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Cheng SH, Chung KP, Wang YC, Tsai HY. The Nudging Effect of a Reminder Letter to Reduce Duplicated Medications: A Randomized Controlled Trial. Med Care 2024; 62:326-332. [PMID: 38498873 DOI: 10.1097/mlr.0000000000001989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND The increasing trend of multiple chronic conditions across the world has worsened the problem of medication duplication in health care systems without gatekeeping or referral requirement. Thus, to overcome this problem, a reminder letter has been developed in Taiwan to nudge patients to engage in medication management. OBJECTIVE To evaluate the effect of reminder letter on reducing duplicated medications. RESEARCH DESIGN A 2-arm randomized controlled trial design. SUBJECTS Patients with duplicated medications in the first quarter of 2019. MEASURES The Taiwanese single-payer National Health Insurance Administration identified the eligible patients for this study. A postal reminder letter regarding medication duplication was mailed to the patients in the study group, and no information was provided to the comparison group. Generalized estimation equation models with a difference-in-differences analysis were used to estimate the effects of the reminder letters. RESULTS Each group included 11,000 patients. Those who had received the reminder letter were less likely to receive duplicated medications in the subsequent 2 quarters (postintervention 1: odds ratio [OR]=0.95, 95% CI=0.87-1.03; postintervention_2: OR=0.99, 95% CI=0.90-1.08) and had fewer days of duplicated medications (postintervention 1: β=-0.115, P =0.015; postintervention 2 (β=-0.091, P =0.089) than those who had not received the reminder letter, showing marginal but significant differences. CONCLUSIONS A one-off reminder letter nudge could mildly decrease the occurrence of duplicated medications. Multiple nudges or nudges incorporating behavioral science insights may be further considered to improve medication safety in health systems without gatekeeping.
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Affiliation(s)
- Shou-Hsia Cheng
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Kuo-Piao Chung
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Ying-Chieh Wang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
- Population Health Research Center, National Taiwan University, Taipei, Taiwan
| | - Hsin-Yun Tsai
- Division of Health Technology Assessment, Center for Drug Evaluation, Taipei, Taiwan
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Unuigbe A, Cintina I, Sheriff J, Koenig L. High-need beneficiary enrollment patterns in Medicare Advantage and traditional Medicare. Am J Manag Care 2024; 30:170-175. [PMID: 38603531 DOI: 10.37765/ajmc.2024.89528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
OBJECTIVES High-need Medicare beneficiaries require elevated levels of care and coordination to manage their conditions. We evaluated the extent to which high-need beneficiaries enrolled in Medicare Advantage (MA) or traditional Medicare (TM) accountable care organizations (ACOs) relative to TM non-ACOs. STUDY DESIGN Using Medicare claims and MA encounter data, we identified 3 groups of high-need beneficiaries: (1) individuals younger than 65 years with a disability or end-stage kidney disease, (2) frail individuals, and (3) older individuals with major complex or multiple noncomplex chronic conditions. For comparison, we included non-high-need beneficiaries in the analysis, including those with minor complex chronic conditions. METHODS Descriptive analysis of Medicare enrollment patterns and beneficiary characteristics of high-need and other beneficiaries between 2016 and 2019. RESULTS In 2019, high-need beneficiaries accounted for 18 million or 32% of enrollees in TM and MA, an increase of approximately 1 million since 2016, driven by growth in MA. A larger share of beneficiaries in TM ACOs was high need (38%) compared with MA (24%). Although the total count of high-need beneficiaries in TM remained stable from 2016 to 2019, ACOs saw an increase of almost 1.5 million high-need beneficiaries (39% increase), and TM non-ACOs saw a decrease of 1.9 million (23% decrease). CONCLUSIONS We found that high-need beneficiaries were more likely to be in TM non-ACOs than in MA through 2019. However, an increasing number of these beneficiaries are enrolling in MA or aligned with a TM ACO. A projected increase in the population of older adults will increase the economic burden of caring for high-need individuals.
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Affiliation(s)
| | | | | | - Lane Koenig
- KNG Health Consulting, LLC, 6116 Executive Blvd, Ste 770, North Bethesda, MD 20852.
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Carvajal Rico J, Alaeddini A, Faruqui SHA, Fisher-Hoch SP, Mccormick JB. A Laplacian regularized graph neural network for predictive modeling of multiple chronic conditions. Comput Methods Programs Biomed 2024; 247:108058. [PMID: 38382304 DOI: 10.1016/j.cmpb.2024.108058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Revised: 01/25/2024] [Accepted: 02/02/2024] [Indexed: 02/23/2024]
Abstract
BACKGROUND AND GOALS One of the biggest difficulties facing healthcare systems today is the prevalence of multiple chronic diseases (MCC). Mortality and the development of new chronic illnesses are more likely in those with MCC. Pre-existing diseases and risk factors specific to the patient have an impact on the complex stochastic process that guides the evolution of MCC. This study's goal is to use a brand-new Graph Neural Network (GNN) model to examine the connections between specific chronic illnesses, patient-level risk factors, and pre-existing conditions. METHODS We propose a graph neural network model to analyze the relationship between five chronic conditions (diabetes, obesity, cognitive impairment, hyperlipidemia, and hypertension). The proposed model adds a graph Laplacian regularization term to the loss function, which aims to improve the parameter learning process and accuracy of the GNN based on the graph structure. For validation, we used historical data from the Cameron County Hispanic Cohort (CCHC). RESULTS Evaluating the Laplacian regularized GNN on data from 600 patients, we expanded our analysis from two chronic conditions to five chronic conditions. The proposed model consistently surpassed a baseline GNN model, achieving an average accuracy of ≥89% across all combinations. In contrast, the performance of the standard model declined more markedly with the addition of more chronic conditions. The Laplacian regularization provided consistent predictions for adjacent nodes, beneficial in cases with shared attributes among nodes. CONCLUSIONS The incorporation of Laplacian regularization in our GNN model is essential, resulting in enhanced node categorization and better predictive performance by harnessing the graph structure. This study underscores the significance of considering graph structure when designing neural networks for graph data. Future research might further explore and refine this regularization method for various tasks using graph-structured data.
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Affiliation(s)
- Julian Carvajal Rico
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, United States of America
| | - Adel Alaeddini
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX, 78249, United States of America.
| | - Syed Hasib Akhter Faruqui
- Department of Engineering Technology, Sam Houston State University, Huntsville, Tx, 77341, United States of America
| | - Susan P Fisher-Hoch
- School of Public Health Brownsville, The University of Texas Health Science Center at Houston, Houston, TX, 78520, United States of America
| | - Joseph B Mccormick
- School of Public Health Brownsville, The University of Texas Health Science Center at Houston, Houston, TX, 78520, United States of America
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Jin Y, Bowers BJ, Cotton QD, Ersig AL. Self-identified culturally related stressors that influence self-care in older adults with multiple chronic conditions: A qualitative study. J Clin Nurs 2024; 33:1550-1561. [PMID: 38151803 DOI: 10.1111/jocn.16979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 11/30/2023] [Accepted: 12/15/2023] [Indexed: 12/29/2023]
Abstract
AIM To identify culturally related stressors that influence self-care in Chinese older adults with multiple chronic conditions. BACKGROUND Effective self-care can improve health outcomes for chronic conditions, but implementing self-care is challenging. Individuals with multiple chronic conditions face even more self-care complexity than those with single chronic conditions, generating additional stressors. Although stressors have been found to negatively influence self-care in multiple chronic conditions, the role of culture in generating stressors has been neglected. DESIGN This paper reports on the qualitative component of a larger mixed-methods study. Two free-response items in a survey were used to identify culturally related stressors that influence self-care. This report adhered to the SRQR guideline checklist. METHODS Data were collected between January and April 2022. One hundred and thirty-eight free text responses asking participants to identify stressors that influenced their self-care effectiveness were analysed sequentially using deductive content analysis and thematic analysis. RESULTS Findings from deductive content analysis largely confirmed published work in Western literature on stressors complicating self-care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. CONCLUSION Chinese older adults with multiple chronic conditions identified a wide range of stressors that impacted their day-to-day self-care. This study provided valuable insights into culturally related stressors in older adults with multiple chronic conditions. Findings deepened our knowledge of cultural influences on the success of self-care in older adults with multiple chronic conditions, suggesting the potential for reaching populations across different cultures and regions. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE Stressors that might influence self-care ability are important for nurses to assess in people with multiple chronic conditions. The design of self-care interventions should take a culturally tailored intergenerational family-centred approach to help mitigate the impact of stressors and ultimately improve patient outcomes. IMPACT What problem did the study address? Stressors documented in older adults with MCCs have all been generated from research with Western populations. China is now home to the largest population of older people in the world. Understanding the influence of culturally relevant stressors on self-care in Chinese older adults with MCCs is lacking. What were the main findings? Findings from deductive content analysis largely confirmed published work in Western literature on stressors that complicated self-care, including symptom burdens, financial strains, social disconnection, caregiving responsibilities and major life events. Findings from reflexive thematic analysis extended current literature by identifying three culturally relevant stressors in older adults with MCCs in China: intergenerational obligations and commitments, ambivalence about receiving care and worries about potential problems. Where and on whom will the research have an impact? The research will have an impact on guiding nurses' assessment of culturally relevant stressors' impact on self-care for older adults with MCCs. In addition, findings could inform research and policy development to aim at mitigating the impact of culturally based stressors on self-care. REPORTING METHOD This study adhered to the Standards for Reporting Qualitative Research (SRQR) guideline checklist. PATIENT OR PUBLIC CONTRIBUTION During the member-checking process, the validation of findings for accuracy was carried out by 10 participants, who also found resonance between these findings and their own experiences.
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Affiliation(s)
- Yuanyuan Jin
- School of Nursing, Medical College of Soochow University, Suzhou, China
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Barbara J Bowers
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Quinton D Cotton
- School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Anne L Ersig
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Russell AM, Bonham M, Lovett R, Pack A, Wolf MS, O’Conor R. Characterizing Caregiver Roles and Conflict in Health Management Support to Older People With Multiple Chronic Conditions. J Appl Gerontol 2024; 43:386-395. [PMID: 37982673 PMCID: PMC10922419 DOI: 10.1177/07334648231211456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023] Open
Abstract
Caregivers provide critical support for older adults managing multiple chronic conditions (MCCs), but few studies describe the assistance caregivers provide or identify factors influencing their provision of support. We conducted qualitative interviews with 25 caregivers to older adults with MCCs to describe caregivers' roles and identify the factors that influence caregivers' ability to carry out these roles. Transcripts were analyzed using the Framework Method. Caregivers supported the management of MCCs in several ways, including monitoring conditions, communicating with clinicians, and tracking health information. Disagreement, or conflicted relationships, between caregivers and older adults over health and behaviors influenced the provision of support, resulting in less involved and less effective caregivers. Caregivers in conflicted relationships were more challenged by resistance from older adults. Greater agreement, or collaboration, between caregivers and older adults resulted in more involved and effective caregivers. Addressing health-related conflict may enhance caregivers' capacity to support older adults with MCCs.
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Affiliation(s)
- Andrea M. Russell
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Morgan Bonham
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rebecca Lovett
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Allison Pack
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Michael S. Wolf
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rachel O’Conor
- Division of General Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL
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Spannella F, Falzetti S, Giulietti F, Sarnari S, Morichi V, Tamburrini P, Gattafoni P, Mannello L, Crippa M, Ferrara L, Sarzani R, Lombrano MR. Prognostic Role of NECPAL CCOMS-ICO Tool on One-Year Mortality in a Hospitalized Older Population. J Palliat Med 2024; 27:367-375. [PMID: 37971772 DOI: 10.1089/jpm.2023.0038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023] Open
Abstract
Background: It is essential to establish both the appropriateness of palliative care (PC) and the prognosis in daily clinical practice to guide decision making in the management of older people with multiple advanced chronic diseases. Objectives: We assessed patients who were appropriate for PC using the NECPAL tool in a hospitalized older population and then we investigated its predictive validity on one-year mortality compared with the multidimensional prognostic index (MPI), a validated geriatric prognostic tool. Design: Prospective cohort study. Setting/Subjects: We enrolled 103 older adults hospitalized for acute medical and surgical conditions in a geriatric hospital in Italy. Measurements: The variables of interest were obtained at baseline through interviews of the ward medical staff and by consulting the computerized medical records. Long-term mortality (one-year) was assessed through the analysis of data acquired from hospital or territorial databases or through telephone contact with caregivers. Results: Mean age was 86.8 ± 7.2 years, with a female prevalence of 54.4%. Prevalence of NECPAL+ patients was 65.1%. MPI low risk: 30.1%; moderate risk: 41.7%; severe risk: 28.2%. Patients deceased during follow-up were 54.4%. NECPAL+ patients were more likely to die, even after adjusting for age, sex, and MPI score (hazard ratio [HR] 2.7, p = 0.020). All the NECPAL categories were associated with one-year mortality. MPI showed a better predictive power than NECPAL (area under the curve [AUC] 0.85 vs. 0.75, p = 0.030). After the exclusion of "Comorbidity: ≥2 concurrent diseases" item from NECPAL, its AUC increased to 0.78 with no statistically significant differences from MPI (p = 0.122). Conclusions: NECPAL is useful to identify the appropriateness of PC in hospitalized older adults, also allowing to predict long-term mortality with a performance similar to that of a validated geriatric prognostic tool.
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Affiliation(s)
- Francesco Spannella
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Sara Falzetti
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Federico Giulietti
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
| | - Silvia Sarnari
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
| | - Valeria Morichi
- Medical Department, Internal Medicine Unit, IRCCS INRCA, Osimo, Italy
| | | | - Pisana Gattafoni
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
| | | | | | - Letizia Ferrara
- Medical Direction Unit, Risk Manager, IRCCS INRCA, Ancona, Italy
| | - Riccardo Sarzani
- Medical Department, Internal Medicine and Geriatrics Unit, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University "Politecnica delle Marche," Ancona, Italy
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Gatwood J, Dashputre A, Rajpurohit A, Gatwood K, Mackler E, Wallace L, Farris K, Rizvi-Toner A, Farley J. Impact of initiating oral anticancer agents for leukemia on adherence to medications for multiple chronic conditions. J Oncol Pharm Pract 2024; 30:342-353. [PMID: 37113049 DOI: 10.1177/10781552231171926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Increased use of oral anticancer agents (OAAs) has empowered adults with chronic lymphocytic leukemia (CLL) and chronic myelogenous leukemia (CML) to manage their therapy, but this shift may complicate medication use, particularly among adults with multiple chronic conditions (MCC). METHODS This retrospective cohort study used 2013-2018 commercial and Medicare claims data to assess medication use in adults with CML or CLL. To be included, patients must have been at least 18 years old, diagnosed with and had 2+ claims for an OAA indicated for either CML or CLL, continuously enrolled 12 months before and after OAA initiation, and treated for (2+ fills) at least two select chronic conditions. Proportion of days covered (PDC) determined medication adherence and was compared for 12 months before and after OAA initiation by Wilcoxon signed-rank tests, McNemar's tests, and difference-in-differences models. RESULTS Among CLL patients, mean OAA adherence in the first year of therapy was 79.8% (SD: 21.1) and 74.7% (SD: 24.9) for commercial and Medicare patients, respectively; mean adherence for CML patients was 84.5% (SD: 15.8) and 80.1% (SD: 20.1) for commercial and Medicare patients, respectively. Adherence and the proportion adherent (PDC ≥ 80%) to comorbid therapies was generally unchanged following OAA initiation. Consistently unremarkable changes in MCC adherence were observed in 12-month difference-in-differences models, but significant decline was observed in MCC adherence after 6 months of OAA use. CONCLUSIONS OAA initiation among adults with CML or CLL was not associated with significant, initial changes to adherence to medications for chronic diseases.
