taking medication; 2) healthcare provider obstacles including lack of patient-centered care, poor patient-provider relationships, lack of care coordination, inflexible organizational structures, lack of access to services and issues in care home or hospital settings; and 3) learning about health and challenges with information provision. The treatment burden led to physical and mental exhaustion of self-care and limitations on the role and social activities of PwP and caregivers.Conclusion:There are potential strategies to improve the treatment burden in Parkinson's disease at an individual level such as patient-centered approach to care, and at system level by improving access and care coordination between services. Future research is needed to determine the modifiable factors of treatment burden in Parkinson's disease.
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Affiliation(s)
- Qian Yue Tan
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Natalie J Cox
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton, UK
| | - Stephen E R Lim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
| | - Laura Coutts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Simon D S Fraser
- National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK.,School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Helen C Roberts
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK.,National Institute for Health Research Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Trust, Southampton, UK
| | - Kinda Ibrahim
- Academic Geriatric Medicine, Faculty of Medicine, University of Southampton, Southampton, UK.,National Institute for Health Research Applied Research Collaboration Wessex, University of Southampton, Southampton, UK
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Hardman R, Begg S, Spelten E. Healthcare professionals' perspective on treatment burden and patient capacity in low-income rural populations: challenges and opportunities. BMC FAMILY PRACTICE 2021; 22:50. [PMID: 33750306 PMCID: PMC7942213 DOI: 10.1186/s12875-021-01387-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Accepted: 01/13/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND The challenges of chronic disease self-management in multimorbidity are well-known. Shippee's Cumulative Complexity Model provides useful insights on burden and capacity factors affecting healthcare engagement and outcomes. This model reflects patient experience, but healthcare providers are reported to have a limited understanding of these concepts. Understanding burden and capacity is important for clinicians, since they can influence these factors both positively and negatively. This study aimed to explore the perspectives of healthcare providers using burden and capacity frameworks previously used only in patient studies. METHODS Participants were twelve nursing and allied health providers providing chronic disease self-management support in low-income primary care settings. We used written vignettes, constructed from interviews with multimorbid patients at the same health centres, to explore how clinicians understood burden and capacity. Interviews were recorded and transcribed verbatim. Analysis was by the framework method, using Normalisation Process Theory to explore burden and the Theory of Patient Capacity to explore capacity. RESULTS The framework analysis categories fitted the data well. All participants clearly understood capacity and were highly conscious of social (e.g. income, family demands), and psychological (e.g. cognitive, mental health) factors, in influencing engagement with healthcare. Not all clinicians recognised the term 'treatment burden', but the concept that it represented was familiar, with participants relating it both to specific treatment demands and to healthcare system deficiencies. Financial resources, health literacy and mental health were considered to have the biggest impact on capacity. Interaction between these factors and health system barriers (leading to increased burden) was a common and challenging occurrence that clinicians struggled to deal with. CONCLUSIONS The ability of health professionals to recognise burden and capacity has been questioned, but participants in this study displayed a level of understanding comparable to the patient literature. Many of the challenges identified were related to health system issues, which participants felt powerless to address. Despite their awareness of burden and capacity, health providers continued to operate within a single-disease model, likely to increase burden. These findings have implications for health system organisation, particularly the need for alternative models of care in multimorbidity.
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Affiliation(s)
- Ruth Hardman
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, VIC, 3500, Australia. .,Sunraysia Community Health Services, 137 Thirteenth Street, Mildura, VIC, 3500, Australia.
| | - Stephen Begg
- La Trobe Rural Health School, La Trobe University, PO Box 199, Bendigo, VIC, 3552, Australia
| | - Evelien Spelten
- La Trobe University Rural Health School, 471 Benetook Avenue, Mildura, VIC, 3500, Australia
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Lesage A, Leclère B, Moret L, Le Glatin C. Decreasing patient-reported burden of treatment: A systematic review of quantitative interventional studies. PLoS One 2021; 16:e0245112. [PMID: 33434200 PMCID: PMC7802949 DOI: 10.1371/journal.pone.0245112] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 12/22/2020] [Indexed: 11/21/2022] Open
Abstract
Objectives To describe and analyse studies aiming at quantitatively assessing the impact of interventions on patient-reported burden of treatment as an outcome (primary or secondary). Methods The aim of the search strategy was to identify all publications describing a medical intervention intended to reduce patient-reported burden of treatment in adult patients with long-term conditions, from January 1, 2008 to July 15, 2019. Four databases (Medline, PsycINFO, the “Trials” section of the Cochrane-Library, and OpenGrey) were searched in English, French, Spanish, Italian and Portuguese. Each identified article was reviewed and the risk of bias was assessed using a tool adapted from the Cochrane Collaboration recommendations. Results Of 641 articles retrieved, 11 were included in this review. There were nine randomized controlled trials, one non-randomized controlled trial, and one before-and-after study. The sample sizes ranged from 55 to 1,546 patients. Eight out of the eleven studies reported significant positive outcomes of the studied interventions. Reducing dosing frequency, improving background therapy, offering home care or providing easier-to-use medical devices were associated with positive outcomes. Conclusions Only a few studies have specifically focused on decreasing the subjective burden of treatment. Small trials conducted in patients with a single specific disorder have reported positive outcomes. However, a large, high-quality study assessing the impact of a change in care process in patients with multiple morbidities did not show such results. Further studies are needed to implement this aspect of patient-centred care.
