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Berglund M, Andersson S, Kjellsdotter A. A feeling of not being alone - Patients' with COPD experiences of a group-based self-management education with a digital website: A qualitative study. Nurs Open 2024; 11:e2153. [PMID: 38641867 PMCID: PMC11031618 DOI: 10.1002/nop2.2153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/11/2024] [Accepted: 03/21/2024] [Indexed: 04/21/2024] Open
Abstract
AIM To describe patients' with chronic obstructive pulmonary disease (COPD) experiences of group-based self-management education with a digital website. DESIGN A qualitative approach with a phenomenologicalmethod. Patients participating in an earlier study, with self-experience of COPD as a special competence, were involved as research partners at the design of this study. METHODS Eleven individual and two group interviews with five participants in each group were conducted. RESULTS Group-based self-management education with a digital website supports learning. Sharing experiences with others in similar situations creates security and reduces the feeling of being alone. Based on questions and discussion in the group, and through self-reflection, general information is transformed into useful knowledge and understanding of one's own situation. COPD information on the website provides an opportunity to gain knowledge continuously based on needs that contributes to learning. This research has demonstrated that adapting learning activities to individual learning styles increases sustainability of learning. Sharing experiences reduces feelings of loneliness. It is therefore important to create spaces for sharing experiences and in-depth reflection that support learning over time.
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Affiliation(s)
- Mia Berglund
- School of Health SciencesSkövde UniversitySkövdeSweden
| | - Susanne Andersson
- FoU‐centrum Skaraborg ‐ R&D Centre SkaraborgRegion Västra GötalandSkövdeSweden
- Department of Health SciencesUniversity WestTrollhättanSweden
| | - Anna Kjellsdotter
- School of Health SciencesSkövde UniversitySkövdeSweden
- Research and Development CentreSkaraborg HospitalSkövdeSweden
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2
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Patel K, Pye A, Edgar RG, Beadle H, Ellis PR, Sitch A, Dickens AP, Turner AM. Cluster randomised controlled trial of specialist-led integrated COPD care (INTEGR COPD). Thorax 2024; 79:209-218. [PMID: 38286619 DOI: 10.1136/thorax-2023-220435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 12/24/2023] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Studies in hospital settings demonstrate that there is greater guideline adherence when care is delivered by a respiratory specialist, however, this has not been explored in primary care. The aim of this study is to determine the impact integrating respiratory specialists into primary care has on the delivery of guideline adherent chronic obstructive pulmonary disease (COPD) care. METHODS 18 general practitioner (GP) practices were randomised to provide either usual or specialist-led COPD care. Patients at participating practices were included if they had an existing diagnosis of COPD. Outcomes were measured at the individual patient level. The primary outcome was guideline adherence, assessed as achieving four or more items of the COPD care bundle. Secondary outcome measures included quality of life, number of exacerbations, number of COPD-related hospitalisations and respiratory outpatient attendances. RESULTS 586 patients from 10 practices randomised to the intervention and 656 patients from 8 practices randomised to the control arm of the study were included. The integration of respiratory specialists into GP practices led to a statistically significant (p<0.001) improvement in the provision of guideline adherent care when compared with usual care in this cohort (92.7% vs 70.1%) (OR 4.14, 95% CI 2.14 to 8.03). CONCLUSION This is the first study to demonstrate that guideline adherence is improved through the integration of respiratory specialists into GP practices to deliver annual COPD reviews. To facilitate changes in current healthcare practice and policy, the findings of this paper need to be viewed in combination with qualitative research exploring the acceptability of specialist integration. TRIAL REGISTRATION NUMBER NCT03482700.
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Affiliation(s)
- Ketan Patel
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Anita Pye
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
| | - Ross G Edgar
- Lung Function and Sleep Department, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Helen Beadle
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Paul R Ellis
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
| | - Alice Sitch
- NIHR Birmingham Biomedical Research Centre, Birmingham, UK
| | - Andrew P Dickens
- Observational and Pragmatic Research Institute Pte Ltd, Singapore
| | - Alice M Turner
- University of Birmingham Institute of Applied Health Research, Birmingham, UK
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3
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Kroenke K, Corrigan JD, Ralston RK, Zafonte R, Brunner RC, Giacino JT, Hoffman JM, Esterov D, Cifu DX, Mellick DC, Bell K, Scott SG, Sander AM, Hammond FM. Effectiveness of care models for chronic disease management: A scoping review of systematic reviews. PM R 2024; 16:174-189. [PMID: 37329557 DOI: 10.1002/pmrj.13027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2022] [Revised: 05/14/2023] [Accepted: 05/31/2023] [Indexed: 06/19/2023]
Abstract
OBJECTIVE To conduct a scoping review of models of care for chronic disease management to identify potentially effective components for management of chronic traumatic brain injury (TBI). METHODS Information sources: Systematic searches of three databases (Ovid MEDLINE, Embase, and Cochrane Database of Systematic Reviews) from January 2010 to May 2021. ELIGIBILITY CRITERIA Systematic reviews and meta-analyses reporting on the effectiveness of the Chronic Care Model (CCM), collaborative/integrated care, and other chronic disease management models. DATA Target diseases, model components used (n = 11), and six outcomes (disease-specific, generic health-related quality of life and functioning, adherence, health knowledge, patient satisfaction, and cost/health care use). SYNTHESIS Narrative synthesis, including proportion of reviews documenting outcome benefits. RESULTS More than half (55%) of the 186 eligible reviews focused on collaborative/integrated care models, with 25% focusing on CCM and 20% focusing on other chronic disease management models. The most common health conditions were diabetes (n = 22), depression (n = 16), heart disease (n = 12), aging (n = 11), and kidney disease (n = 8). Other single medical conditions were the focus of 22 reviews, multiple medical conditions of 59 reviews, and other or mixed mental health/behavioral conditions of 20 reviews. Some type of quality rating for individual studies was conducted in 126 (68%) of the reviews. Of reviews that assessed particular outcomes, 80% reported disease-specific benefits, and 57% to 72% reported benefits for the other five types of outcomes. Outcomes did not differ by the model category, number or type of components, or target disease. CONCLUSIONS Although there is a paucity of evidence for TBI per se, care model components proven effective for other chronic diseases may be adaptable for chronic TBI care.