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Affiliation(s)
- Justin Gatwood
- University of Tennessee Health Science Center, Nashville, TN, USA
| | - Ankur Dashputre
- University of Tennessee Health Science Center, Nashville, TN, USA
| | | | - Katie Gatwood
- Vanderbilt University Medical Center, Nashville, TN, USA
| | - Emily Mackler
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | - Leah Wallace
- University of Tennessee Health Science Center, Nashville, TN, USA
| | - Karen Farris
- University of Michigan College of Pharmacy, Ann Arbor, MI, USA
| | | | - Joel Farley
- University of Minnesota College of Pharmacy, Minneapolis, MN, USA
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Pogue CA, Schlak AE, McHugh MD. Effect of Discharge Readiness on 30-Day Readmissions Among Older Adults Living With Multiple Chronic Conditions. Med Care 2024; 62:205-212. [PMID: 38241081 PMCID: PMC10922299 DOI: 10.1097/mlr.0000000000001976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2024]
Abstract
BACKGROUND Despite decreases in readmissions among Medicare beneficiaries after the implementation of the Hospital Readmissions Reduction Program, older adults living with multiple chronic conditions (MCCs) continue to experience higher readmission rates. Few strategies leverage nursing to identify patients at risk for readmission. OBJECTIVES Examine the effect of nurse assessments of discharge readiness on 30-day readmissions. RESEARCH DESIGN Cross-sectional study linking 3 secondary data sources (ie, nurse survey, hospital survey, and Medicare claims data) representing 424 hospitals. SUBJECTS A total of 188,806 Medicare surgical patients with MCCs. MEASURES Discharge readiness was derived from the 2016 RN4CAST-US survey. Medicare claims data was used to determine the MCC count. The outcome was 30-day readmissions across the MCC count. RESULTS The average discharge readiness score was 0.45 (range=0-0.86) indicating that, in the average hospital, <50% of nurses were confident their patient or caregiver could manage their care after discharge. Nearly 8% of patients were readmitted within 30 days of discharge; the highest rates of readmissions were among individuals with ≥5 MCCs (4293, 13.50%). For each 10% increase in the proportion of nurses in a hospital who were confident in their patients' discharge readiness, the odds of 30-day readmission decreased by 2% (95% CI: 0.96-1.00; P =0.028) for patients with 2-4 MCCs and 3% (95% CI: 0.94-0.99; P =0.015) for patients with ≥5 MCCs, relative to patients with 0-1 MCCs. CONCLUSIONS Nurse assessments of discharge readiness may be a useful signal for hospitals to reduce readmissions and examine factors interfering with discharge processes.
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Affiliation(s)
- Colleen A Pogue
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
| | | | - Matthew D McHugh
- Center for Health Outcomes and Policy Research, University of Pennsylvania School of Nursing, Philadelphia, PA
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Nghiem VT, Jin J, Mennemeyer ST, Wong FL. Health-related risk behaviors among U.S. childhood cancer survivors: a nationwide estimate. BMC Cancer 2024; 24:180. [PMID: 38321375 PMCID: PMC10845633 DOI: 10.1186/s12885-024-11894-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/17/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND Childhood cancer survivors (CCS) are subject to a substantial burden of treatment-related morbidity. Engaging in health protective behaviors and eliminating risk behaviors are critical to preventing chronic diseases and premature deaths. This study is aimed to provide updated information on currently smoking, physical inactivity, binge drinking patterns and associated factors among CCS using a nationwide dataset. METHODS We constructed a sample of CCS (cancer diagnosis at ages < 21y) and healthy controls (matched on age, sex, residency, race/ethnicity) using 2020 Behavioral Risk Factor Surveillance System. We used Chi-square tests and Wilcoxon rank-sum test to examine differences in sociodemographics and clinical characteristics between two groups. Logistic, ordinal regression and multivariable models (conditional models for matching) were used to determine factors associated with risk behaviors. RESULTS The final sample (18-80y) included 372 CCS and 1107 controls. Compared to controls, CCS had a similar proportion of binge drinking (~ 18%) but higher prevalence of currently smoking (26.6% vs. 14.4%, p < 0.001), physical inactivity (23.7% vs. 17.7%, p = 0.012), and of having 2-or-3 risk behaviors (17.2% vs. 8.1%, p < 0.001). Younger age, lower educational attainment, and having multiple chronic health conditions were associated with engaging in more risk behaviors among CCS. Females, compared to male counterparts, had lower odds of binge drinking (adjusted odds ratio (aOR) = 0.30, 95% confidence interval (CI): 0.16-0.57) among CCS but not in all sample. Having multiple chronic health conditions increased odds of both currently smoking (aOR = 3.52 95%CI: 1.76-7.02) and binge drinking (aOR = 2.13 95%CI: 1.11-4.08) among CCS while it only increased odds of currently smoking in all sample. DISCUSSION Our study provided risk behavior information for wide age-range CCS, which is currently lacking. Every one in four CCS was currently smoking. Interventions targeting risk behavior reduction should focus on CCS with multiple chronic health conditions.
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Affiliation(s)
- Van T Nghiem
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA.
| | - Jing Jin
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - Stephen T Mennemeyer
- Department of Health Policy and Organization, University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - F Lennie Wong
- Department of Population Sciences, City of Hope, Duarte, CA, USA
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Keller A, Bai H, Budinger S, Eliazer S, Hansen M, Konopka AR, Morales-Nebreda L, Najt CP, Prahlad V, Victorelli S, Vorland CJ, Yuan R, Rhoads TW, Mihaylova MM. The Third Annual Symposium of the Midwest Aging Consortium. J Gerontol A Biol Sci Med Sci 2024; 79:glad239. [PMID: 37804247 PMCID: PMC10799755 DOI: 10.1093/gerona/glad239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Indexed: 10/09/2023] Open
Abstract
The geroscience hypothesis suggests that addressing the fundamental mechanisms driving aging biology will prevent or mitigate the onset of multiple chronic diseases, for which the largest risk factor is advanced age. Research that investigates the root causes of aging is therefore of critical importance given the rising healthcare burden attributable to age-related diseases. The third annual Midwest Aging Consortium symposium was convened as a showcase of such research performed by investigators from institutions across the Midwestern United States. This report summarizes the work presented during a virtual conference across topics in aging biology, including immune function in the lung-particularly timely given the Corona Virus Immune Disease-2019 pandemic-along with the role of metabolism and nutrient-regulated pathways in cellular function with age, the influence of senescence on stem cell function and inflammation, and our evolving understanding of the mechanisms underlying observation of sex dimorphism in aging-related outcomes. The symposium focused on early-stage and emerging investigators, while including keynote presentations from leaders in the biology of aging field, highlighting the diversity and strength of aging research in the Midwest.
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Affiliation(s)
- Andrea Keller
- Department of Biological Chemistry and Pharmacology, College of Medicine, Ohio State University, Columbus, Ohio, USA
- Comprehensive Cancer Center, Wexner Medical Center, Arthur G. James Cancer Hospital, Ohio State University, Columbus, Ohio, USA
| | - Hua Bai
- Department of Genetics, Development, and Cell Biology, Iowa State University, Ames, Iowa, USA
| | - Scott Budinger
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Susan Eliazer
- Department of Biomedical Sciences, University of North Dakota School of Medicine and Health Sciences, Grand Forks, North Dakota, USA
| | - Malene Hansen
- Buck Institute for Research on Aging, Novato, California, USA
| | - Adam R Konopka
- Division of Geriatrics and Gerontology, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
- Geriatric Research, Education, and Clinical Center, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
| | - Luisa Morales-Nebreda
- Division of Pulmonary and Critical Care Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Charles P Najt
- Department of Biochemistry, Molecular Biology, and Biophysics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Veena Prahlad
- Department of Biology, Aging Mind and Brain Initiative; Iowa Neuroscience Institute, University of Iowa, Iowa City, Iowa, USA
- Department of Cell Stress Biology, Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Stella Victorelli
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
| | - Colby J Vorland
- Department of Epidemiology and Biostatistics, Indiana University School of Public Health-Bloomington, Bloomington, Indiana, USA
| | - Rong Yuan
- Geriatric Research Division, Department of Internal Medicine, Southern Illinois University School of Medicine, Springfield, Illinois, USA
| | - Timothy W Rhoads
- Department of Nutritional Sciences, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Maria M Mihaylova
- Department of Biological Chemistry and Pharmacology, College of Medicine, Ohio State University, Columbus, Ohio, USA
- Comprehensive Cancer Center, Wexner Medical Center, Arthur G. James Cancer Hospital, Ohio State University, Columbus, Ohio, USA
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Coles T, Mkumba LS, Leiva LZ, Plyler K, McDonald SR, Lagoo-Deenadayalan S, Reeve BB. Facilitators and barriers to eliciting physical function goals before and after surgery: A qualitative study with clinicians. Patient Educ Couns 2024; 119:108078. [PMID: 38070300 DOI: 10.1016/j.pec.2023.108078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 10/25/2023] [Accepted: 11/14/2023] [Indexed: 01/02/2024]
Abstract
OBJECTIVE Describe clinicians' perspectives of facilitators and barriers to eliciting physical function goals from patients with multiple chronic conditions pre- and post-surgery. METHODS Semi-structured qualitative interviews were conducted with clinicians, recruited from an academic medical center, who treat adult patients with multiple chronic conditions. Purposive sampling ensured multiple provider types were represented. Interviews were conducted in person or via web conference and were audio recorded. Findings were summarized using descriptive qualitative content analysis. RESULTS Of the 12 participating clinicians, 92% were female and 83% specialized in geriatrics. Clinicians had a mean of 10.7 (min-max: 1-30) years of experience. Key facilitators to goal-setting conversations were sufficient time, familial support, and patient cognitive ability. Barriers included lack of time, lack of training, patient challenges in choosing realistic and specific actionable goals, emotional barriers, and cognitive challenges. CONCLUSION Some facilitators and barriers are modifiable, including time, inclusion of family members in the clinical encounter, and clinician training to enable actionable goal setting. These results highlight areas for intervention to facilitate goal elicitation for physical function in clinical care settings. PRACTICE IMPLICATIONS Clinicians should be aware of the barriers impacting eliciting goals. Healthcare organizations could consider providing effective goal elicitation training and tools to facilitate goal setting conversation.
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Affiliation(s)
- Theresa Coles
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA.
| | - Laura S Mkumba
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Leslie Zapata Leiva
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Kate Plyler
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Shelley R McDonald
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Bryce B Reeve
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
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12
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Petrusevski C, Joy M, Wilson M, Richardson J. "You can because you do and you do, because you can": Using interpretative description to examine what it means to be a physically literate adult living with multiple chronic conditions. PLoS One 2024; 19:e0297261. [PMID: 38261565 PMCID: PMC10805309 DOI: 10.1371/journal.pone.0297261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 01/02/2024] [Indexed: 01/25/2024] Open
Abstract
AIMS Physical literacy is an emerging strategy to increase participation in movement activities for children and youth, however little is known about how to frame physical literacy for aging adults. The purpose of this qualitative study was to explore how adults with multiple chronic conditions describe physically literacy for adults and to understand the needs, preferences, barriers, and facilitators to acquiring and maintaining physical literacy despite fluctuations in health status. METHODS Sixteen semi-structured interviews were conducted with working and retired teachers in Ontario, Canada, with varying self-identified physical activity levels and are living with 2 or more chronic conditions. A semi-structured interview guide was used to conduct the interviews. Thematic analysis was used to analyze the data. RESULTS Participants identified 5 themes when describing physical literacy for adults: understanding one's body, conscious commitment to movement, access to and knowledge of rehabilitation health resources, valuable physical activities, and confident problem solver. Results indicate that when acquiring physical literacy for adults, there are important new constructs, such as self-management and the awareness of rehabilitation strategies to maintain mobility, that differ from the traditional physical literacy model. CONCLUSIONS To improve function and mobility outcomes for adults living with chronic conditions, programs should be guided by a physical literacy framework that addresses the needs unique to aging adults, such as understanding the changes that occur with aging, self-monitoring mobility changes and participating in rehabilitation strategies.
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Affiliation(s)
| | - MacDermid Joy
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Physical Therapy and Surgery, Western University, London, ON, Canada
- Hand and Upper Limb Centre, St. Joseph’s Health Centre, London, ON, Canada
| | - Michael Wilson
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON, Canada
| | - Julie Richardson
- School of Rehabilitation Science, McMaster University, Hamilton, ON, Canada
- Department of Health Evidence & Impact, McMaster University, Hamilton, ON, Canada
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13
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Elayan S, Bei E, Ferraris G, Fisher O, Zarzycki M, Angelini V, Ansmann L, Buskens E, Hagedoorn M, von Kutzleben M, Lamura G, Looijmans A, Sanderman R, Vilchinsky N, Morrison V. Cohort profile: The ENTWINE iCohort study, a multinational longitudinal web-based study of informal care. PLoS One 2024; 19:e0294106. [PMID: 38236932 PMCID: PMC10796045 DOI: 10.1371/journal.pone.0294106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Accepted: 10/25/2023] [Indexed: 01/22/2024] Open
Abstract
Informal care is a key pillar of long-term care provision across Europe and will likely play an even greater role in the future. Thus, research that enhances our understanding of caregiving experiences becomes increasingly relevant. The ENTWINE iCohort Study examines the personal, psychological, social, economic, and geographic factors that shape caregiving experiences. Here, we present the baseline cohort of the study and describe its design, recruitment methods, data collection procedures, measures, and early baseline findings. The study was conducted in nine countries: Germany, Greece, Ireland, Israel, Italy, the Netherlands, Poland, Sweden, and the United Kingdom. The study comprised a web-based longitudinal survey (baseline + 6-month follow-up) and optional weekly diary assessments conducted separately with caregivers and care recipients. From 14 August 2020 to 31 August 2021, 1872 caregivers and 402 care recipients were enrolled at baseline. Participants were recruited via Facebook and, to a lesser extent, via the study website or caregiver/patient organisations. Caregiver participants were predominantly female (87%) and primary caregivers (82%), with a median age of 55 years. A large proportion (80%) held at least post-secondary education, and two-thirds were married/partnered. Over half of the caregivers were employed (53%) and caring for a person with multiple chronic conditions (56%), and nearly three-quarters were caring for either a parent (42%) or a spouse/partner (32%). About three-quarters of care recipient participants were female (77%), not employed (74%), and had at least post-secondary education (77%), with a median age of 55 years. Over half of the care recipients were married/partnered (59%), receiving care primarily from their spouses/partners (61%), and diagnosed with multiple chronic conditions (57%). This study examining numerous potential influences on caregiving experiences provides an opportunity to better understand the multidimensional nature of these experiences. Such data could have implications for developing caregiving services and policies, and for future informal care research.