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Affiliation(s)
- Aurore Lesage
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France
| | - Brice Leclère
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France
- MiHAR Lab, University of Nantes, Nantes, France
| | - Leïla Moret
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France
- UMR INSERM 1246—MethodS in Patients-Centred Outcomes and HEalth ResEarch (SPHERE), University of Nantes, Nantes, France
| | - Clément Le Glatin
- Department of Medical Evaluation and Epidemiology, Nantes University Hospital, Nantes, France
- * E-mail:
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Abu Dabrh AM, Boehmer KR, Shippee N, Rizza SA, Perlman AI, Dick SR, Behnken EM, Montori VM. Minimally disruptive medicine (MDM) in clinical practice: a qualitative case study of the human immunodeficiency virus (HIV) clinic care model. BMC Health Serv Res 2021; 21:24. [PMID: 33407451 PMCID: PMC7788961 DOI: 10.1186/s12913-020-06010-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 12/10/2020] [Indexed: 12/30/2022] Open
Abstract
Background Recent evidence suggests the need to reframe healthcare delivery for patients with chronic conditions, with emphasis on minimizing healthcare footprint/workload on patients, caregivers, clinicians and health systems through the proposed Minimally Disruptive Medicine (MDM) care model named. HIV care models have evolved to further focus on understanding barriers and facilitators to care delivery while improving patient-centered outcomes (e.g., disease progression, adherence, access, quality of life). It is hypothesized that these models may provide an example of MDM care model in clinic practice. Therefore, this study aimed to observe and ascertain MDM-concordant and discordant elements that may exist within a tertiary-setting HIV clinic care model for patients living with HIV or AIDS (PLWHA). We also aimed to identify lessons learned from this setting to inform improving the feasibility and usefulness of MDM care model. Methods This qualitative case study occurred in multidisciplinary HIV comprehensive-care clinic within an urban tertiary-medical center. Participants included Adult PLWHA and informal caregivers (e.g. family/friends) attending the clinic for regular appointments were recruited. All clinic staff were eligible for recruitment. Measurements included; semi-guided interviews with patients, caregivers, or both; semi-guided interviews with varied clinicians (individually); and direct observations of clinical encounters (patient-clinicians), as well as staff daily operations in 2015–2017. The qualitative-data synthesis used iterative, mainly inductive thematic coding. Results Researcher interviews and observations data included 28 patients, 5 caregivers, and 14 care-team members. With few exceptions, the clinic care model elements aligned closely to the MDM model of care through supporting patient capacity/abilities (with some patients receiving minimal social support and limited assistance with reframing their biography) and minimizing workload/demands (with some patients challenged by the clinic hours of operation). Conclusions The studied HIV clinic incorporated many of the MDM tenants, contributing to its validation, and informing gaps in knowledge. While these findings may support the design and implementation of care that is both minimally disruptive and maximally supportive, the impact of MDM on patient-important outcomes and different care settings require further studying. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-06010-x.
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Affiliation(s)
- Abd Moain Abu Dabrh
- Department of Family Medicine, Mayo Clinic Florida, 4500 San Pablo Rd S, Jacksonville, FL, USA. .,Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA. .,Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA.
| | - Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Nathan Shippee
- Division of Health Policy and Management, University of Minnesota, Minneapolis, MN, USA
| | - Stacey A Rizza
- Division of Infectious Diseases, Mayo Clinic, Rochester, MN, USA
| | - Adam I Perlman
- Integrative Medicine and Health, Division of General Internal Medicine, Mayo Clinic Florida, Jacksonville, FL, USA
| | - Sara R Dick
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Emma M Behnken
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, MN, USA
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14
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Espinoza P, Varela CA, Vargas IE, Ortega G, Silva PA, Boehmer KB, Montori VM. The burden of treatment in people living with type 2 diabetes: A qualitative study of patients and their primary care clinicians. PLoS One 2020; 15:e0241485. [PMID: 33125426 PMCID: PMC7598471 DOI: 10.1371/journal.pone.0241485] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 10/15/2020] [Indexed: 12/02/2022] Open
Abstract
Background The burden of treatment can overwhelm people living with type 2 diabetes and lead to poor treatment fidelity and outcomes. Chronic care programs must consider and mitigate the burden of treatment while supporting patients in achieving their goals. Objective To explore what patients with type 2 diabetes and their health providers consider are the workload and the resources they must mobilize, i.e., their capacity, to shoulder it. Methods We conducted focus groups comprised of 30 patients and 32 clinicians from three community health centers in Chile implementing the Chronic Care Model to reduce cardiovascular risk in patients with type 2 diabetes. Transcripts were analyzed using thematic content analysis techniques illuminated by the Minimally Disruptive Medicine framework. Findings Gaining access to and working with their clinicians, implementing complex medication regimens, and changing lifestyles burdened patients. To deal with the distress of the diagnosis, difficulties achieving disease control, and fear of complications, patients drew capacity from their family (mostly men), social environment (mostly women), lay expertise, and spirituality. Clinicians found that administrative tasks, limited formulary, and protocol rigidity hindered their ability to modify care plans to reduce patient workload and support their capacity. Conclusions Chronic primary care programs burden patients living with type 2 diabetes while hindering clinicians’ ability to reduce treatment workloads or support patient capacity. A collaborative approach toward Minimally Disruptive Medicine may result in treatments that fit the lives and loves of patients and improve outcomes.