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Affiliation(s)
- Kurt Kroenke
- Department of Medicine, Indiana School of Medicine and Regenstrief Institute, Indianapolis, Indiana, USA
| | - John D Corrigan
- Department of Physical Medicine & Rehabilitation, The Ohio State University, Columbus, Ohio, USA
| | - Rick K Ralston
- Ruth Lilly Medical Library, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Robert C Brunner
- Department of Physical Medicine and Rehabilitation, University of Alabama, Birmingham, Alabama, USA
| | - Joseph T Giacino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, and Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Jeanne M Hoffman
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - David X Cifu
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University, Richmond, Virginia, USA
- U.S. Department of Veterans Affairs, Washington, DC, USA
| | | | - Kathleen Bell
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern, Dallas, Texas, USA
| | - Steven G Scott
- Center of Innovation on Disability & Rehab Research (CINDRR), James A Haley Veterans' Hospital, Tampa, Florida, USA
| | - Angelle M Sander
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, and Brain Injury Research Center, TIRR Memorial Hermann, Houston, Texas, USA
| | - Flora M Hammond
- Department of Physical Medicine and Rehabilitation, Indiana University School of Medicine, Indianapolis, Indiana, USA
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4
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Senft JD, Fleischhauer T, Poß-Doering R, Frasch J, Feißt M, Awounvo S, Müller-Bühl U, Altiner A, Szecsenyi J, Laux G. Primary Care Disease Management for Venous Leg Ulceration in German Healthcare: Results of the Ulcus Cruris Care Pilot Study. Healthcare (Basel) 2023; 11:2521. [PMID: 37761717 PMCID: PMC10531034 DOI: 10.3390/healthcare11182521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/29/2023] [Accepted: 09/08/2023] [Indexed: 09/29/2023] Open
Abstract
Despite proven effectiveness, compression therapy is applied in only 20-40% of patients with venous leg ulceration, leading to avoidable chronification and morbidity. The Ulcus Cruris Care project was established to develop a new disease-management concept comparable to existing programs for chronic diseases to support evidence-based treatment of venous leg ulceration. This prospective controlled study assessed its first implementation. Interventional elements comprised online training for general practitioner practices, software support for case management, and educational materials for patients. A total of 20 practices and 40 patients were enrolled in a 1:1 ratio to the intervention and control group. Guideline-conform compression therapy was applied more frequently in the intervention group (19/20 [95%] vs. 11/19 [58%]; p = 0.006). For patients with ulcers existing ≤ 6 months, the healing rate at 12 weeks was 8/11 [73%] (intervention) compared to 4/11 [36%] (control; p = 0.087). Patients after intervention had higher scores for self-help and education in the PACIC-5A questionnaire (42.9 ± 41.6 vs. 11.4 ± 28.8; p = 0.044). Treatment costs were EUR 1.380 ± 1.347 (intervention) and EUR 2.049 ± 2.748 (control; p = 0.342). The results of this study indicate that the Ulcus Cruris Care intervention may lead to a significant improvement in care. Consequently, a broader rollout in German healthcare seems warranted.
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Affiliation(s)
- Jonas D. Senft
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Thomas Fleischhauer
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Regina Poß-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Jona Frasch
- aQua Institute for Applied Quality Promotion and Research in Health Care GmbH, Maschmühlenweg 8-10, 37073 Göttingen, Germany
| | - Manuel Feißt
- Institute of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Sinclair Awounvo
- Institute of Medical Biometry, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Uwe Müller-Bühl
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Attila Altiner
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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Pagano L, Dennis S, Wootton S, Chan ASL, Zwar N, Mahadev S, Pallavicini D, McKeough Z. The effects of an innovative GP-physiotherapist partnership in improving COPD management in primary care. BMC PRIMARY CARE 2023; 24:142. [PMID: 37430190 DOI: 10.1186/s12875-023-02097-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 06/29/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Evidence suggests that management of people with Chronic Obstructive Pulmonary Disease (COPD) in primary care has been suboptimal, in particular, with low referral rates to pulmonary rehabilitation (PR). The aim of this study was to evaluate the effectiveness of a GP-physiotherapist partnership in optimising management of COPD in primary care. METHODS A pragmatic, pilot, before and after study was conducted in four general practices in Australia. A senior cardiorespiratory physiotherapist was partnered with each general practice. Adults with a history of smoking and/or COPD, aged ≥ 40 years with ≥ 2 practice visits in the previous year were recruited following spirometric confirmation of COPD. Intervention was provided by the physiotherapist at the general practice and included PR referral, physical activity and smoking cessation advice, provision of a pedometer and review of inhaler technique. Intervention occurred at baseline, one month and three months. Main outcomes included PR referral and attendance. Secondary clinical outcomes included changes in COPD Assessment Test (CAT) score, dyspnoea, health activation and pedometer step count. Process outcomes included count of initiation of smoking cessation interventions and review of inhaler technique. RESULTS A total of 148 participants attended a baseline appointment where pre/post bronchodilator spirometry was performed. 31 participants with airflow obstruction on post-bronchodilator spirometry (mean age 75yrs (SD 9.3), mean FEV1% pred = 75% (SD 18.6), 61% female) received the intervention. At three months, 78% (21/27) were referred to PR and 38% (8/21) had attended PR. No significant improvements were seen in CAT scores, dyspnoea or health activation. There was no significant change in average daily step count at three months compared to baseline (mean difference (95% CI) -266 steps (-956 to 423), p = 0.43). Where indicated, all participants had smoking cessation interventions initiated and inhaler technique reviewed. CONCLUSION The results of this study suggest that this model was able to increase referrals to PR from primary care and was successful in implementing some aspects of COPD management, however, was insufficient to improve symptom scores and physical activity levels in people with COPD. TRIAL REGISTRATION ANZCTR, ACTRN12619001127190. Registered 12 August 2019 - Retrospectively registered, http://www.ANZCTR.org.au/ACTRN12619001127190.aspx .