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Affiliation(s)
- Saif Elayan
- Faculty of Economics and Business, Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
| | - Eva Bei
- Faculty of Social Sciences, Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Giulia Ferraris
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Oliver Fisher
- Department of Economics and Social Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Mikołaj Zarzycki
- Department of Psychology, Liverpool Hope University, Liverpool, United Kingdom
| | - Viola Angelini
- Faculty of Economics and Business, Department of Economics, Econometrics and Finance, University of Groningen, Groningen, The Netherlands
| | - Lena Ansmann
- Department of Health Services Research, Division of Organizational Health Services Research, University of Oldenburg, Oldenburg, Germany
- Faculty of Medicine, Institute of Medical Sociology, Health Services Research and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany
| | - Erik Buskens
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Mariët Hagedoorn
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Milena von Kutzleben
- Department of Health Services Research, Division of Organizational Health Services Research, University of Oldenburg, Oldenburg, Germany
| | - Giovanni Lamura
- IRCCS INRCA-National Institute of Health and Science on Ageing, Centre for Socio-Economic Research on Ageing, Ancona, Italy
| | - Anne Looijmans
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Robbert Sanderman
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Noa Vilchinsky
- Faculty of Social Sciences, Department of Psychology, Bar-Ilan University, Ramat Gan, Israel
| | - Val Morrison
- School of Human and Behavioural Sciences, Bangor University, Bangor, United Kingdom
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14
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Bookey-Bassett S. Feasibility testing of an interprofessional education intervention to support collaborative practice in home care for older stroke survivors with multiple chronic conditions. J Interprof Care 2024; 38:121-132. [PMID: 37871996 DOI: 10.1080/13561820.2023.2262511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Accepted: 09/07/2023] [Indexed: 10/25/2023]
Abstract
This mixed-methods study examined the feasibility of implementing a new six-month, theory-based, interprofessional education intervention, and explored its effects and impact on collaborative practice among home care providers caring for older adult stroke survivors (≥65) with multiple chronic conditions. The evaluation utilized a qualitative descriptive and one group repeated measures design which included participant questionnaires, focus groups and field notes. Participants included 37 home care providers (registered nurses, physiotherapists, occupational therapists, personal support workers, care coordinators, and their supervisors) in Ontario, Canada. The intervention was feasible and acceptable to home care providers. Perceived benefits included improved communication and collaboration within teams, enhanced role understanding, increased learning with and from each other, and increased appreciation of all team members' expertise. From 3 to 6 months post initial IPE training, there was a statistically significant improvement in three domains of collaborative practice as measured by the Collaborative Practice Assessment Tool (communication/information exchange; community linkage and coordination of care; decision-making and conflict management) and one domain of collaborative practice, as measured by the 19-item Team Climate Inventory (task orientation). Implications for implementing interprofessional education in home care practice settings are described. Further testing in other populations and settings is warranted.
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Affiliation(s)
- Sue Bookey-Bassett
- Daphne Cockwell School of Nursing, Toronto Metropolitan University (formerly Ryerson University), Toronto, Ontario, Canada
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15
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Thompson ED, Miller AE, Reisman DS. Characterizing the impact of multiple chronic conditions on return to participation in chronic stroke survivors. Top Stroke Rehabil 2024; 31:97-103. [PMID: 37057761 PMCID: PMC10576011 DOI: 10.1080/10749357.2023.2202018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Accepted: 04/09/2023] [Indexed: 04/15/2023]
Abstract
BACKGROUND Each year, 795,000 Americans experience a stroke. As stroke mortality declines, more individuals are in the chronic phase of recovery (>6 months post-stroke). Over 80% of stroke survivors have multiple, chronic health conditions (MCC). While the relationship between MCC and mortality and function during acute recovery has been explored, less is known about how MCC burden affects participation in chronic stroke survivors. OBJECTIVE This study investigated whether MCC burden is related to participation in those with chronic stroke. METHODS Two hundred and sixty-six participants with chronic (≥6 months) stroke were included in this cross-sectional and retrospective analysis. Participants had a mean age of 62.2 ± 12.8 years, and time since stroke (TSS) of 36.0 ± 44.6 months (114F/152 M). Participants completed the 6-minute Walk Test (6MWT), Activities-Specific Balance Confidence Scale (ABC), Modified Cumulative Illness Rating Scale (MCIR) to quantify the presence and severity of chronic illness across 14 body systems, and the Stroke Impact Scale - Participation subscale (SIS-P). Participation (SIS-P) was the dependent variable. Independent variables were entered into a sequential regression model in three blocks: demographic variables, physical capacity (6MWT distance) and balance self-efficacy (ABC), and MCC burden (MCIR). RESULTS After adjusting for age, sex, and time since stroke, physical capacity and balance self-efficacy explained 31.4% (p < 0.001), and the MCC burden explained 2.0% (p = 0.004). Higher participation was related to lower MCC burden. CONCLUSIONS MCC burden is a significant contributor to variance in participation in chronic stroke survivors, above and beyond demographics, physical capacity, and self-efficacy, and therefore should be considered when creating rehabilitation programs to improve participation.
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Affiliation(s)
| | - Allison E Miller
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
- Program in Physical Therapy, Washington University School of Medicine, St. Louis, MO, USA
| | - Darcy S Reisman
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
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16
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Shafer PR, Davis A, Clark JA. Finding social need-les in a haystack: ascertaining social needs of Medicare patients recorded in the notes of care managers. BMC Health Serv Res 2023; 23:1400. [PMID: 38087286 PMCID: PMC10717654 DOI: 10.1186/s12913-023-10446-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Accepted: 12/06/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Unmet social needs may impair health and access to health care, and intervening on these holds particular promise in high-risk patient populations, such as those with multiple chronic conditions. Our objective was to identify social needs in a patient population at significant risk-Medicare enrollees with multiple chronic illnesses enrolled in care management services-and measure their prevalence prior to any systematic screening. METHODS We partnered with Renova Health, an independent Medicare Chronic Care Management (CCM) provider with patients in 10 states during our study period (January 2017 through August 2020). Our data included over 3,000 Medicare CCM patients, representing nearly 20,000 encounters. We used a dictionary-based natural language processing approach to ascertain the prevalence of six domains of barriers to care (food insecurity, housing instability, utility hardship) and unmet social needs (health care affordability, need for supportive services, transportation) in notes taken during telephonic Medicare CCM patient encounters. RESULTS Barriers to care, specifically need for supportive services (2.4%) and health care affordability (0.8%), were the most prevalent domains identified. Transportation as a barrier to care came up relatively less frequently in CCM encounters (0.1%). Unmet social needs were identified at a comparatively lower rate, with potential housing instability (0.3%) flagged most followed by potential utility hardship (0.2%) and food insecurity (0.1%). CONCLUSIONS There is substantial untapped opportunity to systematically screen for social determinants of health and unmet social needs in care management.
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Affiliation(s)
- Paul R Shafer
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, United States of America.
| | - Amanda Davis
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, United States of America
| | - Jack A Clark
- Department of Health Law, Policy, and Management, School of Public Health, Boston University, 715 Albany Street, Boston, MA, 02118, United States of America
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17
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Mamo SK, Pearlman J, Wheeler KA. Associations Between Age-Related Hearing Loss, Cognitive Impairment, and Multiple Chronic Conditions in a Group Care Setting. J Speech Lang Hear Res 2023; 66:5087-5108. [PMID: 37934882 PMCID: PMC11001376 DOI: 10.1044/2023_jslhr-23-00067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/22/2023] [Accepted: 08/24/2023] [Indexed: 11/09/2023]
Abstract
PURPOSE The purpose of this study was to explore the relationships between hearing loss, cognitive status, and a range of health outcomes over a period of 2 years in a sample of older adults who are enrolled in Program of All-Inclusive Care for the Elderly, which is a Medicare/Medicaid beneficiary program for individuals who are nursing home eligible but living in the community at time of enrollment. METHOD The sample (N = 144) includes a diverse (47% White/non-Hispanic, 35% Black/African American, and 16% Latin/Hispanic) group of adults ranging from 55 to 93 years old. We used medical chart data to measure respondents' cognitive and health status, including chronic conditions and hospital use. Hearing status was measured once at the beginning of the 2-year review period. We used logistic regression and negative binomial hurdle models for analyses. We used latent class analysis (LCA) to explore the extent to which respondents cluster into a set of "health profiles" characterized by their hearing, cognitive status, and health conditions. RESULTS We found that hearing loss is weakly associated with heart disease and diabetes and associated with cerebrovascular disease and falls; cognitive impairment is also associated with cerebrovascular disease and the number of falls. LCA indicates that respondents cluster into a variety of health profiles with a consistent pairing of hearing loss and depression. CONCLUSIONS The results are largely consistent with associations reported in epidemiological studies that include age-related hearing loss. Of particular interest in this study is the LCA that suggested that all of the profiles associated with a high likelihood of hearing loss included a high risk of depression. The co-occurrence of these two factors highlights the need to identify and treat hearing loss in older adults, especially as part of the treatment plan for individuals with depressive symptoms.
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Affiliation(s)
- Sara K. Mamo
- Department of Speech, Language, and Hearing Sciences, University of Massachusetts Amherst
| | - Jessica Pearlman
- Institute for Social Science Research, University of Massachusetts Amherst
| | - Kara A. Wheeler
- Department of Speech, Language, and Hearing Sciences, University of Massachusetts Amherst
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18
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Matsuo Y. Natural Products and Cancer. Nutrients 2023; 15:5064. [PMID: 38140322 PMCID: PMC10745974 DOI: 10.3390/nu15245064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2023] [Revised: 10/31/2023] [Accepted: 11/30/2023] [Indexed: 12/24/2023] Open
Abstract
Natural and dietary compounds are known to offer protection and affect the pathogeneses of numerous chronic diseases [...].
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Affiliation(s)
- Yoichi Matsuo
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Sciences, Kawasumi 1, Mizuho-cho, Mizuho-ku, Nagoya 4678601, Japan
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19
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McMenamin A, Turi E, Schlak A, Poghosyan L. A Systematic Review of Outcomes Related to Nurse Practitioner-Delivered Primary Care for Multiple Chronic Conditions. Med Care Res Rev 2023; 80:563-581. [PMID: 37438917 PMCID: PMC10784406 DOI: 10.1177/10775587231186720] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/14/2023]
Abstract
Multiple chronic conditions (MCCs) are more common and costly than any individual health condition in the United States. The growing workforce of nurse practitioners (NPs) plays an active role in providing primary care to this patient population. This study identifies the effect of NP primary care models, compared with models without NP involvement, on cost, quality, and service utilization by patients with MCCs. We conducted a literature search of six databases and performed critical appraisal. Fifteen studies met inclusion criteria (years: 2003-2021). Overall, most studies showed reduced or similar costs, equivalent or better quality, and similar or lower rates of emergency department use and hospitalization associated with NP primary care models for patients with MCCs, compared with models without NP involvement. No studies found them associated with worse outcomes. Thus, NP primary care models, compared with models without NP involvement, have similar or positive impacts on MCC patient outcomes.
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Affiliation(s)
- Amy McMenamin
- Columbia University in the City of New York, New York City, USA
| | - Eleanor Turi
- Columbia University in the City of New York, New York City, USA
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20
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Littenberg B, Clifton J, Crocker AM, Baldwin LM, Bonnell LN, Breshears RE, Callas P, Chakravarti P, Clark/Keefe K, Cohen DJ, deGruy FV, Eidt-Pearson L, Elder W, Fox C, Frisbie S, Hekman K, Hitt J, Jewiss J, Kaelber DC, Kelley KS, Kessler R, O'Rourke-Lavoie JB, Leibowitz GS, Macchi CR, Martin MP, McGovern M, Mollis B, Mullin D, Nagykaldi Z, Natkin LW, Pace W, Pinckney RG, Pomeroy D, Reynolds P, Rose GL, Scholle SH, Sieber WJ, Soucie J, Stancin T, Stange KC, Stephens KA, Teng K, Waddell EN, van Eeghen C. A Cluster Randomized Trial of Primary Care Practice Redesign to Integrate Behavioral Health for Those Who Need It Most: Patients With Multiple Chronic Conditions. Ann Fam Med 2023; 21:483-495. [PMID: 38012036 PMCID: PMC10681692 DOI: 10.1370/afm.3027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 05/05/2023] [Accepted: 05/31/2023] [Indexed: 11/29/2023] Open
Abstract
PURPOSE Patient outcomes can improve when primary care and behavioral health providers use a collaborative system of care, but integrating these services is difficult. We tested the effectiveness of a practice intervention for improving patient outcomes by enhancing integrated behavioral health (IBH) activities. METHODS We conducted a pragmatic, cluster randomized controlled trial. The intervention combined practice redesign, quality improvement coaching, provider and staff education, and collaborative learning. At baseline and 2 years, staff at 42 primary care practices completed the Practice Integration Profile (PIP) as a measure of IBH. Adult patients with multiple chronic medical and behavioral conditions completed the Patient-Reported Outcomes Measurement Information System (PROMIS-29) survey. Primary outcomes were the change in 8 PROMIS-29 domain scores. Secondary outcomes included change in level of integration. RESULTS Intervention assignment had no effect on change in outcomes reported by 2,426 patients who completed both baseline and 2-year surveys. Practices assigned to the intervention improved PIP workflow scores but not PIP total scores. Baseline PIP total score was significantly associated with patient-reported function, independent of intervention. Active practices that completed intervention workbooks (n = 13) improved patient-reported outcomes and practice integration (P ≤ .05) compared with other active practices (n = 7). CONCLUSION Intervention assignment had no effect on change in patient outcomes; however, we did observe improved patient outcomes among practices that entered the study with greater IBH. We also observed more improvement of integration and patient outcomes among active practices that completed the intervention compared to active practices that did not. Additional research is needed to understand how implementation efforts to enhance IBH can best reach patients.
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Affiliation(s)
- Benjamin Littenberg
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.);
| | - Jessica Clifton
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
- Parhelia Wellness, Santa Rosa, California (J.C.)
| | - Abigail M Crocker
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Laura-Mae Baldwin
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Levi N Bonnell
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Peter Callas
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Kelly Clark/Keefe
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Deborah J Cohen
- Oregon Health & Science University, Portland, Oregon (D.J.C., E.N.W.)
| | - Frank V deGruy
- University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.)
| | | | | | - Chester Fox
- University at Buffalo, Buffalo, New York (C.F.)
| | - Sylvie Frisbie
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Katie Hekman
- University of California San Diego, San Diego, California (K.H., W.J.S.)
| | - Juvena Hitt
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Jennifer Jewiss
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - David C Kaelber
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
- Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.)
| | - Kairn Stetler Kelley
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Rodger Kessler
- University of Colorado School of Medicine, Aurora, Colorado (F.V.D., R.K.)
| | - Jennifer B O'Rourke-Lavoie
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - C R Macchi
- Arizona State University, Tempe, Arizona (C.R.M., M.P.M.)
| | | | - Mark McGovern
- Stanford University School of Medicine, Stanford, California (M.M.)
| | - Brenda Mollis
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Daniel Mullin
- UMass Chan Medical School, Worcester, Massachusetts (L.E-P., D.M.)
| | - Zsolt Nagykaldi
- University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma (Z.N.)
| | - Lisa W Natkin
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - Richard G Pinckney
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Douglas Pomeroy
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Paula Reynolds
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | - Gail L Rose
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
| | | | - William J Sieber
- University of California San Diego, San Diego, California (K.H., W.J.S.)
| | - Jeni Soucie
- National Committee for Quality Assurance, Washington, DC (S.H.S., J.S.)
| | - Terry Stancin
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
| | - Kurt C Stange
- Case Western Reserve University, Cleveland, Ohio (D.C.K., K.C.S.)
| | - Kari A Stephens
- University of Washington, Seattle, Washington (L-M.B., B.M., K.A.S.)
| | - Kathryn Teng
- The MetroHealth System, Cleveland, Ohio (D.C.K., T.S., K.T.)
| | | | - Constance van Eeghen
- University of Vermont, Burlington, Vermont (B.L., J.C., A.M.C., L.N.B., P.C., K.C/K., S.F., J.H., J.J., K.S.K., J.B.O-L., L.W.N., R.G.P., D.P., P.R., G.L.R., C.vE.)