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Affiliation(s)
- Pilar Espinoza
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
- * E-mail:
| | - Camila A. Varela
- Mental Community Health Center Pedro Aguirre Cerda, Santiago, Chile
| | - Ivonne E. Vargas
- School of Nursing, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Paulo A. Silva
- School of Nutrition, Universidad San Sebastian, Santiago, Chile
| | - Kasey B. Boehmer
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, New York, United States of America
| | - Victor M. Montori
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, New York, United States of America
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15
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Choi M. Association of eHealth Use, Literacy, Informational Social Support, and Health-Promoting Behaviors: Mediation of Health Self-Efficacy. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17217890. [PMID: 33126469 PMCID: PMC7662976 DOI: 10.3390/ijerph17217890] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/11/2020] [Accepted: 10/20/2020] [Indexed: 01/16/2023]
Abstract
This descriptive, cross-sectional study identified the association of eHealth use, literacy, informational support, and health-promoting behaviors among older adults, as mediated by health self-efficacy. Convenience sampling was conducted at senior welfare centers in Chuncheon, in the Republic of Korea. Data analysis was performed using Pearson’s correlation and via path analyses. The findings showed that eHealth use had an indirect effect on health-promoting behaviors, as mediated by self-efficacy. Informational support was indirectly mediated by self-efficacy and had direct effects upon health-promoting behaviors. eHealth can facilitate self-efficacy and health management, despite not having direct effects upon health-promoting behaviors themselves. Thus, older adults need to be prepared for the increased use of eHealth. In addition, healthcare professionals should support older people in their use of eHealth and encourage informational support through comprehensive interventions so as to facilitate self-efficacy and health behaviors.
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Affiliation(s)
- MoonKi Choi
- College of Nursing, Kangwon National University, Chuncheon 24341, Korea
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16
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Perlman AI, Abu Dabrh AM. Health and Wellness Coaching in Serving the Needs of Today's Patients: A Primer for Healthcare Professionals. Glob Adv Health Med 2020; 9:2164956120959274. [PMID: 33014630 PMCID: PMC7509728 DOI: 10.1177/2164956120959274] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/06/2020] [Accepted: 05/26/2020] [Indexed: 11/17/2022] Open
Abstract
The past six decades have been marked by leaps and bounds in medical advances, while concurrently clinical outcomes and the quality of life continued to lag or decline. There is a need for more comprehensive approaches to delivering healthcare to patients that address illness and wellness within and outside healthcare settings. Mounting evidence shows that making sustainable changes in healthcare requires approaching patients'/individuals' care as a continuum-within and outside healthcare settings-while addressing their capacity (ie ability) and workload (ie demands) and incorporating their values and preferences. Health and Wellness Coaching (HWC) has been proposed as a solution to create partnerships to empower individuals to take ownership, leadership, and accountability of their well-being, using nondirective, empathic, and mindful conversations that employ motivational-interviewing and evidence-based approaches. Insufficient clarity exists among healthcare professionals in understanding the definition, roles, and types of HWC. This primer summarizes HWC concepts and history and compares HWC types and its potential role in promoting, supporting, and improving the well-being, clinical outcomes, and quality of life of the pertinent stakeholders. This primer also highlights current and potential areas of application of HWC within different subpopulations and healthcare-related settings.
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Affiliation(s)
- Adam I Perlman
- Integrative Medicine and Health, General Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida
| | - Abd Moain Abu Dabrh
- Integrative Medicine and Health, General Internal Medicine, Mayo Clinic Florida, Jacksonville, Florida.,Department of Family Medicine, Mayo Clinic Florida, Jacksonville, Florida
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17
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Jørgensen MJ, Pedersen CG, Martin HM, Lomborg K. Implementation of patient involvement methods in the clinical setting: A qualitative study exploring the health professional perspective. J Eval Clin Pract 2020; 26:765-776. [PMID: 31264360 DOI: 10.1111/jep.13217] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Revised: 06/03/2019] [Accepted: 06/09/2019] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Patient involvement is increasingly recognized as a key component on the international health care agenda. This attention has brought a need for developing generic and standardized open-source methods, tools, and guidelines on how to systematically implement patient involvement initiatives in the clinical setting. The large-scale project the User-involving Hospital was initiated to implement two systematic methods for patient involvement at a Danish university hospital, but the required methods can only be implemented if embraced by the health professionals. This evaluation study aimed to explore the health professional perspective on the development and implementation of shared decision making (SDM) and user-led health care. Specifically, the objectives were to identify the most crucial preconditions for success and to translate the findings into practice recommendations. METHOD The study was based on a simple questionnaire survey and a qualitative descriptive analysis of semistructured focus group interviews with representatives of 21 multidisciplinary clinical teams (nine interviews) and 18 health professional department managers (six interviews). RESULTS Two years after the initiation of the User-involving Hospital, 13 out of 21 developed patient involvement initiatives were fully incorporated into clinical practice. Five domains were found significant for successful development and implementation of the patient involvement methods: the patients' perspectives, composition of multidisciplinary teams, bottom-up and skill building, support from management, and information sharing with colleagues. CONCLUSIONS The findings draw attention to several significant factors for successful implementation of large-scale patient involvement initiatives in hospitals, including the importance of having both a top-down and bottom-up approach and of active listening to the patients' perspectives. On the basis of these findings, the study outlines four recommendations incorporating the five identified key domains, which may inspire future projects on systematic development and implementation of patient-involvement initiatives based on either shared decision making or user-led health care in the clinical setting.
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Affiliation(s)
| | | | - Helle Max Martin
- Danish Knowledge Center for User Involvement in Health Care, Copenhagen, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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18
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Mustapha FI, Aagaard-Hansen J, Lim SC, Nasir NH, Aris T, Bjerre-Christensen U. Variations in the Delivery of Primary Diabetes Care in Malaysia: Lessons to Be Learnt and Potential for Improvement. Health Serv Res Manag Epidemiol 2020; 7:2333392820918744. [PMID: 32313820 PMCID: PMC7160766 DOI: 10.1177/2333392820918744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Revised: 03/18/2020] [Accepted: 03/18/2020] [Indexed: 11/16/2022] Open
Abstract
Background: The article describes variations in the organization of clinical services for diabetes
patients in 10 public primary health clinics in Malaysia with the view to learn from
current innovations and improve diabetes service provision. Methods: This study combined the use of secondary data and a qualitative multicase study
approach applying observations in 10 randomly selected Ministry of Health (MOH) health
clinics in Kuala Lumpur and Selangor and semistructured interviews of the family
medicine specialists from the same clinics. Results: Although there are specific MOH guidelines for diabetes care, some clinics had
introduced innovations for diabetes care such as the novel ‘personalized care’,
‘one-stop-centre’ and utilization of patients’ waiting time for health education.