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Affiliation(s)
- Lisa Pagano
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sarah Dennis
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research, Sydney, Australia
- South Western Sydney Local Health District, Liverpool, Australia
| | - Sally Wootton
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
| | - Andrew S L Chan
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Sriram Mahadev
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, Sydney, Australia
- Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | | | - Zoe McKeough
- Sydney School of Health Sciences, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
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6
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Scarffe AD, Licskai CJ, Ferrone M, Brand K, Thavorn K, Coyle D. Cost-effectiveness of integrated disease management for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease in a primary care setting. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2022; 20:39. [PMID: 35962399 PMCID: PMC9373353 DOI: 10.1186/s12962-022-00377-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 07/27/2022] [Indexed: 11/24/2022] Open
Abstract
Background We evaluate the cost-effectiveness of the ‘Best Care’ integrated disease management (IDM) program for high risk, exacerbation prone, patients with chronic obstructive pulmonary disease (COPD) compared to usual care (UC) within a primary care setting from the perspective of a publicly funded health system (i.e., Ontario, Canada). Methods We conducted a model-based, cost-utility analysis using a Markov model with expected values of costs and outcomes derived from a Monte-Carlo Simulation with 5000 replications. The target population included patients started in GOLD II with a starting age of 68 years in the trial-based analysis. Key input parameters were based on a randomized control trial of 143 patients (i.e., UC (n = 73) versus IDM program (n = 70)). Results were shown as incremental cost per quality-adjusted life year (QALY) gained. Results The IDM program for high risk, exacerbation prone, patients is dominant in comparison with the UC group. After one year, the IDM program demonstrated cost savings and improved QALYs (i.e., UC was dominated by IDM) with a positive net-benefit of $5360 (95% CI: ($5175, $5546) based on a willingness to pay of $50,000 (CAN) per QALY. Conclusions This study demonstrates that the IDM intervention for patients with COPD in a primary care setting is cost-effective in comparison to the standard of care. By demonstrating the cost-effectiveness of IDM, we confirm that investment in the delivery of evidence based best practices in primary care delivers better patient outcomes at a lower cost than UC. Supplementary Information The online version contains supplementary material available at 10.1186/s12962-022-00377-w. Interventions that can reduce the frequency and severity of exacerbations in patients who suffer from COPD have the potential to reduce the financial burden of COPD on the health system; This is the first study that demonstrates the cost-effectiveness of integrated disease management for patients who suffer from COPD within a primary care environment; This study makes the case for embedding Certified Respiratory Educators (CREs) within the primary care environment to improve the quality of life of patients who suffer from COPD, as well as alleviating unnecessary health services utilization and decreasing the overall financial burden of the disease on the health system.
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Affiliation(s)
- Andrew D Scarffe
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada.
| | - Christopher J Licskai
- London Health Sciences Centre, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Asthma Research Group Windsor Essex County Inc., ON, Windsor, Canada
| | - Madonna Ferrone
- Asthma Research Group Windsor Essex County Inc., ON, Windsor, Canada.,Hotel-Dieu Grace Healthcare, Windsor, ON, Canada
| | - Kevin Brand
- Telfer School of Management, University of Ottawa, 55 Laurier Avenue East, Ottawa, ON, K1N 6N5, Canada
| | - Kednapa Thavorn
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, ON, Canada.,Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Doug Coyle
- Faculty of Medicine, School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,Department of Clinical Sciences, College of Health and Life Sciences, Brunel University London, London, UK
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Schmid-Mohler G, Hübsch C, Steurer-Stey C, Greco N, Schuurmans MM, Beckmann S, Chadwick P, Clarenbach C. Supporting Behavior Change After AECOPD - Development of a Hospital-Initiated Intervention Using the Behavior Change Wheel. Int J Chron Obstruct Pulmon Dis 2022; 17:1651-1669. [PMID: 35923357 PMCID: PMC9339665 DOI: 10.2147/copd.s358426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 04/30/2022] [Indexed: 11/23/2022] Open
Abstract
After hospitalization due to acute COPD exacerbations, patient-manageable behaviors influence rehospitalization frequency. This study's aim was to develop a hospital-ward-initiated Behaviour-Change-Wheel (BCW)-based intervention targeting patients' key health behaviors, with the aim to increase quality of life and reduce rehospitalization frequency. Intervention development was performed by University Hospital Zurich working groups and followed the three BCW stages for each of the three key literature-identified problems: insufficient exacerbation management, lack of physical activity and ongoing smoking. In stage one, by analyzing published evidence - including but not limited to patients' perspective - and health professionals' perspectives regarding these problems, we identified six target behaviors. In stage two, we identified six corresponding intervention functions. As our policy category, we chose developing guidelines and service provision. For stage three, we defined eighteen basic intervention packages using 46 Behaviour Change Techniques in our basic intervention. The delivery modes will be face-to-face and telephone contact. In the inpatient setting, this behavioral intervention will be delivered by a multi-professional team. For at least 3 months following discharge, an advanced nursing practice team will continue and coordinate the necessary care package via telephone. The intervention is embedded in a broader self-management intervention complemented by integrated care components. The BCW is a promising foundation upon which to develop our COPD intervention. In future, the interaction between the therapeutic care team-patient relationships and the delivery of the behavioral intervention will also be evaluated.