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21
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Zhang T, Su M, Li D, Zhang W, Yang F, Li W. Equity in health service utilisation among middle-aged and elderly people with multiple chronic conditions in China: evidence from longitudinal data of 2011-2018 CHARLS. BMJ Open 2023; 13:e072320. [PMID: 37816559 PMCID: PMC10565265 DOI: 10.1136/bmjopen-2023-072320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 09/04/2023] [Indexed: 10/12/2023] Open
Abstract
OBJECTIVES Equity in health service utilisation is a central objective for health systems. Middle-aged and elderly patients with multiple chronic conditions (MCCs) are particularly vulnerable to healthcare inequity. This study aimed to update the information on the trends in the incidence and equity of outpatient health service utilisation (OHSU) and inpatient health service utilisation (IHSU) for middle-aged and elderly MCCs patients in China, identify socioeconomic determinants that may contribute to inequity, and suggest optimisation strategies to mitigate this disparity. METHODS Panel data obtained from four waves of the China Health and Retirement Longitudinal Study (CHARLS) were used to determine the trends in OHSU and IHSU. The inequity in OHSU and IHSU was measured by the Concentration Index (CI) and Horizontal Inequity Index (HI), which is a valid measure of health service utilisation equity. The decomposition model of the CI was set up to explore the contribution of various determinants of overall equity. RESULTS The annual rate of OHSU gradually decreased from 29.32% in 2011 to 27.27% in 2018. The HI remained positive and decreased from 0.0803 in 2011 to 0.0662 in 2018, indicating the existence of pro-rich inequity. The annual rate of IHSU gradually increased from 13.31% in 2011 to 19.89% in 2018. The HI remained positive and showed a declining trend from 0.2363 in 2011 to 0.0574 in 2018, evidencing pro-rich inequity; however, a trend towards the easing of inequity was observed. CONCLUSIONS Pro-rich inequity was present in both OHSU and IHSU among middle-aged and elderly MCCs patients in China. Economic status, area, education and age were the main contributors to pro-rich inequity. Concerted efforts are needed to allocate resources for mitigating health service utilisation inequity in middle-aged and elderly people with MCCs.
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Affiliation(s)
- Tianjiao Zhang
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Min Su
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Dongxu Li
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Weile Zhang
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Fan Yang
- School of Public Administration, Inner Mongolia University, Hohhot, China
| | - Wenhui Li
- School of Public Administration, Inner Mongolia University, Hohhot, China
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22
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Jetelina KK, Lee SC, Booker-Nubie QS, Obinwa UC, Zhu H, Miller ME, Sadeghi N, Dickerson U, Balasubramanian BA. Importance of primary care for underserved cancer patients with multiple chronic conditions. J Cancer Surviv 2023; 17:1276-1285. [PMID: 34984632 PMCID: PMC9320948 DOI: 10.1007/s11764-021-01159-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Accepted: 12/22/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE To understand the impact of pre-existing conditions on healthcare utilization among under- and uninsured patients in the transition from cancer treatment to post-treatment survivorship. METHODS Using electronic health record data, we constructed a cohort of patients seen in an integrated county health system between 1/1/2010 and 12/31/2016. Six hundred thirty-one adult patients diagnosed with non-metastatic breast or colorectal cancer during this period (cases) were matched 1:1 on sex and Charlson comorbidity index to non-cancer patients who had at least two chronic conditions and with at least one visit to the health system during the study period (controls). Conditional fixed effects Poisson regression models compared number of primary care and emergency department (ED) visits and completed [vs. no show or missed] appointments between cancer and non-cancer patients. RESULTS Cancer patients had significantly lower number of visits compared with non-cancer patients (N = 46,965 vs. 85,038). Cancer patients were less likely to have primary care (IRR = 0.25; 95% CI: 0.24, 0.27) and ED visits (IRR = 0.57; 95% CI: 0.50, 0.64) but more likely to complete a scheduled appointment (AOR = 4.83; 95% CI: 4.32, 5.39) compared with non-cancer patients. Cancer patients seen in primary care at a higher rate were more likely to visit the ED (IRR = 2.06; 95% CI: 1.52, 2.80) than those seen in primary care at a lower rate. CONCLUSION Health systems need to find innovative, effective solutions to increase primary care utilization among cancer patients with chronic care conditions to ensure optimal management of both chronic conditions and cancer. IMPLICATIONS FOR CANCER SURVIVORS Maintaining regular connections with primary care providers during active cancer treatment should be promoted.
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Affiliation(s)
- Katelyn K Jetelina
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA
| | - Simon Craddock Lee
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA.
- Department of Population and Data Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA.
| | - Quiera S Booker-Nubie
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
| | - Udoka C Obinwa
- Dallas Department of Health and Human Services, Dallas, TX, USA
| | - Hong Zhu
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA
- Department of Population and Data Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA
| | - Michael E Miller
- Department of Population and Data Sciences, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA
| | - Navid Sadeghi
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA
- Department of Internal Medicine, Division of Hematology/Oncology, UT Southwestern Medical Center, Dallas, TX, USA
- Parkland Health & Hospital System, Dallas, TX, USA
| | | | - Bijal A Balasubramanian
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Dallas, TX, USA
- Harold C. Simmons Comprehensive Cancer Center, UT Southwestern Medical Center, 5323 Harry Hines Blvd, MSC 9066, Dallas, TX, 75390-9066, USA
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De Maria M, Erba I, Ferro F, Ausili D, Matarese M, Vellone E. The influence of dyad sex combination on patient self-care and caregiver contribution to self-care in multiple chronic conditions: An observational study. J Nurs Scholarsh 2023; 55:1008-1019. [PMID: 37721456 DOI: 10.1111/jnu.12895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/22/2023] [Accepted: 03/02/2023] [Indexed: 04/05/2023]
Abstract
INTRODUCTION We know that patient and caregiver sex influence patient self-care and caregiver contribution to self-care in multiple chronic conditions. However, the role of dyad sex combination (e.g., male patient and female caregiver, female patient and male caregiver, male patient and caregiver, and female patient and caregiver) in influencing patient self-care and caregiver contribution to self-care remains unexplored. Our aim was to investigate the relationship between patient and caregiver sex combination and patient self-care and caregiver contribution to self-care in multiple chronic conditions. DESIGN Multicentre cross-sectional study. METHODS We enrolled patients with multiple chronic conditions and caregiver dyads in outpatient and community settings from April 2017 to December 2019. We used the Self-Care of Chronic Illness Inventory and the Caregiver Contribution to Self-Care of Chronic Illness Inventory that measure, from the patient and caregiver perspective, self-care maintenance (i.e., behaviors to maintain illness stability), self-care monitoring (i.e., monitoring of illness signs and symptoms), and self-care management (i.e., behaviors to manage signs and symptoms). We used multivariate analysis of covariance to evaluate the association between sex and self-care and caregiver contribution to self-care. RESULTS We recruited 540 patient-caregiver dyads. Male patients cared by female caregivers performed higher self-care maintenance compared to female patients cared by female caregivers. Female caregivers caring for female patients performed higher caregiver contribution to self-care monitoring compared to male caregivers caring for female or male patients. CONCLUSIONS Clinicians should consider the influence of patient and caregiver sex combination on self-care and caregiver contribution to self-care in multiple chronic conditions to provide tailored interventions. CLINICAL RELEVANCE Healthcare professionals should consider the patient and caregiver sex combination in the dyad to tailor better interventions aimed at improving patient self-care and caregiver contribution to self-care in multiple chronic conditions.
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Affiliation(s)
- Maddalena De Maria
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Ilaria Erba
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Federico Ferro
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Davide Ausili
- Department of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Maria Matarese
- School of Nursing, Campus Bio-Medico of Rome University, Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
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Wang YH, Enguidanos S. The Relationship Between Multiple Chronic Conditions and Physician Visits in Advance Care Planning Activities. Am J Hosp Palliat Care 2023; 40:965-970. [PMID: 36307974 DOI: 10.1177/10499091221136854] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/19/2023] Open
Affiliation(s)
- Yu-Hsuan Wang
- Leonard Davis School, University of Southern California, Los Angeles, CA, USA
| | - Susan Enguidanos
- Leonard Davis School, University of Southern California, Los Angeles, CA, USA
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Coatsworth-Puspoky R, Dahlke S, Duggleby W, Hunter KF. Safeguarding survival: Older persons with multiple chronic conditions' unplanned readmission experiences: A mixed methods systematic review. J Clin Nurs 2023; 32:5793-5815. [PMID: 37095609 DOI: 10.1111/jocn.16705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 03/11/2023] [Accepted: 03/15/2023] [Indexed: 04/26/2023]
Abstract
AIMS AND OBJECTIVES The aim of this study was to create a holistic understanding of the psychosocial processes of older persons with multiple chronic conditions' experience with unplanned readmission experiences within 30 days of discharge home and identify factors influencing these psychosocial processes. DESIGN Mixed methods systematic review. DATA SOURCES Six electronic databases (Ovid MEDLINE (R) All 1946-present, Scopus, CINAHL, Embase, PsychINFO and Web of Science). REVIEW METHODS Peer-reviewed articles published between 2010 and 2021 and addressed study aims (n = 6116) were screened. Studies were categorised by method: qualitative and quantitative. Qualitative data synthesis used a meta-synthesis approach and applied thematic analysis. Quantitative data synthesis used vote counting. Data (qualitative and quantitative) were integrated through aggregation and configuration. RESULTS Ten articles (n = 5 qualitative; n = 5 quantitative) were included. 'Safeguarding survival' described older persons' unplanned readmission experience. Older persons experienced three psychosocial processes: identifying missing pieces of care, reaching for lifelines and feeling unsafe. Factors influencing these psychosocial processes included chronic conditions and discharge diagnosis, increased assistance with functional needs, lack of discharge planning, lack of support, increased intensity of symptoms and previous hospital readmission experiences. CONCLUSIONS Older persons felt more unsafe as their symptoms increased in intensity and unmanageability. Unplanned readmission was an action older persons required to safeguard their recovery and survival. RELEVANCE TO CLINICAL PRACTICE Nurses play a critical role in assessing and addressing factors that influence older persons' unplanned readmission. Identifying older persons' knowledge about chronic conditions, discharge planning, support (caregivers and community services), changes in functional needs, intensity of symptoms and past readmission experiences may prepare older persons to cope with their return home. Focusing on their health-care needs across the continuum of care (community, home and hospital) will mitigate the risks for unplanned readmission within 30 days of discharge. REPORTING METHOD PRISMA guidelines. PATIENT OR PUBLIC CONTRIBUTION No patient or public contribution due to design.
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Affiliation(s)
| | - Sherry Dahlke
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Wendy Duggleby
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
| | - Kathleen F Hunter
- Faculty of Nursing, University of Alberta, Edmonton, Alberta, Canada
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Dinh TTH, Bonner A. Exploring the relationships between health literacy, social support, self-efficacy and self-management in adults with multiple chronic diseases. BMC Health Serv Res 2023; 23:923. [PMID: 37649013 PMCID: PMC10466814 DOI: 10.1186/s12913-023-09907-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Accepted: 08/12/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Self-management in chronic diseases is essential to slowing disease progression and preventing complications. However, empirical research on the associations of critical factors, such as health literacy, social support, and self-efficacy with self-management in the context of multiple chronic diseases is scarce. This study aimed to investigate these associations and provides insights for healthcare providers to develop effective educational strategies for people with multiple chronic diseases. METHODS Using a cross-sectional survey design, adults (n = 600) diagnosed with at least two chronic diseases were conveniently recruited. To measure health literacy, social support, self-efficacy, and chronic disease self-management behaviours, the Health Literacy Questionnaire (HLQ), Medical Outcome Study - Social Support Survey, Self-efficacy in Managing Chronic Disease, and Self-management in Chronic Diseases instruments were utilized respectively. Comorbidity status was assessed using Age-adjusted Charlson Comorbidity Index (ACCI). A generalised linear regression model was used with a backward technique to identify variables associated with self-management. RESULTS Participants' mean age was 61 years (SD = 15.3), 46% were female, and most had up to 12 years of education (82.3%). Mean scores for HLQ domains 1-5 varied from 2.61 to 3.24 (possible score 1-4); domains 6-9 from 3.29 to 3.65 (possible score 1-5). The mean scores were 52.7 (SD = 10.4, possible score 0-95), 5.46 (SD = 1.9, possible score 0-10) and 82.1 (SD = 12.4, possible score 30-120) for social support, self-efficacy, and self-management, respectively. Mean ACCI was 6.7 (SD = 2.1). Eight factors (age > 65 years, being female, 4 health literacy domains, greater social support, and higher self-efficacy levels) were significantly associated with greater self-management behaviours while comorbidity status was not. The factors that showed the strongest associations with self-management were critical health literacy domains: appraisal of health information, social support for health, and healthcare provider support. CONCLUSIONS Developing critical health literacy abilities is a more effective way to enhance self-management behaviours than relying solely on self-confidence or social support, especially for people with multiple chronic diseases. By facilitating communication and patient education, healthcare providers can help patients improve their critical health literacy, which in turn can enhance their self-management behaviours.
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Affiliation(s)
- Thi Thuy Ha Dinh
- School of Nursing, University of Tasmania, Launceston, TAS, Australia.
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia.
| | - Ann Bonner
- School of Nursing and Midwifery, Griffith University, Brisbane, QLD, Australia
- Kidney Health Service, Metro North Hospital and Health Service, Brisbane, QLD, Australia
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27
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Lv B, Zhang L, Meng K. Effect of multiple chronic conditions on family doctor contracting in the elderly in China: the moderating role of socioeconomic status. BMC Public Health 2023; 23:1540. [PMID: 37573398 PMCID: PMC10422842 DOI: 10.1186/s12889-023-16438-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Accepted: 08/02/2023] [Indexed: 08/14/2023] Open
Abstract
BACKGROUND China's family doctor contracting service is an important part of deepening the reform of the healthcare systems, aiming to further develop chronic disease management services, enhance the capacity of primary health care services and improve the health of residents. The purpose of this study was to explore the influence of multiple chronic conditions in the elderly on family doctor contracting and whether socioeconomic status played a moderating role. METHODS A cross-sectional survey was conducted in Beijing, China. A total of 1814 elderly people over 60 years old were included in this study using a whole-group sampling method. The univariate analysis and logistic regression analysis was used to analyze the data. RESULTS 21.72% of the elderly signed up with family doctors. The multiple chronic conditions was a factor influencing the elderly to sign up with family doctors (OR = 1.44, 95%CI = 1.28-1.61), and the higher the degree of multiple chronic conditions, the stronger willingness to sign up. Socioeconomic status positively moderates the effect of multiple chronic conditions on signing. Also, physical activity intensity (OR = 1.25, 95%CI = 1.03-1.54) and willingness to first visit primary care facilities (OR = 1.38, 95%CI = 1.25-1.54) influenced the elderly to sign up with family doctors. CONCLUSIONS The elderly with a high degree of multiple chronic conditions, high activity intensity, and a strong willingness to first visit primary care facilities were more likely to sign up with family doctors. The health literacy of the elderly should be further improved, and publicity on the family doctor contracting service policies for the elderly with lower socioeconomic status should be strengthened to guide them to sign up with family doctors. At the same time, the service capacity of primary care facilities should be further improved to meet the health needs of the elderly.