Analysis showed that there was room for improvement in terms of task shifting to free
precious time of staff with specialized functions, streamlining appointments for various
examinations, increasing continuity of consultations with same doctors, and monitoring
of performance. Conclusion: We contend that there is a potential for increased effectiveness and efficiency of
primary diabetes care in Malaysia without increasing the resources – a potential that
may be tapped into by systematic learning from ongoing innovation.
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Affiliation(s)
- Feisul Idzwan Mustapha
- Ministry of Health Malaysia Disease Control Division, Wilayah Persekutuan, Putrajaya, Malaysia
| | - Jens Aagaard-Hansen
- Steno Diabetes Center Copenhagen, Gentofte, Denmark.,University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | | | | | - Tahir Aris
- Institute for Public Health, Kuala Lumpur, Malaysia
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19
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Alsadah A, van Merode T, Alshammari R, Kleijnen J. A systematic literature review looking for the definition of treatment burden. Heliyon 2020; 6:e03641. [PMID: 32300666 PMCID: PMC7150517 DOI: 10.1016/j.heliyon.2020.e03641] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 04/16/2019] [Accepted: 03/18/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Treatment burden is an emerging concept in health care literature. It can complicate the patients' condition and perhaps result in poor adherence to treatment, which is linked to worse clinical outcomes. However, until now there is no definition for treatment burden recognized by all stakeholders. This review was prepared in order to find what available definitions for treatment burden are present in the literature. METHODS A systematic review of the literature was prepared looking for definitions of treatment burden in adult patients. Articles about adults aged 18 years or older from both genders with one or more medical conditions that contained a (new) definition of treatment burden were included. The search approach consisted of conventional systematic review database searching of multiple resources including Embase, Medline, PsycINFO, and CINAHL. Two independent reviewers screened the titles and abstracts, and full papers. RESULTS The searches resulted in 8045 records, of which 16 articles were included. Based on quality appraisal criteria, we decided that two definitions had better evaluations than the rest of the definitions, the first one defining it as the impact of the 'work of being a patient' on functioning and well-being, the second as the actions and resources they devote to their healthcare. CONCLUSION We consider the definition concentrating on actions and resources patients devote to their healthcare, including difficulty, time, and out-of-pocket costs dedicated to the healthcare tasks such as adhering to medications, dietary recommendations, and self-monitoring as the one probably comprising most domains of Treatment Burden that we have found in our search in the existing literature. However, adding even more domains to this definition and differentiating explicitly between patient's perception and caregiver's perception in the definition could in our opinion result in an improved definition. Also patients' evaluation of this definition is commendable.
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Affiliation(s)
| | - Tiny van Merode
- School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, Limburg, the Netherlands
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20
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Gray ID, Kross AR, Renfrew ME, Wood P. Precision Medicine in Lifestyle Medicine: The Way of the Future? Am J Lifestyle Med 2020; 14:169-186. [PMID: 32231483 PMCID: PMC7092395 DOI: 10.1177/1559827619834527] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 12/21/2018] [Accepted: 02/08/2019] [Indexed: 02/06/2023] Open
Abstract
Precision medicine has captured the imagination of the medical community with visions of therapies precisely targeted to the specific individual's genetic, biological, social, and environmental profile. However, in practice it has become synonymous with genomic medicine. As such its successes have been limited, with poor predictive or clinical value for the majority of people. It adds little to lifestyle medicine, other than in establishing why a healthy lifestyle is effective in combatting chronic disease. The challenge of lifestyle medicine remains getting people to actually adopt, sustain, and naturalize a healthy lifestyle, and this will require an approach that treats the patient as a person with individual needs and providing them with suitable types of support. The future of lifestyle medicine is holistic and person-centered rather than technological.
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Affiliation(s)
- Ian D. Gray
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Andrea R. Kross
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Melanie E. Renfrew
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
| | - Paul Wood
- Avondale College of Higher Education, Cooranbong,
New South Wales, Australia
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21
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Schougaard LMV, de Thurah A, Christensen J, Lomborg K, Maindal HT, Mejdahl CT, Vestergaard JM, Winding TN, Biering K, Hjollund NH. Sociodemographic, personal, and disease-related determinants of referral to patient-reported outcome-based follow-up of remote outpatients: a prospective cohort study. Qual Life Res 2020; 29:1335-1347. [PMID: 31900763 PMCID: PMC7190685 DOI: 10.1007/s11136-019-02407-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2019] [Indexed: 11/09/2022]
Abstract
Purpose We examined the association between sociodemographic, personal, and disease-related determinants and referral to a new model of health care that uses patient-reported outcomes (PRO) measures for remote outpatient follow-up (PRO-based follow-up). Methods We conducted a prospective cohort study among outpatients with epilepsy at the Department of Neurology at Aarhus University Hospital, Denmark. Included were all persons aged ≥ 15 years visiting the department for the first time during the period from May 2016 to May 2018. Patients received a questionnaire containing questions about health literacy, self-efficacy, patient activation, well-being, and general health. We also collected data regarding sociodemographic status, labour market affiliation, and co-morbidity from nationwide registers. Associations were analysed as time-to-event using the pseudo-value approach. Missing data were handled using multiple imputations. Results A total of 802 eligible patients were included in the register-based analyses and 411 patients (51%) responded to the questionnaire. The results based on data from registers indicated that patients were less likely to be referred to PRO-based follow-up if they lived alone, had low education or household income, received temporary or permanent social benefits, or if they had a psychiatric diagnosis. The results based on data from the questionnaire indicated that patients were less likely to be referred to PRO-based follow-up if they reported low levels of health literacy, self-efficacy, patient activation, well-being, or general health. Conclusion Both self-reported and register-based analyses indicated that socioeconomically advantaged patients were referred more often to PRO-based follow-up than socioeconomically disadvantaged patients. Electronic supplementary material The online version of this article (10.1007/s11136-019-02407-2) contains supplementary material, which is available to authorised users.