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Affiliation(s)
- Gabriela Schmid-Mohler
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Christine Hübsch
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
| | - Claudia Steurer-Stey
- Epidemiology, Biostatistics and Prevention Institute, University Zurich, Zurich, Switzerland
- mediX Group Practice Zurich, Zurich, Switzerland
| | - Nico Greco
- Physiotherapy Occupational Therapy, University Hospital Zurich, Zurich, Switzerland
| | - Macé M Schuurmans
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
| | - Sonja Beckmann
- Centre of Clinical Nursing Science, University Hospital Zurich, Zurich, Switzerland
| | - Paul Chadwick
- Centre for Behavior Change, University College London, London, UK
| | - Christian Clarenbach
- Division of Pulmonology, University Hospital Zurich, Zurich, Switzerland
- Faculty of Medicine, University of Zurich, Zurich, Switzerland
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Jones AW, McKenzie JE, Osadnik CR, Stovold E, Cox NS, Burge AT, Lahham A, Lee JYT, Hoffman M, Holland AE. Non-pharmacological interventions for the prevention of hospitalisations in stable chronic obstructive pulmonary disease: component network meta-analysis. Hippokratia 2022. [DOI: 10.1002/14651858.cd015153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Arwel W Jones
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Joanne E McKenzie
- School of Public Health and Preventive Medicine; Monash University; Melbourne Australia
| | | | - Elizabeth Stovold
- Population Health Research Institute; St George's, University of London; London UK
| | - Narelle S Cox
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
- Institute for Breathing and Sleep; Melbourne Australia
| | - Angela T Burge
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
- Institute for Breathing and Sleep; Melbourne Australia
- Department of Physiotherapy; Alfred Health; Melbourne Australia
| | - Aroub Lahham
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Joanna YT Lee
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Mariana Hoffman
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
| | - Anne E Holland
- Respiratory Research@Alfred, Department of Immunology and Pathology; Monash University; Melbourne Australia
- Institute for Breathing and Sleep; Melbourne Australia
- Department of Physiotherapy; Alfred Health; Melbourne Australia
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9
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Mansour MHH, Pokhrel S, Anokye N. Effectiveness of integrated care interventions for patients with long-term conditions: a review of systematic reviews. INTEGRATED HEALTHCARE JOURNAL 2022. [DOI: 10.1136/ihj-2021-000083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
To examine the effectiveness of integrated care intervention (ICI) models (stand-alone or combination of self-management, discharge management, case management and multidisciplinary teams models) targeting patients with one or more chronic conditions, and to identify outcome measures/indicators of effectiveness, we conducted a systematic review of published systematic reviews and meta-analyses. Included reviews comprise ICIs targeting adult patients with one or more long-term conditions. We searched MEDLINE, CINAHL and the Cochrane Database of Systematic Reviews: 60 reviews were included in the final analysis; 28 reviews evaluated ICIs focused on self-management, 4 on case management, 10 on discharge management and 5 on multidisciplinary teams; 13 reviews assessed multiple interventions that were labelled as complex. Across all reviews, only 19 reviews included intervention with multiple ICIs. Overall, interventions with multiple components, compared with interventions with single components, were more likely to improve hospital use outcomes effectively. Clinical/lifestyle/condition-specific outcomes were more likely to be improved by self-management interventions. Outcome measures identified could be classified into three main categories: organisational, patient-centred and clinical/lifestyle/condition-specific. The findings of this review may provide inputs to future design and evaluation of ICIs.
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10
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Lopez-Campos JL, Almagro P, Gómez JT, Chiner E, Palacios L, Hernández C, Navarro MD, Molina J, Rigau D, Soler-Cataluña JJ, Calle M, Cosío BG, Casanova C, Miravitlles M. Spanish COPD Guideline (GesEPOC) Update: Comorbidities, Self-Management and Palliative Care. Arch Bronconeumol 2022; 58:334-344. [PMID: 35315327 DOI: 10.1016/j.arbres.2021.08.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 08/09/2021] [Accepted: 08/09/2021] [Indexed: 12/20/2022]
Abstract
The current health care models described in GesEPOC indicate the best way to make a correct diagnosis, the categorization of patients, the appropriate selection of the therapeutic strategy and the management and prevention of exacerbations. In addition, COPD involves several aspects that are crucial in an integrated approach to the health care of these patients. The evaluation of comorbidities in COPD patients represents a healthcare challenge. As part of a comprehensive assessment, the presence of comorbidities related to the clinical presentation, to some diagnostic technique or to some COPD-related treatments should be studied. Likewise, interventions on healthy lifestyle habits, adherence to complex treatments, developing skills to recognize the signs and symptoms of exacerbation, knowing what to do to prevent them and treat them within the framework of a self-management plan are also necessary. Finally, palliative care is one of the pillars in the comprehensive treatment of the COPD patient, seeking to prevent or treat the symptoms of a disease, the side effects of treatment, and the physical, psychological and social problems of patients and their caregivers. Therefore, the main objective of this palliative care is not to prolong life expectancy, but to improve its quality. This chapter of GesEPOC 2021 presents an update on the most important comorbidities, self-management strategies, and palliative care in COPD, and includes a recommendation on the use of opioids for the treatment of refractory dyspnea in COPD.