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Affiliation(s)
- Bo Lv
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China
| | - Ling Zhang
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
| | - Kai Meng
- School of Public Health, Capital Medical University, No.10 Xitoutiao, Youanmenwai Street, Fengtai District, Beijing, 100069, China.
- Beijing Tiantan Hospital, Capital Medical University, No.119 South of the Fourth Ring Road, Fengtai District, Beijing, 100070, China.
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Hag Mohamed S, Sabbah W. Is tooth loss associated with multiple chronic conditions? Acta Odontol Scand 2023; 81:443-448. [PMID: 36634031 DOI: 10.1080/00016357.2023.2166986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2021] [Revised: 09/07/2022] [Accepted: 01/04/2023] [Indexed: 01/13/2023]
Abstract
OBJECTIVES To examine the relationship between tooth loss and co-occurrence of multiple chronic conditions (MCC) among American adults at working age. MATERIALS AND METHODS Data was from the Behavioural Risk Factor Surveillance System 2018, a cross-sectional telephone-based, nationally representative survey of American adults. We included participants aged 25-64 years. The survey included sociodemographic data, reported diagnosis of chronic conditions, the number of missing teeth and health behaviours. An aggregate variable of chronic conditions was created which included heart attack, angina, stroke, cancer, chronic pulmonary disease, diabetes, asthma, arthritis, depression, and kidney diseases. The association between the number of missing teeth and the aggregate of chronic conditions was assessed adjusting for confounders. RESULTS The analysis included 202,809 participants. The mean number of MCC was 0.86 (95% Confidence Interval 'CI':0.85,0.87). Tooth loss was significantly associated with MCC with rate ratio 1.18 (95% CI:1.15,1.21), 1.53 (95% CI:1.48,1.59) and 1.62 (95% CI:1.55,1.69) for those reporting losing 1-5 teeth, 6 or more but not all, and all teeth, respectively after adjusting for demographic, socioeconomic, and behavioural factors. CONCLUSION Tooth loss could be an early marker for the co-occurrence of multiple chronic conditions among adults of working age. The association could be attributed to common risk factors for oral and general health.
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Chivela FL, Burch AE, Asagbra O. An Assessment of Patient Portal Messaging Use by Patients With Multiple Chronic Conditions Living in Rural Communities: Retrospective Analysis. J Med Internet Res 2023; 25:e44399. [PMID: 37526967 PMCID: PMC10427930 DOI: 10.2196/44399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 03/26/2023] [Accepted: 05/31/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Patient portals can facilitate the delivery of health care services and support self-management for patients with multiple chronic conditions. Despite their benefits, the evidence of patient portal use among patients with multimorbidity in rural communities is limited. OBJECTIVE This study aimed to explore the factors associated with portal messaging use by rural patients. METHODS We assessed patient portal use among patients with ≥1 chronic diagnoses who sent or received messages via the Epic MyChart (Epic Systems Corporation) portal between January 1, 2015, and November 9, 2021. Patient portal use was defined as sending or receiving a message through the portal during the study period. We fit a zero-inflated negative binomial model to predict portal use based on the patient's number of chronic conditions, sex, race, age, marital status, and insurance type. County-level characteristics, based on the patient's home address, were also included in the model to assess the influence of community factors on portal use. County-level factors included educational attainment, smartphone ownership, median income, and primary care provider density. RESULTS A total of 65,178 patients (n=38,587, 59.2% female and n=21,454, 32.92% Black) were included in the final data set, of which 38,380 (58.88%) sent at least 1 message via the portal during the 7-year study period. As the number of chronic diagnoses increased, so did portal messaging use; however, this relationship was driven primarily by younger patients. Patients with 2 chronic conditions were 1.57 times more likely to send messages via the portal than those with 1 chronic condition (P<.001). In comparison, patients with ≥7 chronic conditions were approximately 11 times more likely to send messages than patients with 1 chronic condition (P<.001). A robustness check confirmed the interaction effect of age and the number of diagnoses on portal messaging. In the model including only patients aged <65 years, there was a significant effect of increased portal messaging corresponding to the number of chronic conditions (P<.001). Conversely, this relationship was not significant for the model consisting of older patients. Other significant factors associated with increased portal use include being female; White; married; having private insurance; and living in an area with a higher average level of educational attainment, greater medical provider density, and a lower median income. CONCLUSIONS Patients' use of the portal to send messages to providers was incrementally related to their number of diagnoses. As the number of chronic diagnoses increased, so did portal messaging use. Patients of all ages, particularly those living in rural areas, could benefit from the convenience and cost-effectiveness of portal communication. Health care systems and providers are encouraged to increase the use of patient portals by implementing educational interventions to promote the advantages of portal communication, particularly among patients with multimorbidity.
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Affiliation(s)
- Fernando L Chivela
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States
| | - Ashley E Burch
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States
- Department of Internal Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, United States
| | - Oghale Asagbra
- Department of Health Services and Information Management, East Carolina University, Greenville, NC, United States
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Selvakumar D, Sivanandy P, Ingle PV, Theivasigamani K. Relationship between Treatment Burden, Health Literacy, and Medication Adherence in Older Adults Coping with Multiple Chronic Conditions. Medicina (Kaunas) 2023; 59:1401. [PMID: 37629691 PMCID: PMC10456640 DOI: 10.3390/medicina59081401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/27/2023] [Accepted: 06/29/2023] [Indexed: 08/27/2023]
Abstract
A prospective study was conducted to investigate the impact of treatment burden and health literacy on medication adherence among older adults with multiple chronic conditions (MCC) and to explore the potential moderating effects of demographic and clinical factors. Face-to-face structured interviews were conducted among older adults aged 60 and above using the Burden of Treatment Questionnaire (TBQ-15), Short Form Health Literacy Questionnaire (HLS-SF12), and Malaysia Medication Adherence Assessment Tool (MyMAAT). This study included 346 older adults aged 60 years and above with two or more chronic conditions (n = 346). Hypertension (30.2%), hyperlipidemia (24.0%), and diabetes (18.0%) were the most reported chronic conditions among participants. The mean score of treatment burden was 53.4 (SD = 28.2), indicating an acceptable burden of treatment. The mean score of health literacy was 16.4 (SD = 12.6), indicating a limited health literacy level among participants; meanwhile, the mean score of medication adherence was 32.6 (SD = 12.3), indicating medication non-adherence among participants. Medication adherence was significantly correlated with treatment burden (r = -0.22, p < 0.0001), health literacy (r = 0.36, p < 0.0001), number of chronic conditions (r = -0.23, p < 0.0001), and age (r = -0.11, p < 0.05). The study findings emphasize that multimorbid older adults with high treatment burdens and low health literacy are more likely to have poor medication adherence. This underscores the importance for clinicians to address these factors in order to improve medication adherence among older adults with multiple chronic conditions (MCC).
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Affiliation(s)
- Dharrshinee Selvakumar
- School of Postgraduate Studies, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Palanisamy Sivanandy
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Pravinkumar Vishwanath Ingle
- Department of Pharmacy Practice, School of Pharmacy, International Medical University, Kuala Lumpur 57000, Malaysia
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Wallace DD, Then-Paulino A, Jiménez Paulino G, Tejada Castro F, Castro SD, Palar K, Derose KP. The co-management of HIV and chronic non-communicable diseases in the Dominican Republic: A qualitative study. PLoS One 2023; 18:e0288583. [PMID: 37440525 PMCID: PMC10343047 DOI: 10.1371/journal.pone.0288583] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 07/01/2023] [Indexed: 07/15/2023] Open
Abstract
People living with HIV and a non-communicable disease (NCD) experience multi-level barriers when co-managing multiple conditions. We explored the factors affecting living with multiple chronic conditions in the Dominican Republic. We conducted 21 in-depth interviews from October 2019-February 2020 with Dominican adults who participated in a food security intervention and managed HIV and at least one chronic NCD. Using thematic analysis, we explored participant lived experiences co-managing multiple chronic conditions. All participants (mean age = 45.5 years) were linked to HIV care, but only three were linked to NCD-specific care. Individual-level barriers to managing NCDs included limited education and limited self-efficacy for self-management. Interpersonally, barriers included limited rapport building with an NCD-specific specialist. Structural barriers to managing NCDs were no health insurance, poor referral systems, and limited financial assistance. Health system adaptation requires equitably considering the needs of individuals managing multiple chronic conditions. Key factors to address include patient-provider relationships, improved referral systems, accessibility and availability of specialists, and financial assistance.
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Affiliation(s)
- Deshira D. Wallace
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Amarilis Then-Paulino
- Instituto de Investigación en Salud de la Facultad de Ciencias de la Salud, Facultad de Ciencias de la Salud, Universidad Autónoma de Santo Domingo, Alma Máter, Ciudad Universitaria, Santo Domingo, Dominican Republic
| | - Gipsy Jiménez Paulino
- Viceministerio de Garantía de la Calidad, Ministerio de Salud Pública, Santo Domingo, Dominican Republic
| | | | - Stephanie Daniela Castro
- Center for Diagnosis, Advanced Medicine, and Telemedicine (CEDIMAT), Santo Domingo, Dominican Republic
| | - Kartika Palar
- Department of Medicine, Division of HIV, Infectious Disease, and Global Medicine, University of California, San Francisco, San Francisco, California, United States of America
| | - Kathryn P. Derose
- Department of Health Promotion & Policy, University of Massachusetts Amherst, Amherst, Massachusetts, United States of America
- Department of Behavioral and Policy Sciences, RAND Corporation, Santa Monica, California, United States of America
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Ramírez-Carrillo E, G-Santoyo I, López-Corona O, Rojas-Ramos OA, Falcón LI, Gaona O, de la Fuente Rodríguez RM, Hernández Castillo A, Cerqueda-García D, Sánchez-Quinto A, Hernández-Muciño D, Nieto J. Similar connectivity of gut microbiota and brain activity networks is mediated by animal protein and lipid intake in children from a Mexican indigenous population. PLoS One 2023; 18:e0281385. [PMID: 37384745 PMCID: PMC10310019 DOI: 10.1371/journal.pone.0281385] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 01/22/2023] [Indexed: 07/01/2023] Open
Abstract
The gut microbiota-brain axis is a complex communication network essential for host health. Any long-term disruption can affect higher cognitive functions, or it may even result in several chronic neurological diseases. The type and diversity of nutrients an individual consumes are essential for developing the gut microbiota (GM) and the brain. Hence, dietary patterns might influence networks communication of this axis, especially at the age that both systems go through maturation processes. By implementing Mutual Information and Minimum Spanning Tree (MST); we proposed a novel combination of Machine Learning and Network Theory techniques to study the effect of animal protein and lipid intake on the connectivity of GM and brain cortex activity (BCA) networks in children from 5-to 10 years old from an indigenous community in the southwest of México. Socio-ecological conditions in this nonwestern lifestyle community are very homogeneous among its inhabitants but it shows high individual heterogeneity in the consumption of animal products. Results suggest that MST, the critical backbone of information flow, diminishes under low protein and lipid intake. So, under these nonwestern regimens, deficient animal protein and lipid consumption diets may significantly affect the GM-BCA connectivity in crucial development stages. Finally, MST offers us a metric that unifies biological systems of different nature to evaluate the change in their complexity in the face of environmental pressures or disturbances. Effect of Diet on gut microbiota and brain networks connectivity.
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Affiliation(s)
- Elvia Ramírez-Carrillo
- NeuroEcology Lab, Department of Psychology, UNAM, CDMX, México
- Investigadoras por México, Posdoc-CONACyT, Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), CDMX, México
| | - Isaac G-Santoyo
- NeuroEcology Lab, Department of Psychology, UNAM, CDMX, México
- Unidad de Investigación en Psicobiología y Neurociencias, Department of Psychology, Universidad Nacional Autónoma de México (UNAM), CDMX, México
| | - Oliver López-Corona
- Cátedras CONACyT, Instituto de Investigaciones en Matemáticas Aplicadas y en Sistemas (IIMAS), Universidad Nacional Autónoma de México (UNAM), CDMX, México
- Centro de Ciencias de la Complejidad (C3), Universidad Nacional Autónoma de México, CDMX, México
| | - Olga A. Rojas-Ramos
- NeuroEcology Lab, Department of Psychology, UNAM, CDMX, México
- Coordinación de Psciobiología y Neurociencias, Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), CDMX, México
| | - Luisa I. Falcón
- Laboratorio de Ecología Bacteriana, Instituto de Ecología, Universidad Nacional Autónoma de México, UNAM, Parque Científico y Tecnológico de Yucatán, Mérida, México
| | - Osiris Gaona
- Laboratorio de Ecología Bacteriana, Instituto de Ecología, Universidad Nacional Autónoma de México, UNAM, Parque Científico y Tecnológico de Yucatán, Mérida, México
| | | | | | - Daniel Cerqueda-García
- Consorcio de Investigación del Golfo de México (CIGoM), Centro de Investigación y de Estudios Avanzados del Instituto Politécnico Nacional, Unidad Mérida, Departamento de Recursos del Mar, Mérida, Yucatán, México
| | - Andrés Sánchez-Quinto
- Laboratorio de Ecología Bacteriana, Instituto de Ecología, Universidad Nacional Autónoma de México, UNAM, Parque Científico y Tecnológico de Yucatán, Mérida, México
| | - Diego Hernández-Muciño
- Laboratorio de Agroecología Instituto de Investigaciones en Ecosistema y Sustentabilidad, UNAM, Morelia, México
| | - Javier Nieto
- Laboratorio de Aprendizaje y Adaptación, Facultad de Psicología, Universidad Nacional Autónoma de México (UNAM), CDMX, México
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Murali KP, Merriman JD, Yu G, Vorderstrasse A, Kelley AS, Brody AA. Complex Care Needs at the End of Life for Seriously Ill Adults With Multiple Chronic Conditions. J Hosp Palliat Nurs 2023; 25:146-155. [PMID: 37040386 PMCID: PMC10175220 DOI: 10.1097/njh.0000000000000946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023]
Abstract
Understanding the complex care needs of seriously ill adults with multiple chronic conditions with and without cancer is critical for the delivery of high-quality serious illness and palliative care at the end of life. The objective of this secondary data analysis of a multisite randomized clinical trial in palliative care was to elucidate the clinical profile and complex care needs of seriously ill adults with multiple chronic conditions and to highlight key differences among those with and without cancer at the end of life. Of the 213 (74.2%) older adults who met criteria for multiple chronic conditions (eg, 2 or more chronic conditions requiring regular care with limitations of daily living), 49% had a diagnosis of cancer. Hospice enrollment was operationalized as an indicator for severity of illness and allowed for the capture of complex care needs of those deemed to be nearing the end of life. Individuals with cancer had complex symptomatology with a higher prevalence of nausea, drowsiness, and poor appetite and end of life and lower hospice enrollment. Individuals with multiple chronic conditions without cancer had lower functional status, greater number of medications, and higher hospice enrollment. The care of seriously ill older adults with multiple chronic conditions requires tailored approaches to improve outcomes and quality of care across health care settings, particularly at the end of life.