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Affiliation(s)
- Liv Marit Valen Schougaard
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Gl. Landevej 61, 7400, Herning, Denmark.
| | - Annette de Thurah
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,National Centre for Register-based Research, Department of Economics and Business Economics, Aarhus BSS, Aarhus University, Aarhus, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Caroline Trillingsgaard Mejdahl
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Gl. Landevej 61, 7400, Herning, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
| | - Trine Nøhr Winding
- Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
| | - Karin Biering
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark.,Department of Occupational Medicine, University Research Clinic, Regional Hospital West Jutland, Herning, Denmark
| | - Niels Henrik Hjollund
- AmbuFlex/WestChronic, Occupational Medicine, University Research Clinic, Aarhus University, Gl. Landevej 61, 7400, Herning, Denmark.,Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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22
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Brutus L, Poupard A, Le Glatin C. Major imbalance of thyroid function after laparoscopic sleeve gastrectomy. BMJ Case Rep 2019; 12:12/8/e230515. [PMID: 31401581 DOI: 10.1136/bcr-2019-230515] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
In patients with substituted hypothyroidism, laparoscopic sleeve gastrectomy may interfere with thyroid balance by varying body weight or by altering the absorption of hormone therapy. A 58-year-old female patient presented with a major thyroid imbalance after sleeve gastrectomy, manifesting itself in large-scale changes in thyroid stimulating hormone (TSH) levels. The transition from a tablet treatment to a liquid form alleviated burden of treatment, unfortunately without normalising TSH. Our case emphasises the importance of the understanding of hypothalamic-pituitary-thyroid feedback control mechanisms together with good galenic choice, management of associated conditions and the elimination of other causes of variations of TSH levels during the management of hypothyroid patients after sleeve gastrectomy.
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Affiliation(s)
- Laurent Brutus
- Pôle de Santé du Marais, Sallertaine, France.,Département de médecine générale, Université de Nantes, Nantes, Pays de la Loire, France
| | - Armelle Poupard
- Pôle de Santé du Marais, Sallertaine, France.,Département de médecine générale, Université de Nantes, Nantes, Pays de la Loire, France
| | - Clément Le Glatin
- Pôle de Santé du Marais, Sallertaine, France.,Département de médecine générale, Université de Nantes, Nantes, Pays de la Loire, France
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24
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Manning M, MacFarlane A, Hickey A, Franklin S. Perspectives of people with aphasia post-stroke towards personal recovery and living successfully: A systematic review and thematic synthesis. PLoS One 2019; 14:e0214200. [PMID: 30901359 PMCID: PMC6430359 DOI: 10.1371/journal.pone.0214200] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 03/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background There is increased focus on supporting people with chronic conditions to live well via person-centred, integrated care. There is a growing body of qualitative literature examining the insider perspectives of people with post-stroke aphasia (PWA) on topics relating to personal recovery and living successfully (PR-LS). To date no synthesis has been conducted examining both internal and external, structural influences on living well. In this study, we aimed to advance theoretical understanding of how best to promote and support PR-LS by integrating the perspectives of PWA on a wide range of topics relating to PR-LS. This is essential for planning and delivering quality care. Methods and findings We conducted a systematic review, following PRISMA guidelines, and thematic synthesis. Following a search of 7 electronic databases, 31 articles were included and critically appraised using predetermined criteria. Inductive and iterative analysis generated 5 analytical themes about promoting PR-LS. Aphasia occurs in the context of a wider social network that provides valued support and social companionship and has its own need for formal support. PWA want to make a positive contribution to society. The participation of PWA is facilitated by enabling environments and opportunities. PWA benefit from access to a flexible, responsive, life-relevant range of services in the long-term post-stroke. Accessible information and collaborative interactions with aphasia-aware healthcare professionals empower PWA to take charge of their condition and to navigate the health system. Conclusion The findings highlight the need to consider wider attitudinal and structural influences on living well. PR-LS are promoted via responsive, long-term support for PWA, friends and family, and opportunities to participate autonomously and contribute to the community. Shortcomings in the quality of the existing evidence base must be addressed in future studies to ensure that PWA are meaningfully included in research and service development initiatives. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO 2017: CRD42017056110.
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Affiliation(s)
- Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
- * E-mail:
| | - Anne MacFarlane
- Graduate Entry Medical School (GEMS), Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Republic of Ireland
| | - Anne Hickey
- Dept Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Sue Franklin
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
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Lindgreen P, Lomborg K, Clausen L. Patient Experiences Using a Self-Monitoring App in Eating Disorder Treatment: Qualitative Study. JMIR Mhealth Uhealth 2018; 6:e10253. [PMID: 29934285 PMCID: PMC6035344 DOI: 10.2196/10253] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 04/26/2018] [Accepted: 05/15/2018] [Indexed: 11/15/2022] Open
Abstract
Background The Recovery Record smartphone app is a self-monitoring tool for individuals recovering from an eating disorder. Unlike traditional pen-and-paper meal diaries, which are often used in eating disorder treatment, the app holds novel features, such as meal reminders, affirmations, and patient-clinician in-app linkage, the latter allowing for clinicians to continuously monitor patients' app data. Objective To explore patients' experiences with using Recovery Record as part of outpatient eating disorder treatment. Methods A total of 41 patients from a Danish eating disorder treatment facility were included in the study. All 41 patients participated in participant observations of individual or group treatment sessions, and 26 were interviewed about their experiences with using the app in treatment. The data material was generated and analyzed concurrently, applying the inductive methodology of Interpretive Description. Results The patients' experiences with Recovery Record depended on its app features, the impact of these features on patients, and their specific app usage. This patient-app interaction affected and was affected by changeable contexts making patients' experiences dynamic. The patient-app interaction affected patients' placement of specific Recovery Record app features along a continuum from supportive to obstructive of individual everyday life activities including the eating disorder treatment. As an example, some patients found it supportive being notified by their clinician when their logs had been monitored as it gave them a sense of relatedness. Contrarily, other patients felt under surveillance, which was obstructive, as it made them feel uneasy or even dismissing the app. Conclusions Some patients experienced the app and its features as mostly supportive of their everyday life and the eating disorder treatment, while others experienced it primarily as obstructive. When applying apps in eating disorder treatment, we therefore recommend that patients and clinicians collaborate to determine how the app in question best fits the capacities, preferences, and treatment needs of the individual patient. Thus, we encourage patients and clinicians to discuss how specific features of the applied app affect the individual patient to increase the use of supportive features, while limiting the use of obstructive ones.