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Affiliation(s)
- José Luis Lopez-Campos
- Unidad Médico-Quirúrgica de Enfermedades Respiratorias, Instituto de Biomedicina de Sevilla (IBiS), Hospital Universitario Virgen del Rocío, Universidad de Sevilla, Sevilla, España; Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España.
| | - Pere Almagro
- Servicio de Medicina Interna, Hospital Universitario Mutua de Tarrasa, Tarrasa, Barcelona, España
| | | | - Eusebi Chiner
- Servicio de Neumología, Hospital Universitario San Juan de Alicante, Alicante, España
| | - Leopoldo Palacios
- Unidad de Gestión Clínica El Torrejón, Distrito Sanitario Huelva-Costa y Condado-Campiña, Huelva, España
| | - Carme Hernández
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Dispositivo transversal hospitalización a domicilio, Dirección Médica y Enfermera, Hospital Clínic, Universidad de Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, España
| | | | - Jesús Molina
- Centro de Salud Francia, Dirección Asistencial Oeste, Fuenlabrada, Madrid, España
| | - David Rigau
- Centro Cochrane Iberoamericano, Barcelona, España
| | | | - Myriam Calle
- Servicio de Neumología, Hospital Clínico San Carlos, Departamento de Medicina, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), Madrid, España
| | - Borja G Cosío
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitario Son Espases-IdISBa, Palma de Mallorca, Baleares, España
| | - Ciro Casanova
- Unidad de Investigación, Servicio de Neumología, Hospital Universitario de La Candelaria, Universidad de La Laguna, Santa Cruz de Tenerife, Tenerife, España
| | - Marc Miravitlles
- Centro de Investigación Biomédica en Red de Enfermedades Respiratorias (CIBERES), Instituto de Salud Carlos III, Madrid, España; Servicio de Neumología, Hospital Universitari Vall d'Hebron, Vall d'Hebron Institut de Recerca (VHIR), Barcelona, España
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11
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Lopez-Campos JL, Almagro P, Gómez JT, Chiner E, Palacios L, Hernández C, Navarro MD, Molina J, Rigau D, Soler-Cataluña JJ, Calle M, Cosío BG, Casanova C, Miravitlles M. [Translated article] Spanish COPD Guideline (GesEPOC) Update: Comorbidities, Self-Management and Palliative Care. ARCHIVOS DE BRONCONEUMOLOGÍA 2022. [DOI: 10.1016/j.arbres.2021.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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12
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Giusti EM, Papazian B, Manna C, Giussani V, Perotti M, Castelli F, Battaglia S, Galli P, Rossi A, Re V, Goulene K, Castelnuovo G, Stramba-Badiale M. The Effects of an Acceptance and Commitment-Informed Interdisciplinary Rehabilitation Program for Chronic Airway Diseases on Health Status and Psychological Symptoms. Front Psychol 2022; 12:818659. [PMID: 35153934 PMCID: PMC8828560 DOI: 10.3389/fpsyg.2021.818659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 12/31/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Chronic airway diseases are prevalent and costly conditions. Interdisciplinary rehabilitation programs that include Acceptance and Commitment-based (ACT) components could be important to tackle the vicious circle linking progression of the disease, inactivity, and psychopathological symptoms. METHODS A retrospective evaluation of routinely collected data of an interdisciplinary rehabilitation program was performed. The program included group sessions including patient education, breathing exercise, occupational therapy and an ACT-based psychological treatment, and individual sessions of physical therapy. Demographic data, clinical characteristics of the patients and the values of outcome variables (health status, quality of life, anxiety, and depression) before treatment, at discharge, at 3 months, and at 6 months were extracted from medical records. Multiple imputation was employed to address missing data. Linear mixed models were employed to assess changes over time. Multivariable logistic regression was performed to assess predictors of a minimum clinically important change of health status from baseline to the 6-months follow-up. RESULTS Data from 31 patients with chronic obstructive pulmonary disease (COPD) and 12 patients with bronchiectasis were extracted. Health status improved from baseline to discharge to the 3 months follow-up, but not to the 6 months follow-up. Anxiety and depression improved across all the time points. Quality of life did not improve over time. Having a worse health status at baseline and fewer depressive symptoms were significantly associated with achieving a minimum clinically important change of health status at 6 months. The effects of the interdisciplinary program were not different for patients with COPD or with bronchiectasis. DISCUSSION Interdisciplinary programs including ACT-based components are promising treatments for the rehabilitation of patients with chronic airway diseases.