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Affiliation(s)
| | | | - Gary Yu
- New York University Rory Meyers College of Nursing
| | | | - Amy S. Kelley
- Icahn School of Medicine at Mount Sinai, Geriatrics and Palliative Medicine
| | - Abraham A. Brody
- New York University Rory Meyers College of Nursing
- New York University Grossman School of Medicine
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Tisminetzky M, Gurwitz JH, Tabada G, Reynolds K, Smith DH, Sung SH, Goldberg R, Go AS. Approach to Multimorbidity Burden Classification and Outcomes in Older Adults With Heart Failure. Med Care 2023; 61:268-278. [PMID: 36920167 PMCID: PMC10079617 DOI: 10.1097/mlr.0000000000001828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND The optimal approach to classifying multimorbidity burden in assessing treatment-associated outcomes using real-world data remains uncertain. We assessed whether 2 measurement approaches to characterize multimorbidity influenced observed associations of β-blocker use with outcomes in adults with heart failure (HF). METHODS We conducted a retrospective study on adults with HF from 4 integrated health care delivery systems. Multimorbidity burden was characterized by either (1) simple counts of chronic conditions or (2) a weighted multiple chronic conditions score using data from electronic health records. We assessed the impact of these 2 approaches to characterizing multimorbidity on associations between exposure to β-blockers and subsequent all-cause death, hospitalization for HF, and hospitalization for any cause. RESULTS The study population characterized by a count of chronic conditions included 9988 adults with HF who had a mean (SD) age of 76.4 (12.5) years, with 48.7% women and 24.7% racial/ethnic minorities. The cohort characterized by weighted multiple chronic conditions included 10,082 adults with HF who had a mean (SD) age of 76.4 (12.4) years, 48.9% women, and 25.5% racial/ethnic minorities. The multivariable associations of risks of death or hospitalizations for HF or for any cause associated with incident β-blocker use were similar regardless of how multimorbidity burden was characterized. CONCLUSIONS Simple counts of chronic conditions performed similarly to a weighted multimorbidity score in predicting outcomes using real-world data to examine clinical outcomes associated with β-blocker therapy in HF. Our findings challenge conventional wisdom that more complex measures of multimorbidity are always necessary to characterize patients in observational studies examining therapy-associated outcomes.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Jerry H. Gurwitz
- Meyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
- Division of Geriatric Medicine, Department of Medicine, University of Massachusetts Chan Medical School
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Grace Tabada
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Kristi Reynolds
- Department of Research & Evaluation, Kaiser Permanente Southern California, Pasadena, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
| | - David H. Smith
- Center for Health Research, Kaiser Permanente Northwest, Portland Oregon
| | - Sue Hee Sung
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Robert Goldberg
- Meyers Health Care Institute, a joint endeavor of University of Massachusetts Chan Medical School, Reliant Medical Group, and Fallon Health, Worcester, Massachusetts
- Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, Worcester, Massachusetts
| | - Alan S. Go
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA
- Departments of Epidemiology, Biostatistics and Medicine, University of California, San Francisco, CA
- Department of Medicine, Stanford University, Stanford, CA
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Davis-Ajami ML, Lu ZK, Wu J. US Older Adults with Multiple Chronic Conditions Perceptions of Provider-Patient Communication: Trends and Racial Disparities from MEPS 2013-2019. J Gen Intern Med 2023; 38:1459-1467. [PMID: 36352202 PMCID: PMC10160303 DOI: 10.1007/s11606-022-07899-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2022] [Accepted: 10/26/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND Multiple chronic conditions (MCC) require complex patient-centered approaches with effective provider-patient communication. OBJECTIVE To describe trends in patient perceptions of provider-patient communication during non-emergency care and identify associated racial disparities in US older adults with MCC. DESIGN, SETTING, PARTICIPANTS Observational study using pooled US Medical Expenditure Panel Survey (2013-2019) data included adults > 65 with two or more chronic conditions. MAIN MEASURES Provider-patient communication was measured by four indicators (how often their doctor explained things clearly, listened carefully, showed respect, and spent enough time with them). The primary outcomes were the annual rates of reporting "always" for the communication indicators. Cochran-Armitage trend tests examined the trends of reporting "always" and associated racial disparities. Multivariable logistic regression identified racial and other factors associated with respondents choosing "always" for one or more categories for provider-patient communication, defined as positive communication. RESULTS Among 9758 older adults with MCC, declining trends for positive communication were shown across all provider-patient communication categories during 2013 to 2019 (p<0.001). The greatest decrease occurred in "always listening carefully", from 68.6% in 2013 to 59.1% in 2019 (p<0.001). The declining trends of four communication measures in non-Hispanic Whites with MCC were significant (p<0.001). Older adults from Hispanic or Non-Hispanic Black racial backgrounds were 28 to 51% more likely to report "always" for the four indicators of provider-patient communication than non-Hispanic Whites after adjusting for respondents' characteristics. CONCLUSION The rates of "always" reporting positive communication with providers significantly declined from 2013 to 2019 in older adults with MCC, particularly in non-Hispanic Whites. Hispanics and non-Hispanic Blacks were more likely to report positive communication with providers than other races.
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Affiliation(s)
| | - Zhiqiang K Lu
- University of South Carolina College of Pharmacy, Columbia, SC, USA
| | - Jun Wu
- Presbyterian College School of Pharmacy, Clinton, SC, USA.
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Shirazi D, Haudenschild C, Lynch DH, Fanous M, Kahkoska AR, Jimenez D, Spangler H, Driesse T, Batsis JA. Obesity, multiple chronic conditions, and the relationship with physical function: Data from the national health and aging trends survey. Arch Gerontol Geriatr 2023; 107:104913. [PMID: 36565604 PMCID: PMC9975009 DOI: 10.1016/j.archger.2022.104913] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 12/17/2022] [Accepted: 12/18/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND The population of older adults living with multiple chronic conditions (MCC) continues to grow. MCC is independently associated with functional limitation and obesity. The aim of our study was to evaluate the association between obesity and MCC, and secondarily, the combined presence of obesity and functional limitations with MCC. METHODS We analyzed cross-sectional survey data from the National Health and Aging Trends Survey (NHATS) 2011 baseline data, a nationally representative Medicare beneficiary cohort of adults in the United States. We evaluated the coexistent prevalence of obesity and MCC overall, and by standard body mass index (BMI) categories. We then evaluated the prevalence of functional limitations (mobility, self-care, and household activities) and Fried-defined frailty status in persons with a BMI ≥ 30 kg/m2. Logistic regression was used to measure the association between MCC and BMI, and functional limitations and MCC among those with obesity. RESULTS In the 6,600 participants, the prevalence of concurrent obesity and MCC was 30.4%. Of those with obesity, the prevalence of MCC was 84.0%, and were more likely to have MCC (adjusted OR: 2.17, 95% CI 1.86, 2.54) compared to a normal BMI. Obesity and functional limitations or frailty were more likely have MCC than individuals with obesity alone. CONCLUSIONS We found that individuals with obesity is strongly associated with MCC and that functional limitations and frailty status have a greater association with having MCC than individuals with obesity without MCC. Future longitudinal analyses are needed to ascertain this relationship.
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Affiliation(s)
- Daniela Shirazi
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States; California University of Science and Medicine, CA, United States
| | | | - David H Lynch
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - Marco Fanous
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - Anna R Kahkoska
- Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States
| | - Daniel Jimenez
- University of Miami Miller School of Medicine, MI, United States
| | - Hillary Spangler
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - Tiffany Driesse
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States
| | - John A Batsis
- Division of Geriatric Medicine, University of North Carolina at Chapel Hill, 5017 Old Clinic Building, Chapel Hill, NC 27517, United States; Department of Nutrition, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, United States.
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Pel-Littel RE, Buurman BM, van de Pol MH, Twisk JWR, Tulner LR, Minkman MM, Scholte Op Reimer WJM, van Weert JCM. Effects of a shared decision making intervention for older adults with multiple chronic conditions: the DICO study. BMC Med Inform Decis Mak 2023; 23:42. [PMID: 36859287 PMCID: PMC9976432 DOI: 10.1186/s12911-023-02099-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Accepted: 01/03/2023] [Indexed: 03/03/2023] Open
Abstract
BACKGROUND To evaluate the effects of a shared decision making (SDM) intervention for older adults with multiple chronic conditions (MCCs). METHODS A pragmatic trial evaluated the effects of the SDMMCC intervention, existing of SDM training for nine geriatricians in two hospitals and a preparatory tool for patients. A prospective pre-intervention post-intervention multi-center clinical study was conducted in which an usual care group of older patients with MCC and their informal caregivers was included before the implementation of the intervention and a new cohort of patients and informal caregivers after the implementation of the intervention. SDM was observed using the OPTIONMCC during video-recorded consultations. Patient- and caregivers reported outcomes regarding their role in SDM, involvement, perceived SDM and decisional conflict were measured. The differences between groups regarding the level of observed SDM (OPTIONMCC) were analyzed with a mixed model analysis. Dichotomous patient-reported outcomes were analyzed with a logistic mixed model. RESULTS From two outpatient geriatric clinics 216 patients with MCCs participated. The mean age was 77.3 years, and 56.3% of patients were female. No significant difference was found in the overall level of SDM as measured with the OPTIONMCC or in patient-reported outcomes. However, at item level the items discussing 'goals', 'options', and 'decision making' significantly improved after the intervention. The items discussing 'partnership' and 'evaluating the decision-making process' showed a significant decrease. Fifty-two percent of the patients completed the preparatory tool, but the results were only discussed in 12% of the consultations. CONCLUSION This study provides scope for improvement of SDM in geriatrics. Engaging older adults with MCCs and informal caregivers in the decision making process should be an essential part of SDM training for geriatricians, beyond the SDM steps of explaining options, benefits and harms. More attention should be paid to the integration of preparatory work in the consultation.
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Affiliation(s)
- Ruth E Pel-Littel
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
- Vilans, Center of Expertise for Long-Term Care, Utrecht, The Netherlands.
| | - Bianca M Buurman
- Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
- ACHIEVE, Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
| | - Marjolein H van de Pol
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Linda R Tulner
- Department of Geriatric Medicine, OLVG, Amsterdam, The Netherlands
| | - Mirella M Minkman
- Vilans, Center of Expertise for Long-Term Care, Utrecht, The Netherlands
- TIAS School for Business and Society, Tilburg University, Tilburg, The Netherlands
| | - Wilma J M Scholte Op Reimer
- ACHIEVE, Center of Applied Research, Faculty of Health, Amsterdam University of Applied Sciences, Amsterdam, The Netherlands
- Department of Cardiology, Amsterdam UMC, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Julia C M van Weert
- Amsterdam School of Communication Research/ASCoR, University of Amsterdam, PO Box 15791, 1001 NG, Amsterdam, The Netherlands.
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Ronis SD, Selvaraj D, Albert JM, Koroukian SM, Nelson S. Dental Caries in Medicaid-Insured Preschool Children With or Without Special Health Care Needs in Northeast Ohio. JAMA Netw Open 2023; 6:e230999. [PMID: 36853605 PMCID: PMC9975899 DOI: 10.1001/jamanetworkopen.2023.0999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/01/2023] Open
Abstract
IMPORTANCE Children with special health care needs (CSHCN) are recognized to be at increased risk of developing dental caries (decay). Evidence is mixed regarding the association of preventive oral health care delivered by pediatric primary care clinicians with caries experience among CSHCN. OBJECTIVE To investigate caries experience, including untreated decay, among Medicaid-enrolled preschoolers with or without special health care needs. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used baseline data from the Pediatric Providers Against Cavities in Children's Teeth study, a cluster-randomized hybrid effectiveness-implementation trial conducted among 1022 Medicaid-enrolled preschoolers aged 3 to 6 years attending well-child visits at 18 participating community pediatric primary care practices in northeast Ohio. Baseline data were collected from November 1, 2017, to August 31, 2019, with statistical analyses conducted from April to August 2022. EXPOSURES Presence of special health care needs, as assessed by applying the Pediatric Medical Complexity Algorithm to International Statistical Classification of Diseases and Related Health Problems, Tenth Revision codes, was abstracted from electronic medical records. CSHCN were defined as having either noncomplex chronic disease (presence of only 1 nonprogressive chronic condition, or multiple nonprogressive chronic conditions in a single body system) or complex chronic disease (presence of any progressive chronic condition, malignant neoplasm, or significant chronic conditions involving multiple body systems). MAIN OUTCOMES AND MEASURES Untreated dental decay and caries experience as assessed through clinical dental examinations using International Caries Detection and Assessment System criteria. RESULTS A total of 1022 children aged 3 to 6 years from 18 practices were enrolled in the study. The mean (SD) age of the study population was 4.3 (1.1) years, 554 (54.2%) were boys, and of 988 with data on race and ethnicity, 451 (45.6%) were Black. Of these, 301 of 1019 (29.5%) had a likely special health care need (225 with noncomplex chronic conditions and 76 with complex chronic conditions). The most frequent chronic conditions included asthma (n = 209) and mental or behavioral health disorders (n = 146), including attention-deficit/hyperactivity disorder, autism, and developmental delays. Overall, 296 children (29.0%) had untreated decay, and 378 (37.0%) had caries experience (decayed and filled teeth). Accounting for sociodemographic characteristics, CSHCN had 34% reduced odds of untreated decay (adjusted odds ratio [AOR], 0.66 [95% CI, 0.48-0.92]) compared with those with without chronic disease. In addition, caries experience was lower among CSHCN (AOR, 0.79 [95% CI, 0.60-1.04]). CONCLUSIONS AND RELEVANCE In this cross-sectional study of Medicaid-enrolled children who attended well-child visits as preschoolers, untreated dental decay was lower among CSHCN compared with those without chronic conditions. This study suggests that CSHCN may have had better access to the various types of dental care facilitated in medical settings.
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Affiliation(s)
- Sarah D. Ronis
- UH Rainbow Center for Child Health & Policy, Cleveland, Ohio
- Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - David Selvaraj
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio
| | - Jeffrey M. Albert
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Siran M. Koroukian
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Suchitra Nelson
- Department of Community Dentistry, Case Western Reserve University School of Dental Medicine, Cleveland, Ohio
- Department of Population and Quantitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio
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Akugizibwe M, Zalwango F, Namulundu CM, Namakoola I, Birungi J, Okebe J, Bachmann M, Jamie M, Jaffar S, Van Hout MC. "After all, we are all sick": multi-stakeholder understanding of stigma associated with integrated management of HIV, diabetes and hypertension at selected government clinics in Uganda. BMC Health Serv Res 2023; 23:20. [PMID: 36624438 PMCID: PMC9827009 DOI: 10.1186/s12913-022-08959-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 12/12/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Integrated care is increasingly used to manage chronic conditions. In Uganda, the integration of HIV, diabetes and hypertension care has been piloted, to leverage the advantages of well facilitated and established HIV health care provision structures. This qualitative study aimed to explore HIV stigma dynamics whilst investigating multi-stakeholder perceptions and experiences of providing and receiving integrated management of HIV, diabetes and hypertension at selected government clinics in Central Uganda. METHODS: We adopted a qualitative-observational design. Participants were purposively selected. In-depth interviews were conducted with patients and with health care providers, clinical researchers, policy makers, and representatives from international nongovernmental organizations (NGOs). Focus group discussions were conducted with community members and leaders. Clinical procedures in the integrated care clinic were observed. Data were managed using Nvivo 12 and analyzed thematically. RESULTS Triangulated findings revealed diverse multi-stakeholder perceptions around HIV related stigma. Integrated care reduced the frequency with which patients with combinations of HIV, diabetes, hypertension visited health facilities, reduced the associated treatment costs, increased interpersonal relationships among patients and healthcare providers, and increased the capacity of health care providers to manage multiple chronic conditions. Integration reduced stigma through creating opportunities for health education, which allayed patient fears and increased their resolve to enroll for and adhere to treatment. Patients also had an opportunity to offer and receive psycho-social support and coupled with the support they received from healthcare worker. This strengthened patient-patient and provider-patient relationships, which are building blocks of service integration and of HIV stigma reduction. Although the model significantly reduced stigma, it did not eradicate service level challenges and societal discrimination among HIV patients. CONCLUSION The study reveals that, in a low resource setting like Uganda, integration of HIV, diabetes and hypertension care can improve patient experiences of care for multiple chronic conditions, and that integrated clinics may reduce HIV related stigma.