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Affiliation(s)
- Pil Lindgreen
- Research Unit, Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Kirsten Lomborg
- Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark
| | - Loa Clausen
- Research Unit, Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark.,Department of Clinical Medicine, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Public Health, Faculty of Health, Aarhus University, Aarhus, Denmark.,Department of Psychology, Behavioral and Social Sciences, Aarhus University, Aarhus, Denmark
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Abu Dabrh AM, Shannon RP, Presutti RJ. Sharing is Caring: Minimizing the Disruption with Palliative Care. Cureus 2018; 10:e2321. [PMID: 29755917 PMCID: PMC5947928 DOI: 10.7759/cureus.2321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
There is an upward trend incidence of multiple chronic life-limiting conditions with a well-documented associated impact on patients and their caregivers. When patients approach the end of life, they are often faced with a challenging multidimensional burden while navigating a complex health care system. Patients and families/caregivers are faced with daily decisions, often with little or no frame of reference or medical knowledge. The “what, how, when, and where” puzzle during this challenging time can be overwhelming for patients and their families, and when clinicians do not contemplate this associated workload’s impact on patients and caregivers’ capacity for self-care, patients and caregivers scramble to find compensatory solutions, often putting their health care at lower priority. This consequently warrants the underlying importance of palliative care and integrating it into the patients’ health care plans earlier. There is increasing evidence from recent trials that supported implementing national policies regarding the early integration of palliative care and its role in improving the quality of life, increasing survival, and supporting patients’ and caregivers’ values when making decisions about their health care while possibly minimizing the burden of illness. The mission of palliative care is to assess, anticipate, and alleviate the challenges and suffering for patients and their caregivers by providing well-constructed approaches to disease-related physical treatments as well as psychological, financial, and spiritual aspects. Communication among all participants (the patient, family/caregivers, and all involved health care professionals) ought to be timely, thorough, and patient-centric. Palliative medicine arguably represents an example of shared decision-making (SDM)—facilitating a patient-centered, informed decision-making through an empathic conversation that is supported by clinicians’ expertise and the best available evidence that takes patients values and preferences into consideration. Palliative care teams often consider the burden placed on patients and their caregivers, thus treatment plans would be assessed and introduced into the patients’ lives with reflection on the related workload and the potential capacity to take on those plans. Such an approach to pause-and-examine, understand-and-discuss, and assess-and-alleviate might provide a possible example of a health care system that is minimally disruptive to patients and their families. This is an opportunity to replace the information-filled encounter with a more constructive engagement and empowerment to all major stakeholders to participate—an axiom integral to palliative care. Using the best available evidence in caring for patients while enacting SDM, palliative care, primary care, and other subspecialty clinicians need to consider the significant workload and burden that comes with health care and thus explore pathways to minimize the disruption in patients and caregivers’ lives. As we collaborate to end cancer and all other mobdeities, we a need a concurrent movement to transform this disease-centered, payer-driven health care era to a rather patient-entered, thoughtful, and minimally disruptive one will benefit patients and physicians alike.
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Affiliation(s)
| | - Robert P Shannon
- Department of Family Medicine/palliative Medicine Fellowship, Mayo Clinic Jacksonville, Fl
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Ehrlich C, Chester P, Kisely S, Crompton D, Kendall E. Making sense of self-care practices at the intersection of severe mental illness and physical health-An Australian study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2018; 26:e47-e55. [PMID: 28685496 DOI: 10.1111/hsc.12473] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2017] [Indexed: 06/07/2023]
Abstract
The poor physical health of people who experience severe mental illness (SMI) is an important public health issue that has been acknowledged, yet not properly addressed. People who live with SMI perform a myriad of complex tasks in order to take care of their physical health, while receiving unpredictable levels of support and assistance from health professionals. In this qualitative study, we aimed to uncover the kinds of work people with SMI do in order to look after their physical health. In a metropolitan area in Queensland, Australia, 32 people with lived experience of SMI participated in semi-structured, face-to-face interviews. Data were digitally recorded, transcribed verbatim and open coded. They were then themed using a constant comparative process. We found that people with SMI were engaged in a "rhythm of life with illness" that consisted of relatively short, acute and chaotic cycles of mental and physical illness, accompanied by much longer mental and physical illness recovery cycles. Participants engaged in three specific types of health-related work to manage these cycles: discovery work (and the associated role of the health professional); sense-making work to meaningfully interpret health and illness; and embedding work to become engaged self-managers of illness and producers of health. We discuss how varying levels of support from health professionals impact consumers' self-management of their physical and mental health; how health professionals influence consumers' experience of treatment burden; and implications for practice.