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Affiliation(s)
| | - Barbara Papazian
- Physical and Rehabilitation Medicine Unit, ASST Fatebenefratelli Sacco, Milan, Italy
| | - Chiara Manna
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Valentina Giussani
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Milena Perotti
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Francesca Castelli
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Silvia Battaglia
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Pietro Galli
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Agnese Rossi
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Valentina Re
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Karine Goulene
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Gianluca Castelnuovo
- Psychology Research Laboratory, Istituto Auxologico Italiano IRCCS, Milan, Italy
- Department of Psychology, Catholic University of Milan, Milan, Italy
| | - Marco Stramba-Badiale
- Department of Geriatrics and Cardiovascular Medicine, IRCCS Istituto Auxologico Italiano, Milan, Italy
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13
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Issac H, Moloney C, Taylor M, Lea J. Mapping of Modifiable Factors with Interdisciplinary Chronic Obstructive Pulmonary Disease (COPD) Guidelines Adherence to the Theoretical Domains Framework: A Systematic Review. J Multidiscip Healthc 2022; 15:47-79. [PMID: 35046662 PMCID: PMC8759995 DOI: 10.2147/jmdh.s343277] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 12/16/2021] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND COPD guidelines non-concordance is a challenge frequently highlighted by respiratory experts. Despite the provision of comprehensive evidence-based national and international guidelines, the COPD burden to frontline healthcare services has increased in the last decade. Suboptimal guidelines concordance can be disruptive to health-related quality of life (HRQoL), hastening pulmonary function decline and surging overall morbidity and mortality. A lack of concordance with guidelines has created an escalating economic burden on health-care systems. Identifying interdisciplinary interventions to facilitate improved adherence to guidelines may significantly reduce re-admissions, enhance HRQoL amongst patients and their families, and facilitate economic efficiency. MATERIALS AND METHODS This review adhered to the Joanna Briggs Institute (JBI) methodology for mixed methods systematic reviews and the PRISMA ScR reporting guidelines. Two independent reviewers screened abstracts and full text articles in consonance with inclusion criteria. The convergent integrative JBI method collated quantitative, qualitative and mixed methods studies from nine databases. JBI critical appraisal tools were utilised to assess the quality of research papers. The theoretical domains framework (TDF) along with a specifically developed COPD data extraction tool were adopted as a priori to collect and collate data. Identified barriers and corresponding clinical behavioural change solutions were categorised using TDF domains and behavior change wheel (BCW) to provide future research and implementation recommendations. RESULTS Searches returned 1068 studies from which 37 studies were included (see Figure 1). COPD recommendations identified to be discordant with clinical practice included initiating non-invasive ventilation, over- or under-prescription of corticosteroids and antibiotics, and a lack of discharging patients with a smoking cessation plan or pulmonary rehabilitation. TDF domains with highest frequency scores were knowledge, environmental resources, and clinical behaviour regulation. Electronic order sets/digital proforma with guideline resources at point of care and easily accessible digital community referrals to target both pharmacological and non-pharmacological management appear to be a solution to improve concordance. CONCLUSION Implementation of consistent quality improvement intervention within hospitals for patients with COPD may exclude any implementation gap and prevent readmissions. Electronic proformas with digital referrals will assist with future evaluation audits to prioritise and target interventions to improve guidelines concordance. ETHICS AND DISSEMINATION Ethical approval is not required, and results dissemination will occur through peer-reviewed publication. PROSPERO REGISTRATION NUMBER CRD42020156267.
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Affiliation(s)
- Hancy Issac
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
- College of Health and Biomedicine, Nursing and Midwifery, Victoria University, Melbourne, Australia
- Clinical Community Health and Wellbeing, Research Institute for Health and Sport, Victoria University, Melbourne, Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
- Centre for Health Research, University of Southern Queensland, Toowoomba, Australia
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14
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Liu Y, Zhao Y, Liu F, Liu L. Effects of Physical Exercises on Pulmonary Rehabilitation, Exercise Capacity, and Quality of Life in Children with Asthma: A Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2021; 2021:5104102. [PMID: 34976094 PMCID: PMC8718301 DOI: 10.1155/2021/5104102] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/03/2021] [Accepted: 12/06/2021] [Indexed: 01/02/2023]
Abstract
OBJECTIVE This study aimed to systematically evaluate the effect of exercise on pulmonary function, exercise capacity, and quality of life in children with bronchial asthma. METHODS A comprehensive search was performed using PubMed, Cochrane Library, Web of Science, EBSCO, CNKI, and Wanfang Data Knowledge Service platform to identify any relevant randomized controlled trials (RCTs) published from inception to April 2021. The Cochrane risk of the bias tool was utilized to evaluate the methodological quality of the included studies, and RevMan 5.3 was applied to perform data analyses. RESULTS A total of 22 RCTs involving 1346 patients were included. The results of the meta-analysis showed that exercise had significant advantages in improving lung function and exercising capacity and quality of life in children with asthma compared with conventional treatment, such as the forced vital capacity to predicted value ratio (SMD = 0.27; 95% CI: 0.13, 0.40, and P < 0.0001), the peak expiratory flow to predicted value ratio (MD = 4.53; 95% CI: 1.27, 7.80, and P=0.007), the 6-minute walk test (MD = 110.65; 95% CI: 31.95, 189.34, and P=0.006), rating of perceived effort (MD = -2.28; 95% CI: -3.21, -1.36, and P < 0.0001), and peak power (MD = 0.94; 95% CI: 0.37, 1.52, and P=0.001) on exercise capacity and pediatric asthma quality of life questionnaire (MD = 1.28; 95% CI: 0.60, 1.95, and P=0.0002) on quality of life. However, no significant difference was observed in the forced expiratory flow between 25% and 75% of vital capacity (P=0.25) and the forced expiratory volume at 1 second to predicted value ratio(P=0.07). CONCLUSIONS Current evidence shows that exercise has a certain effect on improving pulmonary function recovery, exercise capacity, and quality of life in children with bronchial asthma. Given the limitation of the number and quality of included studies, further research and verification are needed to guide clinical application.