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Affiliation(s)
| | | | | | - Ivan Namakoola
- MRC/UVRI and LSHTM, Uganda Research Unit, Entebbe, Uganda
| | | | - Joseph Okebe
- Liverpool School of Tropical Medicine, Liverpool, UK, England
| | | | | | - Shabbar Jaffar
- Liverpool School of Tropical Medicine, Liverpool, UK, England
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Liu H, Zhou Z, Fan X, Shen C, Ma Y, Sun H, Xu Z. Association Between Multiple Chronic Conditions and Depressive Symptoms Among Older Adults in China: Evidence From the China Health and Retirement Longitudinal Study (CHARLS). Int J Public Health 2023; 68:1605572. [PMID: 36938299 PMCID: PMC10020227 DOI: 10.3389/ijph.2023.1605572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/15/2023] [Indexed: 03/06/2023] Open
Abstract
Objectives: The purpose of this study was to explore the association between multiple chronic conditions (MCCs) and depressive symptoms among older adults in China. Methods: We used the fourth round of data from the China Health and Retirement Longitudinal Study, and included 9789 older adults aged 60 years old and above. Results: Compared with the older adults without chronic disease, older adults with MCCs and those with one chronic disease had a high risk of depression (MCCs: OR-adjusted: 1.55, 95% CI: 1.37 to 1.75; one chronic disease: OR-adjusted: 1.20, 95% CI: 1.05-1.37). In urban areas, the prevalence among older adults with MCCs was 2.01 times higher than that among older adults without chronic disease (OR-adjusted: 2.01, 95% CI: 1.56-2.60), while it was 1.44 times higher in rural areas (OR-adjusted:1.44, 95% CI: 1.25-1.65). Self-reported health, duration of sleep, social activities, and type of medical insurance were the influencing factors of depressive symptoms in older adults. Conclusion: This study contributed to enriching the research on the relationship between MCCs and depressive symptoms in older adults in China.
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Affiliation(s)
- Haixia Liu
- School of Public Health and Management, Binzhou Medical University, Yantai, Shandong, China
- *Correspondence: Haixia Liu,
| | - Zhongliang Zhou
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Xiaojing Fan
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Chi Shen
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, Shaanxi, China
| | - Yang Ma
- School of Public Health and Management, Binzhou Medical University, Yantai, Shandong, China
| | - Hongwei Sun
- School of Public Health and Management, Binzhou Medical University, Yantai, Shandong, China
| | - Zhaoyang Xu
- School of Public Health and Management, Binzhou Medical University, Yantai, Shandong, China
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Hill CM, Tseng AS, Holzhauer K, Littman AJ, Jones-Smith JC. Association between health care access and food insecurity among lower-income older adults with multiple chronic conditions in Washington State, USA. Public Health Nutr 2023; 26:199-207. [PMID: 35603699 PMCID: PMC11077446 DOI: 10.1017/s1368980022001240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 02/03/2022] [Accepted: 05/04/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Lower-income older adults with multiple chronic conditions (MCC) are highly vulnerable to food insecurity. However, few studies have considered how health care access is related to food insecurity among older adults with MCC. The aims of this study were to examine associations between MCC and food insecurity, and, among older adults with MCC, between health care access and food insecurity. DESIGN Cross-sectional study data from the 2019 Behavioral Risk Factor Surveillance System survey. SETTING Washington State, USA. PARTICIPANTS Lower-income adults, aged 50 years or older (n 2118). MCC was defined as having ≥ 2 of 11 possible conditions. Health care access comprised three variables (unable to afford seeing the doctor, no health care coverage and not having a primary care provider (PCP)). Food insecurity was defined as buying food that did not last and not having money to get more. RESULTS The overall prevalence of food insecurity was 26·0 % and was 1·50 times greater (95 % CI 1·16, 1·95) among participants with MCC compared to those without MCC. Among those with MCC (n 1580), inability to afford seeing a doctor was associated with food insecurity (prevalence ratio (PR) 1·83; 95 % CI 1·46, 2·28), but not having health insurance (PR 1·49; 95 % CI 0·98, 2·24) and not having a PCP (PR 1·10; 95 % CI 0·77, 1·57) were not. CONCLUSIONS Inability to afford healthcare is related to food insecurity among older adults with MCC. Future work should focus on collecting longitudinal data that can clarify the temporal relationship between MCC and food insecurity.
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Affiliation(s)
- Courtney M Hill
- Department of Epidemiology, University of
Washington, Seattle, WA98195, USA
| | - Ashley S Tseng
- Department of Epidemiology, University of
Washington, Seattle, WA98195, USA
| | | | - Alyson J Littman
- Department of Epidemiology, University of
Washington, Seattle, WA98195, USA
- Seattle Epidemiologic Research and Information
Center, Department of Veterans Affairs Puget Sound Health Care System,
Seattle, WA, USA
- Seattle-Denver Center of Innovation for Veteran-Centered and
Value-Driven Care, Health Services Research and Development,
Department of Veterans Affairs Puget Sound Health Care System, Seattle,
WA, USA
| | - Jessica C Jones-Smith
- Department of Epidemiology, University of
Washington, Seattle, WA98195, USA
- Department of Health Systems and Population Health,
University of Washington, Seattle,
WA, USA
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Regan B, Mahajan N, Sabo R, Lail Kashiri P, Hinesley J, O'Loughlin K, Webel B, Krist A, Richards A. Patients' Progress and Confidence Addressing Root Causes of Poor Health in Primary Care. Ann Fam Med 2023; 21:4355. [PMID: 38226950 PMCID: PMC10549574 DOI: 10.1370/afm.21.s1.4355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024] Open
Abstract
Context: Patients with multiple chronic conditions (MCC) may have unmet behavioral, mental, and social needs which can be difficult to address in primary care. Care planning provides a framework for patients to be screened, collaborate on a care plan, and access a patient navigator who can support them achieving their personal health goals. Objective: To compare patients' progress and confidence in addressing personal care plans for different topics. Study Design and Analysis: Clinician level randomized control trial and descriptive analyses. Dataset: My Own Health Report (MOHR) study and navigator field notes. Population Studied: As part of a randomized controlled trial (RCT) to evaluate a feasible approach to patient care planning, 24 clinicians from 12 practices in the Virginia Ambulatory Care Outcomes Research Network (ACORN) in the Greater Richmond metro and the Northern Virginia areas participated in a care planning intervention. 91 patients in the intervention arm received support from a patient navigator for making and working on a goal. We focused on patients with uncontrolled chronic conditions that have complex needs. Intervention/Instrument: Community-clinical linkage support and navigator field notes in My Own Health Report (MOHR). Outcome Measures: We determined confidence and progress ratings (ranked by patients on 1-10 point scale), health risk assessment responses, and care plan topics selected by patients. Results: Patients feel more confident addressing nutrition than weight loss (mean = 8.07 vs 6.31, p=0.0031). Patients tended to report better prior progress on nutrition care plans (mean = 3.80) than physical activity (mean =2.95, p=0.0024) and weight loss (mean=2.93, p=0.004). Conclusions: Helping patients create care plans on topics they feel most comfortable addressing may better address root causes of poor health associated with chronic conditions. Connecting them with a patient navigator for the short-term may have long-term benefits for patients and care teams.
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Doose M, Verhoeven D, Sanchez JI, McGee-Avila JK, Chollette V, Weaver SJ. Clinical Multiteam System Composition and Complexity Among Newly Diagnosed Early-Stage Breast, Colorectal, and Lung Cancer Patients With Multiple Chronic Conditions: A SEER-Medicare Analysis. JCO Oncol Pract 2023; 19:e33-e42. [PMID: 36473151 PMCID: PMC10166428 DOI: 10.1200/op.22.00304] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/23/2022] [Accepted: 09/30/2022] [Indexed: 12/12/2022] Open
Abstract
PURPOSE Sixty percent of adults have multiple chronic conditions at cancer diagnosis. These patients may require a multidisciplinary clinical team-of-teams, or a multiteam system (MTS), of high-complexity involving multiple specialists and primary care, who, ideally, coordinate clinical responsibilities, share information, and align clinical decisions to ensure comprehensive care needs are managed. However, insights examining MTS composition and complexity among individuals with cancer and comorbidities at diagnosis using US population-level data are limited. METHODS Using SEER-Medicare data (2006-2016), we identified newly diagnosed patients with breast, colorectal, or lung cancer who had a codiagnosis of cardiopulmonary disease and/or diabetes (n = 75,201). Zaccaro's theory-based classification of MTSs was used to categorize clinical MTS complexity in the 4 months following cancer diagnosis: high-complexity (≥ 4 clinicians from ≥ 2 specialties) and low-complexity (1-3 clinicians from 1-2 specialties). We describe the proportions of patients with different MTS compositions and quantify the incidence of high-complexity MTS care by patient groups. RESULTS The most common MTS composition was oncology with primary care (37%). Half (50.3%) received high-complexity MTS care. The incidence of high-complexity MTS care for non-Hispanic Black and Hispanic patients with cancer was 6.7% (95% CI, -8.0 to -5.3) and 4.7% (95% CI, -6.3 to -3.0) lower than non-Hispanic White patients with cancer; 13.1% (95% CI, -14.1 to -12.2) lower for rural residents compared with urban; 10.4% (95% CI, -11.2 to -9.5) lower for dual Medicaid-Medicare beneficiaries compared with Medicare-only; and 16.6% (95% CI, -17.5 to -15.8) lower for colorectal compared with breast cancer. CONCLUSION Incidence differences of high-complexity MTS care were observed among cancer patients with multiple chronic conditions from underserved populations. The results highlight the need to further understand the effects of and mechanisms through which care team composition, complexity, and functioning affect care quality and outcomes.
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Affiliation(s)
- Michelle Doose
- Division of Clinical and Health Services Research, National Institute on Minority Health and Health Disparities, Bethesda, MD
| | - Dana Verhoeven
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Janeth I Sanchez
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Jennifer K McGee-Avila
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
- Infections and Immunoepidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Rockville, MD
| | - Veronica Chollette
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
| | - Sallie J Weaver
- Health Systems and Interventions Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD
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Clements JM. Access to care by Medicare beneficiaries in the U.S. with diabetes and multiple chronic conditions during the COVID-19 pandemic. J Diabetes Complications 2022; 36:108355. [PMID: 36372056 PMCID: PMC9640381 DOI: 10.1016/j.jdiacomp.2022.108355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 10/24/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Determine characteristics of Medicare beneficiaries with diabetes and multiple chronic conditions (MCC) associated with being unable to obtain medical services during COVID-19. RESEARCH DESIGN AND METHODS Retrospective cohort study of data from COVID-19 Supplements of Medicare Current Beneficiary Surveys administered in Summer (N = 11,114, unweighted) and Fall (N = 9686, unweighted) 2020, and Winter 2021 (N = 11,107, unweighted). Binary logistic regression was used to model for adjusted odds of self-reports of being unable to access different types of care. RESULTS In three time periods from March 2020 through March/April 2021 beneficiaries with diabetes plus MCC combinations reported being unable to get medical care, compared to beneficiaries with diabetes alone. Notably, patterns persisted at the 12-month mark with beneficiaries with diabetes plus cancer (OR = 1.24), and diabetes plus cancer/stroke (OR = 2.53) experiencing increased odds of being unable to get care because of COVID-19, compared to beneficiaries with diabetes alone. By March/April 2021 beneficiaries with diabetes plus COPD (OR = 1.08), diabetes plus stroke (OR = 1.49), and diabetes plus Alzheimer's (OR = 1.09) experienced increased odds of being unable to get treatment for ongoing conditions. Beneficiaries with diabetes plus Alzheimer's (OR = 1.40) also experienced increased odds of being unable to get a regular check-up 12 months into the pandemic. Finally, members of racial/ethnic minority groups experienced increased odds of being unable to obtain services at various times during the pandemic compared to non-Hispanic Whites, with increased odds persisting at 12 months for non-Hispanic Blacks and Hispanics. CONCLUSIONS Beneficiaries with MCC, and minorities, experienced increased odds of being unable to obtain some services during COVID-19, even when controlling for similar diabetes and MCC combinations. Work remains for providers and public health systems to dismantle and reimagine systems to provide equitable access to care.
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Affiliation(s)
- John M Clements
- Michigan State University, College of Human Medicine, Division of Public Health, 130 E 2nd Street, Flint, MI 48502, United States of America.
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Zhang Y, Chen C, Huang L, Liu G, Lian T, Yin M, Zhao Z, Xu J, Chen R, Fu Y, Liang D, Zeng J, Ni J. Associations Among Multimorbid Conditions in Hospitalized Middle-aged and Older Adults in China: Statistical Analysis of Medical Records. JMIR Public Health Surveill 2022; 8:e38182. [PMID: 36422885 PMCID: PMC9732753 DOI: 10.2196/38182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 07/13/2022] [Accepted: 09/10/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Multimorbidity has become a new challenge for medical systems and public health policy. Understanding the patterns of and associations among multimorbid conditions should be given priority. It may assist with the early detection of multimorbidity and thus improve quality of life in older adults. OBJECTIVE This study aims to comprehensively analyze and compare associations among multimorbid conditions by age and sex in a large number of middle-aged and older Chinese adults. METHODS Data from the home pages of inpatient medical records in the Shenzhen National Health Information Platform were evaluated. From January 1, 2017, to December 31, 2018, inpatients aged 50 years and older who had been diagnosed with at least one of 40 conditions were included in this study. Their demographic characteristics (age and sex) and inpatient diagnoses were extracted. Association rule mining, Chi-square tests, and decision tree analyses were combined to identify associations between multiple chronic conditions. RESULTS In total, 306,264 hospitalized cases with available information on related chronic conditions were included in this study. The prevalence of multimorbidity in the overall population was 76.46%. The combined results of the 3 analyses showed that, in patients aged 50 years to 64 years, lipoprotein metabolism disorder tended to be comorbid with multiple chronic conditions. Gout and lipoprotein metabolism disorder had the strongest association. Among patients aged 65 years or older, there were strong associations between cerebrovascular disease, heart disease, lipoprotein metabolism disorder, and peripheral vascular disease. The strongest associations were observed between senile cataract and glaucoma in men and women. In particular, the association between osteoporosis and malignant tumor was only observed in middle-aged and older men, while the association between anemia and chronic kidney disease was only observed in older women. CONCLUSIONS Multimorbidity was prevalent among middle-aged and older Chinese individuals. The results of this comprehensive analysis of 4 age-sex subgroups suggested that associations between particular conditions within the sex and age groups occurred more frequently than expected by random chance. This provides evidence for further research on disease clusters and for health care providers to develop different strategies based on age and sex to improve the early identification and treatment of multimorbidity.