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Affiliation(s)
- Carolyn Ehrlich
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- Hopkins Centre, Menzies Health Institute, Griffith University, Meadowbrook, Queensland, Australia
| | - Polly Chester
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- Hopkins Centre, Menzies Health Institute, Griffith University, Meadowbrook, Queensland, Australia
| | - Steve Kisely
- School of Medicine, The University of Queensland, Woolloongabba, Queensland, Australia
| | - David Crompton
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- Hopkins Centre, Menzies Health Institute, Griffith University, Meadowbrook, Queensland, Australia
- Metro South Addiction and Mental Health Services, Upper Mount Gravatt, Queensland, Australia
| | - Elizabeth Kendall
- School of Human Services and Social Work, Griffith University, Meadowbrook, Queensland, Australia
- Hopkins Centre, Menzies Health Institute, Griffith University, Meadowbrook, Queensland, Australia
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28
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Waterworth S, Honey M. On-line health seeking activity of older adults: an integrative review of the literature. Geriatr Nurs 2017; 39:310-317. [PMID: 29198622 DOI: 10.1016/j.gerinurse.2017.10.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 10/25/2017] [Accepted: 10/30/2017] [Indexed: 11/25/2022]
Abstract
The internet is increasingly used to provide health information. Supporting older people to access on-line health information requires understanding their current usage and possible barriers and facilitators. Methods involved searching three databases. Inclusion criteria were: (i) articles published within 10 years; (ii) people aged >65; (iii) explored reasons for older people accessing on-line health information and (iv) in English. Eight articles met these criteria. Older people use on-line health information to learn about a disease, medication, treatment, or healthy living. Factors influencing usefulness of on-line health information included demographics, health status, trust in the information, lack of skills using the internet and attitudes of health professionals. Findings indicate that while older people access on-line health information there are barriers: Low trust, financial barriers, lack of familiarity with the internet and low health literacy levels. Implications for nursing include working in partnership with older people to assist them to identify appropriate on-line information.
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Affiliation(s)
- Susan Waterworth
- School of Nursing, University of Auckland, Private Bag 92019, Auckland, New Zealand.
| | - Michelle Honey
- School of Nursing, University of Auckland, Private Bag 92019, Auckland, New Zealand
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29
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Kuluski K, Ho JW, Hans PK, Nelson MLA. Community Care for People with Complex Care Needs: Bridging the Gap between Health and Social Care. Int J Integr Care 2017; 17:2. [PMID: 28970760 PMCID: PMC5624113 DOI: 10.5334/ijic.2944] [Citation(s) in RCA: 90] [Impact Index Per Article: 12.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 07/12/2017] [Indexed: 11/20/2022] Open
Abstract
INTRODUCTION A growing number of people are living with complex care needs characterized by multimorbidity, mental health challenges and social deprivation. Required is the integration of health and social care, beyond traditional health care services to address social determinants. This study investigates key care components to support complex patients and their families in the community. METHODS Expert panel focus groups with 24 care providers, working in health and social care sectors across Toronto, Ontario, Canada were conducted. Patient vignettes illustrating significant health and social care needs were presented to participants. The vignettes prompted discussions on i) how best to meet complex care needs in the community and ii) the barriers to delivering care to this population. RESULTS Categories to support care needs of complex patients and their families included i) relationships as the foundation for care, ii) desired processes and structures of care, and iii) barriers and workarounds for desired care. DISCUSSION AND CONCLUSIONS Meeting the needs of the population who require health and social care requires time to develop authentic relationships, broadening the membership of the care team, communicating across sectors, co-locating health and social care, and addressing the barriers that prevent providers from engaging in these required practices.
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Affiliation(s)
- Kerry Kuluski
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, CA
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
| | - Julia W. Ho
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
| | - Parminder Kaur Hans
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, CA
| | - Michelle LA Nelson
- Bridgepoint Collaboratory for Research and Innovation, Lunenfeld-Tanenbaum Research Institute, Sinai Health System, CA
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, CA
- Daphne Cockwell School of Nursing, Ryerson University, CA
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30
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Harb N, Foster JM, Dobler CC. Patient-perceived treatment burden of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2017; 12:1641-1652. [PMID: 28615937 PMCID: PMC5459974 DOI: 10.2147/copd.s130353] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While chronic morbidity and mortality from COPD is well documented, little is known about the treatment burden faced by patients with COPD. SUBJECTS AND METHODS Patients with severe airflow obstruction (forced expiratory volume in 1 second [FEV1] <50% predicted) representing different age-groups, sex, and number of comorbidities participated in a semistructured interview. Interviews were conducted until thematic saturation was reached. Interviews were recorded, transcribed, and analyzed thematically using an established treatment-burden framework. RESULTS A total of 26 patients (42% male, mean age 66.7±9.8 years) with severe (n=15) or very severe (n=11) airflow limitation (mean FEV1 32.1%±9.65% predicted) were interviewed. Participants struggled with various treatment-burden domains, predominantly with changing health behaviors, such as smoking cessation and exercise. Interviewees often only ceased smoking after a major health event, despite being advised to do so earlier by a doctor. Recommended exercise regimens, such as pulmonary rehabilitation classes, were curtailed, although some patients replaced them with light home-based exercise. Interviewees had difficulty attending medical appointments, often relying on others to transport them. Overall, COPD patients indicated they were not willing to accept the burden of treatments where they perceived minimal benefit. CONCLUSION This study describes the substantial treatment burden experienced by patients with COPD. Medical advice may be rejected by patients if the benefit of following the advice is perceived as insufficient. Health professionals need to recognize treatment burden as a source of nonadherence, and should tailor treatment discussions to fit patients' values and capacity to achieve optimal patient outcomes.