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Affiliation(s)
- Yan Zhang
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Chao Chen
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
- Institute of Public Health and Wellness, Guangdong Medical University, Dongguan, China
| | - Lingfeng Huang
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
- Institute of Public Health and Wellness, Guangdong Medical University, Dongguan, China
| | - Gang Liu
- Department of Primary Public Health Promotion, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Tingyu Lian
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
- Institute of Public Health and Wellness, Guangdong Medical University, Dongguan, China
| | - Mingjuan Yin
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
- Institute of Public Health and Wellness, Guangdong Medical University, Dongguan, China
| | - Zhiguang Zhao
- Administration Office, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Jian Xu
- Department of Elderly Health Management, Shenzhen Center for Chronic Disease Control, Shenzhen, China
| | - Ruoling Chen
- Faculty of Education, Health and Wellbeing, University of Wolverhampton, Wolverhampton, United Kingdom
| | - Yingbin Fu
- Department of Primary Public Health Promotion, Shenzhen Center for Disease Control and Prevention, Shenzhen, China
| | - Dongmei Liang
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
- Institute of Public Health and Wellness, Guangdong Medical University, Dongguan, China
| | - Jinmei Zeng
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
- Institute of Public Health and Wellness, Guangdong Medical University, Dongguan, China
| | - Jindong Ni
- Precision Key Laboratory of Public Health, School of Public Health, Guangdong Medical University, Dongguan, China
- Institute of Public Health and Wellness, Guangdong Medical University, Dongguan, China
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Bonnell LN, Clifton J, Rose GL, Waddell EN, Littenberg B. Urban-Rural Differences in Mental and Physical Health among Primary Care Patients with Multiple Chronic Conditions: A Secondary Analysis from a Randomized Clinical Trial. Int J Environ Res Public Health 2022; 19:15580. [PMID: 36497657 PMCID: PMC9741371 DOI: 10.3390/ijerph192315580] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 06/17/2023]
Abstract
PURPOSE Rural health disparities are largely attributable to access to healthcare, socioeconomic status, and health behaviors. Little is known about the persistence of these disparities when differences in access to care are eliminated. We sought to investigate urban-rural differences in physical and mental health in primary care patients with demonstrated access to primary care. METHODS We obtained cross-sectional survey responses from a multicenter randomized controlled trial on 2726 adult primary care patients with multiple chronic medical or behavioral conditions from 42 primary care practices in 13 states. Study outcomes include measures of mental health including: The Patient-Reported Outcomes Measurement Information System (PROMIS-29®), General Anxiety Disorder-7 (GAD-7), and Patient Health Questionnaire-9 (PHQ-9), as well as physical health including: the PROMIS-29® and the Duke Activity Status Index (DASI). Urban-rural residence was indicated by census-tract Rural Urban Commuting Areas of the participant's home address. Differences in mental and physical health outcomes attributable to rurality were assessed using multilevel models with a random intercept for census-tract. RESULTS After adjustment for demographic and neighborhood characteristics, urban residents had significantly worse generalized anxiety disorder (GAD-7) (ß = 0.7; 95% CI = 0.1, 1.3; p = 0.027), depression (PHQ-9) (ß = 0.7; 95% CI = 0.1, 1.4; p = 0.024), and functional capacity (DASI) (ß = -0.4; 95% CI = -0.5, -0.2; p < 0.001) compared to rural residents. Urban residents also had significantly worse anxiety and depression as measured by the PROMIS-29® compared to their rural counterparts. There were no urban-rural differences in the other PROMIS-29® subdomains. CONCLUSIONS Among adults with demonstrated access to care and multiple diagnosed chronic conditions, rural residents had better mental health and functional capacity than their urban counterparts. This finding is not consistent with prior research documenting rural health disparities and should be confirmed.
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Affiliation(s)
- Levi N. Bonnell
- Department of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Jessica Clifton
- Department of Medicine, University of Vermont, Burlington, VT 05405, USA
| | - Gail L. Rose
- Department of Psychiatry, University of Vermont, Burlington, VT 05405, USA
| | - Elizabeth N. Waddell
- Division of General Internal Medicine and Geriatrics, Oregon Health and Science University, Portland, OR 97201, USA
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Beck AM, Serrano NH, Toler A, Brownson RC. Multilevel correlates of domain-specific physical activity among rural adults - a cross-sectional study. BMC Public Health 2022; 22:2150. [PMID: 36419021 PMCID: PMC9686077 DOI: 10.1186/s12889-022-14634-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 11/15/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Increasing physical activity (PA) in rural communities is a vital prevention tactic in multiple chronic diseases; however, little is known on the multilevel correlates of PA rural areas. A better understanding of domain-specific PA adds context for promoting PA in rural communities. The current study sought to determine factors associated with domain-specific and overall moderate-vigorous physical activity (MVPA) in rural communities. METHODS Surveys were conducted across 14 rural mid-Western communities, with the final analytical sample including 1241 adults (ages 19-96, M = 57.0 [SD = 16.7], 67.8% female, 83.8% white). Generalized linear models with negative binomial distributions examined the relation between demographics, trail use, and perceptions of the neighborhood environment, with domain-specific and overall MVPA, measured via the Global Physical Activity Questionnaire. RESULTS Rural residents reported an average of 617 total minutes of weekly MVPA (SD = 1141), with 58.5% meeting MVPA guidelines. Higher age, female gender, and higher educated individuals had lower levels of overall and occupational MVPA. Females, higher education, and perceived indoor recreational access were associated with lower levels of transportation-related MVPA, while trail use was associated with increased transportation MVPA. Higher age and female gender respondents had lower levels of recreational MVPA, while trail users and those who perceived favorable indoor recreational access had higher levels of recreational MVPA. CONCLUSIONS PA primarily occurred in the occupational domain among this sample of rural mid-Western adults. Findings highlight the need for multilevel interventions to address PA across multiple domains in rural communities, especially among females and older adults.
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Affiliation(s)
- Alan M Beck
- Prevention Research Center, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA.
| | - Natalicio H Serrano
- Institute for Health Research and Policy, University of Illinois at Chicago, Chicago, IL, USA
| | - Audrey Toler
- Prevention Research Center, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
| | - Ross C Brownson
- Prevention Research Center, Washington University in St. Louis, One Brookings Drive, Campus Box 1196, St. Louis, MO, 63130, USA
- Department of Surgery (Division of Public Health Sciences), Washington University School of Medicine, St. Louis, USA
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Xiao Z, Han X. Evaluation of the Effectiveness of Telehealth Chronic Disease Management System: A Systematic Review and Meta-Analysis (Preprint). J Med Internet Res 2022; 25:e44256. [PMID: 37103993 PMCID: PMC10176143 DOI: 10.2196/44256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/15/2022] [Accepted: 03/10/2023] [Indexed: 03/12/2023] Open
Abstract
BACKGROUND Long-term daily health monitoring and management play a more significant role in telehealth management systems nowadays, which require evaluation indicators to present patients' general health conditions and become applicable to multiple chronic diseases. OBJECTIVE This study aims to evaluate the effectiveness of subjective indicators of telehealth chronic disease management system (TCDMS). METHODS We selected Web of Science, ScienceDirect, Scopus, Cochrane library, IEEE, and Chinese National Knowledge Infrastructure and Wanfang, a Chinese medical database, and searched papers published from January 1, 2015, to July 1, 2022, regarding randomized controlled trials on the effectiveness of the telehealth system on patients with chronic diseases. The narrative review summarized the questionnaire indicators presented in the selected studies. In the meta-analysis, Mean Difference (MD) and Standardized Mean Difference (SMD) with a 95% CI were pooled depending on whether the measurements were the same. Subgroup analysis was conducted if the heterogeneity was significant, and the number of studies was sufficient. RESULTS Twenty RCTs with 4153 patients were included in the qualitative review. Seventeen different questionnaire-based outcomes were found, within which quality of life, psychological well-being (including depression, anxiety, and fatigue), self-management, self-efficacy, and medical adherence were most frequently used. Ten RCTs with 2095 patients remained in meta-analysis. Compared to usual care, telehealth system can significantly improve the quality of life (SMD 0.44; 95% CI 0.16-0.73; P=.002), whereas no significant effects were found on depression (SMD -0.25; 95% CI -0.72 to 0.23; P=.30), anxiety (SMD -0.10; 95% CI -0.27 to 0.07; P=.71), fatigue (SMD -0.36; 95% CI -1.06 to 0.34; P<.001), and self-care (SMD 0.77; 95% CI -0.28-1.81; P<.001). In the subdomains of quality of life, telehealth statistically significantly improved physical functioning (SMD 0.15; 95% CI 0.02 to 0.29; P=.03), mental functioning (SMD 0.37; 95% CI 0.13-0.60; P=.002), and social functioning (SMD 0.64; 95% CI 0.00-1.29; P=.05), while there was no difference on cognitive functioning (MD 8.31; 95% CI -7.33 to 23.95; P=.30) and role functioning (MD 5.30; 95% CI -7.80 to 18.39; P=.43). CONCLUSIONS TCDMS positively affected patients' physical, mental, and social quality of life across multiple chronic diseases. However, no significant difference was found in depression, anxiety, fatigue, and self-care. Subjective questionnaires had the potential ability to evaluate the effectiveness of long-term telehealth monitoring and management. However, further well-designed experiments are warranted to validate TCDMS's effects on subjective outcomes, especially when tested among different chronically ill groups.
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Affiliation(s)
- Ziyan Xiao
- Research Center Intelligent Equipment and Technology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China
- Department of Statistics and Actuarial Science, Faculty of Science, The University of Hong Kong, Hong Kong, Hong Kong
| | - Xiuping Han
- Research Center Intelligent Equipment and Technology, Yangtze Delta Region Institute of Tsinghua University, Jiaxing, Zhejiang, China
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Bensken WP, Schiltz NK, Warner DF, Kim DH, Wei MY, Quiñones AR, Ho VP, Kelley AS, Owusu C, Kent EE, Koroukian SM. Comparing the association between multiple chronic conditions, multimorbidity, frailty, and survival among older patients with cancer. J Geriatr Oncol 2022; 13:1244-1252. [PMID: 35786369 PMCID: PMC9798334 DOI: 10.1016/j.jgo.2022.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/06/2022] [Accepted: 06/22/2022] [Indexed: 01/01/2023]
Abstract
INTRODUCTION The high prevalence of multiple chronic conditions (MCC), multimorbidity, and frailty may affect treatment and outcomes for older adults with cancer. The goal of this study was to use three conceptually distinct measures of morbidity to examine the association between these measures and mortality. MATERIALS AND METHODS Using Medicare claims data linked with the 2012-2016 Ohio Cancer Incidence Surveillance System we identified older adults with incident primary cancer sites of breast, colorectal, lung, or prostate (n = 29,140). We used claims data to identify their Elixhauser comorbidities, Multimorbidity-Weighted Index (MWI), and Claims Frailty Index (CFI) as measures of MCC, multimorbidity, and frailty, respectively. We used Cox proportional hazard models to examine the association between these measures and survival time since diagnosis. RESULTS Lung cancer patients had the highest levels of MCC, multimorbidity, and frailty. There was a positive association between all three measures and a greater hazard of death after adjusting for age, sex (colorectal and lung only), and stage. Breast cancer patients with 5+ comorbidities had an adjusted hazard ratio (aHR) of 1.63 (95% confidence interval [CI]: 1.38, 1.93), and those with mild frailty had an aHR of 3.38 (95% CI; 2.12, 5.41). The C statistics for breast cancer were 0.79, 0.78, and 0.79 for the MCC, MWI, and CFI respectively. Similarly, lung cancer patients who were moderately or severely frail had an aHR of 1.82 (95% CI: 1.53, 2.18) while prostate cancer patients had an aHR of 3.39 (95% CI: 2.12, 5.41) and colorectal cancer patients had an aHR of 4.51 (95% CI: 3.23, 6.29). Model performance was nearly identical across the MCC, multimorbidity, and frailty models within cancer type. The models performed best for prostate and breast cancer, and notably worse for lung cancer. The frailty models showed the greatest separation in unadjusted survival curves. DISCUSSION The MCC, multimorbidity, and frailty indices performed similarly well in predicting mortality among a large cohort of older cancer patients. However, there were notable differences by cancer type. This work highlights that although model performance is similar, frailty may serve as a clearer indicator in risk stratification of geriatric oncology patients than simple MCCs or multimorbidity.
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Affiliation(s)
- Wyatt P Bensken
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America.
| | - Nicholas K Schiltz
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America; Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, United States of America
| | - David F Warner
- Department of Sociology, University of Alabama at Birmingham, Birmingham, AL, United States of America; Center for Family & Demographic Research, Bowling Green State University, Bowling Green, OH, United States of America
| | - Dae H Kim
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Boston, MA, United States of America; Division of Gerontology, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, United States of America
| | - Melissa Y Wei
- Division of General Internal Medicine and Health Services Research, Department of Internal Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, United States of America; Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, United States of America
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health & Science University, Portland, OR, United States of America; OHSU-PSU School of Public Health, Oregon Health & Science University, Portland, OR, United States of America
| | - Vanessa P Ho
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America; Department of Surgery, MetroHealth Medical Center, Cleveland, OH, United States of America
| | - Amy S Kelley
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, United States of America
| | - Cynthia Owusu
- Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America; Division of Hematology/Oncology, Department of Medicine, Case Western Reserve University, School of Medicine, Cleveland, OH, United States of America
| | - Erin E Kent
- Gillings School of Global Public Health, Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences, School of Medicine, Case Western Reserve University, Cleveland, OH, United States of America; Case Comprehensive Cancer Center, Case Western Reserve University, Cleveland, OH, United States of America
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Bonnell LN, Troy AR, Littenberg B. Exploring non-linear relationships between neighbourhood walkability and health: a cross-sectional study among US primary care patients with chronic conditions. BMJ Open 2022; 12:e061086. [PMID: 35985786 PMCID: PMC9396151 DOI: 10.1136/bmjopen-2022-061086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND A recent study of licensed drivers found a non-linear relationship between density of non-residential destinations (NRDs), a proxy for walkability and body mass index (BMI) across a wide range of development patterns. It is unclear if this relationship can be replicated in a population with multiple chronic conditions or translated to health outcomes other than BMI. METHODS We obtained health data and home addresses for 2405 adults with multiple chronic conditions from 44 primary care clinics across 13 states using the Integrating Behavioral health and Primary Care Trial. In this cross-sectional study, the relationships between density of NRDs (from a commercial database) within 1 km of the home address and self-reported BMI, and mental and physical health indices were assessed using several non-linear methods, including restricted cubic splines, LOWESS smoothing curves, non-parametric regression with a spline basis and piecewise linear regression. RESULTS All methods demonstrated similar non-linear relationships. Piecewise linear regression was selected for ease of interpretation. BMI had a positive marginal rate of change below the NRD density inflection point of 15 establishments/hectare (β=+0.09 kg/m2/non-residential buildings ha-1; 95% CI +0.01 to +0.14), and a negative marginal rate of change above the inflection point (β=-0.02; 95% CI -0.06 to 0.02). Mental health decreased with NRD density below the inflection point (β=-0.24; 95% CI -0.31 to -0.17) and increased above it (β=+0.03; 95% CI -0.00 to +0.07). Results were similar for physical health (β= -0.28; 95% CI -0.35 to -0.20) and (β=+0.06; 95% CI 0.01 to +0.10). CONCLUSION Health indicators were the lowest in middle density (typically suburban) areas and got progressively better moving in either direction from the peak. NRDs may affect health differently depending on home-address NRD density. TRIAL REGISTRATION NUMBER NCT02868983.
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Affiliation(s)
- Levi Nicolas Bonnell
- General Internal Medicine Research, University of Vermont College of Medicine, Burlington, Vermont, USA
| | - Austin R Troy
- Urban and Regional Planning, University of Colorado Denver College of Architecture and Planning, Denver, Colorado, USA
| | - Benjamin Littenberg
- General Internal Medicine Research, University of Vermont College of Medicine, Burlington, Vermont, USA
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