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Affiliation(s)
- Nathan Harb
- South Western Sydney Clinical School, University of New South Wales.,Department of Respiratory Medicine, Liverpool Hospital
| | - Juliet M Foster
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Claudia C Dobler
- South Western Sydney Clinical School, University of New South Wales.,Department of Respiratory Medicine, Liverpool Hospital.,Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
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31
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Mosher HJ, Lyckholm LJ. A problem of capacity, but whose? The hospitalists' discharge dilemma and social determinants of health. J Hosp Med 2017; 12:57-58. [PMID: 28125833 DOI: 10.1002/jhm.2679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Hilary J Mosher
- Center for Comprehensive Access and Delivery Research and Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, IA, USA
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
| | - Laurel J Lyckholm
- Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA
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32
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Sockolow P, Radhakrishnan K, Chou EY, Wojciechowicz C. Patient Health Goals Elicited During Home Care Admission: A Categorization. West J Nurs Res 2016; 39:1447-1458. [DOI: 10.1177/0193945916676541] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Home care agencies are initiating “patient health goal elicitation” activities as part of home care admission planning. We categorized elicited goals and identified “clinically informative” goals at a home care agency. We examined patient goals that admitting clinicians documented in the point-of-care electronic health record; conducted content analysis on patient goal data to develop a coding scheme; grouped goal themes into codes; assigned codes to each goal; and identified goals that were in the patient voice. Of the 1,763 patient records, 16% lacked a goal; only 15 goals were in a patient’s voice. Nurse and physician experts identified 12 of the 20 codes as clinically important accounting for 82% of goal occurrences. The most frequent goal documented was safety/falls (23%). Training and consistent communication of the intent and operationalization of patient goal elicitation may address the absence of patient voice and the less than universal recording of home care patients’ goals.
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Boehmer KR, Gionfriddo MR, Rodriguez-Gutierrez R, Dabrh AMA, Leppin AL, Hargraves I, May CR, Shippee ND, Castaneda-Guarderas A, Palacios CZ, Bora P, Erwin P, Montori VM. Patient capacity and constraints in the experience of chronic disease: a qualitative systematic review and thematic synthesis. BMC FAMILY PRACTICE 2016; 17:127. [PMID: 27585439 PMCID: PMC5009523 DOI: 10.1186/s12875-016-0525-9] [Citation(s) in RCA: 77] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Accepted: 08/25/2016] [Indexed: 11/30/2022]
Abstract
Background Life and healthcare demand work from patients, more so from patients living with multimorbidity. Patients must respond by mobilizing available abilities and resources, their so-called capacity. We sought to summarize accounts of challenges that reduce patient capacity to access or use healthcare or to enact self-care while carrying out their lives. Methods We conducted a systematic review and synthesis of the qualitative literature published since 2000 identifying from MEDLINE, EMBASE, Psychinfo, and CINAHL and retrieving selected abstracts for full text assessment for inclusion. After assessing their methodological rigor, we coded their results using a thematic synthesis approach. Results The 110 reports selected, when synthesized, showed that patient capacity is an accomplishment of interaction with (1) the process of rewriting their biographies and making meaningful lives in the face of chronic condition(s); (2) the mobilization of resources; (3) healthcare and self-care tasks, particularly, the cognitive, emotional, and experiential results of accomplishing these tasks despite competing priorities; (4) their social networks; and (5) their environment, particularly when they encountered kindness or empathy about their condition and a feasible treatment plan. Conclusion Patient capacity is a complex and dynamic construct that exceeds “resources” alone. Additional work needs to translate this emerging theory into useful practice for which we propose a clinical mnemonic (BREWS) and the ICAN Discussion Aid. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0525-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Michael R Gionfriddo
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Mayo Graduate School, Mayo Clinic, Rochester, MN, USA
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Endocrinology Division, University Hospital "Dr. Jose E. Gonzalez", Universidad Autonoma de Nuevo Leon, Monterrey, Mexico
| | - Abd Moain Abu Dabrh
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Aaron L Leppin
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Ian Hargraves
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Carl R May
- University of Southampton, School of Health Sciences, Southampton, UK
| | - Nathan D Shippee
- Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - Ana Castaneda-Guarderas
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.,Department of Emergency Medicine, Mayo Clinic, Rochester, MN, USA
| | - Claudia Zeballos Palacios
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Pavithra Bora
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Patricia Erwin
- University of Southampton, School of Health Sciences, Southampton, UK.,Mayo Medical Libraries, Mayo Clinic, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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Villalva CM, Alvarez-Muiño XLL, Mondelo TG, Fachado AA, Fernández JC. Adherence to Treatment in Hypertension. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 956:129-147. [PMID: 27757938 DOI: 10.1007/5584_2016_77] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
The lack of adherence to treatment in hypertension affects approximately 30 % of patients. The elderly, those with several co-morbidities, social isolation, low incomes or depressive symptoms are the most vulnerable to this problem. There is no ideal method to quantify the adherence to the treatment. Indirect methods are recommended in clinical practice. Any intervention strategy should not blame the patient and try a collaborative approach. It is recommended to involve the patient in decision-making. The clinical interview style must be patient-centered including motivational techniques. The improvement strategies that showed greater effectiveness in the compliance of hypertension treatment were: treatment simplification, appointment reminders systems, blood pressure self-monitoring, organizational improvements and nurse and pharmacists care. The combination of different interventions are recommended against isolated interventions.
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Affiliation(s)
- Carlos Menéndez Villalva
- Mariñamansa-A Cuña Health Center, Galician Health Service, Centro de Saúde Marinamansa - A Cuña, Dr. Peña Rey 2b, SERGAS (Servicio Galego de Saúde), CP 32005, Ourense, Spain.
| | - Xosé Luís López Alvarez-Muiño
- Mariñamansa-A Cuña Health Center, Galician Health Service, Centro de Saúde Marinamansa - A Cuña, Dr. Peña Rey 2b, SERGAS (Servicio Galego de Saúde), CP 32005, Ourense, Spain
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