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Affiliation(s)
- YiRan Liu
- School of Sport and Health, Nanjing Sport Institute, Nanjing 210014, Jiangsu, China
| | - Yan Zhao
- School of Sport and Health, Nanjing Sport Institute, Nanjing 210014, Jiangsu, China
| | - Fang Liu
- Respiratory Medicine of Xuyi People's Hospital, Huaian 223001, Jiangsu, China
| | - Lin Liu
- School of Sport and Health, Nanjing Sport Institute, Nanjing 210014, Jiangsu, China
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15
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Hussey AJ, Wing K, Ferrone M, Licskai CJ. Integrated Disease Management for Chronic Obstructive Pulmonary Disease in Primary Care, from the Controlled Trial to Clinical Program: A Cohort Study. Int J Chron Obstruct Pulmon Dis 2021; 16:3449-3464. [PMID: 35221683 PMCID: PMC8866979 DOI: 10.2147/copd.s338851] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022] Open
Affiliation(s)
- Anna J Hussey
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Kevin Wing
- London School of Hygiene and Tropical Medicine, London, UK
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Hotel-Dieu Grace Healthcare, Windsor, ON, Canada
| | - Christopher J Licskai
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- London Health Sciences Centre, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Correspondence: Christopher J Licskai Schulich School of Medicine and Dentistry, Western University, London, ON, Canada Email
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16
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Hussey AJ, Sibbald SL, Ferrone M, Hergott A, McKelvie R, Faulds C, Roberts Z, Scarffe AD, Meyer MJ, Vollbrecht S, Licskai C. Confronting complexity and supporting transformation through health systems mapping: a case study. BMC Health Serv Res 2021; 21:1146. [PMID: 34688279 PMCID: PMC8540206 DOI: 10.1186/s12913-021-07168-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/11/2021] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Health systems are a complex web of interacting and interconnected parts; introducing an intervention, or the allocation of resources, in one sector can have effects across other sectors and impact the entire system. A prerequisite for effective health system reorganisation or transformation is a broad and common understanding of the current system amongst stakeholders and innovators. Chronic obstructive pulmonary disease (COPD) and heart failure (HF) are common chronic diseases with high health care costs that require an integrated health system to effectively treat. STUDY DESCRIPTION This case study documents the first phase of system transformation at a regional level in Ontario, Canada. In this first phase, visual representations of the health system in its current state were developed using a collaborative co-creation approach, and a focus on COPD and HF. Multiple methods were used including focus groups, open-ended questionnaires, and document review, to develop a series of graphical and visual representations; a health care ecosystem map. RESULTS The ecosystem map identified key sectoral components, inter-component interactions, and care requirements for patients with COPD and HF and inventoried current programs and services available to deliver this care. Main findings identified that independent system-wide navigation for this vulnerable patient group is limited, primary care is central to the accessibility of nearly half of the identified care elements, and resources are not equitably distributed. The health care ecosystem mapping helped to identify care gaps and illustrates the need to resource the primary care provider and the patient with system navigation resources and interdisciplinary team care. CONCLUSION The co-created health care ecosystem map brought a collective understanding of the health care system as it applies to COPD and HF. The map provides a blueprint that can be adapted to other disease states and health systems. Future transformation will build on this foundational work, continuing the robust interdisciplinary co-creation strategies, exploring predictive health system modelling and identifying areas for integration.
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Affiliation(s)
- Anna J Hussey
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Shannon L Sibbald
- Faculty of Health Sciences, Western University, London, ON, Canada
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Madonna Ferrone
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
- Hotel-Dieu Grace Healthcare, Windsor, ON, Canada
| | - Alyson Hergott
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Robert McKelvie
- St. Joseph's Health Care, London, ON, Canada
- Cardiology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Cathy Faulds
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- St. Joseph's Health Care, London, ON, Canada
| | - Zofe Roberts
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada
| | - Andrew D Scarffe
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada
| | - Matthew J Meyer
- London Health Sciences Centre, London, ON, Canada
- Department of Epidemiology and Biostatistics and Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Ivey Business School, London, ON, Canada
| | | | - Christopher Licskai
- Asthma Research Group Windsor-Essex County Inc., Windsor, ON, Canada.
- London Health Sciences Centre, London, ON, Canada.
- Lawson Health Research Institute, London, ON, Canada.
- Respirology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
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17
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Poot CC, Meijer E, Kruis AL, Smidt N, Chavannes NH, Honkoop PJ. Integrated disease management interventions for patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2021; 9:CD009437. [PMID: 34495549 PMCID: PMC8425271 DOI: 10.1002/14651858.cd009437.pub3] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND People with chronic obstructive pulmonary disease (COPD) show considerable variation in symptoms, limitations, and well-being; this often complicates medical care. A multi-disciplinary and multi-component programme that addresses different elements of care could improve quality of life (QoL) and exercise tolerance, while reducing the number of exacerbations. OBJECTIVES To compare the effectiveness of integrated disease management (IDM) programmes versus usual care for people with chronic obstructive pulmonary disease (COPD) in terms of health-related quality of life (QoL), exercise tolerance, and exacerbation-related outcomes. SEARCH METHODS We searched the Cochrane Airways Group Register of Trials, CENTRAL, MEDLINE, Embase, and CINAHL for potentially eligible studies. Searches were current as of September 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) that compared IDM programmes for COPD versus usual care were included. Interventions consisted of multi-disciplinary (two or more healthcare providers) and multi-treatment (two or more components) IDM programmes of at least three months' duration. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. If required, we contacted study authors to request additional data. We performed meta-analyses using random-effects modelling. We carried out sensitivity analyses for the quality of included studies and performed subgroup analyses based on setting, study design, dominant intervention components, and region. MAIN RESULTS Along with 26 studies included in the 2013 Cochrane Review, we added 26 studies for this update, resulting in 52 studies involving 21,086 participants for inclusion in the meta-analysis. Follow-up periods ranged between 3 and 48 months and were classified as short-term (up to 6 months), medium-term (6 to 15 months), and long-term (longer than 15 months) follow-up. Studies were conducted in 19 different countries. The mean age of included participants was 67 years, and 66% were male. Participants were treated in all types of healthcare settings, including primary (n =15), secondary (n = 22), and tertiary care (n = 5), and combined primary and secondary care (n = 10). Overall, the level of certainty of evidence was moderate to high. We found that IDM probably improves health-related QoL as measured by St. George's Respiratory Questionnaire (SGRQ) total score at medium-term follow-up (mean difference (MD) -3.89, 95% confidence interval (CI) -6.16 to -1.63; 18 RCTs, 4321 participants; moderate-certainty evidence). A comparable effect was observed at short-term follow-up (MD -3.78, 95% CI -6.29 to -1.28; 16 RCTs, 1788 participants). However, the common effect did not exceed the minimum clinically important difference (MCID) of 4 points. There was no significant difference between IDM and control for long-term follow-up and for generic QoL. IDM probably also leads to a large improvement in maximum and functional exercise capacity, as measured by six-minute walking distance (6MWD), at medium-term follow-up (MD 44.69, 95% CI 24.01 to 65.37; 13 studies, 2071 participants; moderate-certainty evidence). The effect exceeded the MCID of 35 metres and was even greater at short-term (MD 52.26, 95% CI 32.39 to 72.74; 17 RCTs, 1390 participants) and long-term (MD 48.83, 95% CI 16.37 to 80.49; 6 RCTs, 7288 participants) follow-up. The number of participants with respiratory-related admissions was reduced from 324 per 1000 participants in the control group to 235 per 1000 participants in the IDM group (odds ratio (OR) 0.64, 95% CI 0.50 to 0.81; 15 RCTs, median follow-up 12 months, 4207 participants; high-certainty evidence). Likewise, IDM probably results in a reduction in emergency department (ED) visits (OR 0.69, 95%CI 0.50 to 0.93; 9 RCTs, median follow-up 12 months, 8791 participants; moderate-certainty evidence), a slight reduction in all-cause hospital admissions (OR 0.75, 95%CI 0.57 to 0.98; 10 RCTs, median follow-up 12 months, 9030 participants; moderate-certainty evidence), and fewer hospital days per person admitted (MD -2.27, 95% CI -3.98 to -0.56; 14 RCTs, median follow-up 12 months, 3563 participants; moderate-certainty evidence). Statistically significant improvement was noted on the Medical Research Council (MRC) Dyspnoea Scale at short- and medium-term follow-up but not at long-term follow-up. No differences between groups were reported for mortality, courses of antibiotics/prednisolone, dyspnoea, and depression and anxiety scores. Subgroup analysis of dominant intervention components and regions of study suggested context- and intervention-specific effects. However, some subgroup analyses were marked by considerable heterogeneity or included few studies. These results should therefore be interpreted with caution. AUTHORS' CONCLUSIONS This review shows that IDM probably results in improvement in disease-specific QoL, exercise capacity, hospital admissions, and hospital days per person. Future research should evaluate which combination of IDM components and which intervention duration are most effective for IDM programmes, and should consider contextual determinants of implementation and treatment effect, including process-related outcomes, long-term follow-up, and cost-effectiveness analyses.
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Affiliation(s)
- Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Annemarije L Kruis
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Nynke Smidt
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Persijn J Honkoop
- Department of Public Health and Primary Care, Leiden University Medical Center (LUMC), Leiden, Netherlands
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18
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Pullen R, Miravitlles M, Sharma A, Singh D, Martinez F, Hurst JR, Alves L, Dransfield M, Chen R, Muro S, Winders T, Blango C, Muellerova H, Trudo F, Dorinsky P, Alacqua M, Morris T, Carter V, Couper A, Jones R, Kostikas K, Murray R, Price DB. CONQUEST Quality Standards: For the Collaboration on Quality Improvement Initiative for Achieving Excellence in Standards of COPD Care. Int J Chron Obstruct Pulmon Dis 2021; 16:2301-2322. [PMID: 34413639 PMCID: PMC8370848 DOI: 10.2147/copd.s313498] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/30/2021] [Indexed: 12/17/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) are managed predominantly in primary care. However, key opportunities to optimize treatment are often not realized due to unrecognized disease and delayed implementation of appropriate interventions for both diagnosed and undiagnosed individuals. The COllaboratioN on QUality improvement initiative for achieving Excellence in STandards of COPD care (CONQUEST) is the first-of-its-kind, collaborative, interventional COPD registry. It comprises an integrated quality improvement program focusing on patients (diagnosed and undiagnosed) at a modifiable and higher risk of COPD exacerbations. The first step in CONQUEST was the development of quality standards (QS). The QS will be imbedded in routine primary and secondary care, and are designed to drive patient-centered, targeted, risk-based assessment and management optimization. Our aim is to provide an overview of the CONQUEST QS, including how they were developed, as well as the rationale for, and evidence to support, their inclusion in healthcare systems. Methods The QS were developed (between November 2019 and December 2020) by the CONQUEST Global Steering Committee, including 11 internationally recognized experts with a specialty and research focus in COPD. The process included an extensive literature review, generation of QS draft wording, three iterative rounds of review, and consensus. Results Four QS were developed: 1) identification of COPD target population, 2) assessment of disease and quantification of future risk, 3) non-pharmacological and pharmacological intervention, and 4) appropriate follow-up. Each QS is followed by a rationale statement and a summary of current guidelines and research evidence relating to the standard and its components. Conclusion The CONQUEST QS represent an important step in our aim to improve care for patients with COPD in primary and secondary care. They will help to transform the patient journey, by encouraging early intervention to identify, assess, optimally manage and followup COPD patients with modifiable high risk of future exacerbations.
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Affiliation(s)
- Rachel Pullen
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Marc Miravitlles
- Pneumology Dept, Hospital Universitari Vall d’Hebron, Vall d’Hebron Institut de Recerca (VHIR), Vall d’Hebron Barcelona Hospital Campus, CIBER de Enfermedades Respiratorias (CIBERES), Barcelona, Spain
| | - Anita Sharma
- Platinum Medical Centre, Chermside, QLD, Australia
| | - Dave Singh
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester University NHS Foundation Trust, Manchester, UK
| | - Fernando Martinez
- New York-Presbyterian Weill Cornell Medical Center, New York, NY, USA
| | - John R Hurst
- UCL Respiratory, University College London, London, UK
| | - Luis Alves
- EPI Unit, Institute of Public Health, University of Porto, Porto, Portugal
- Laboratory for Integrative and Translational Research in Population Health (ITR), Porto, Portugal
| | - Mark Dransfield
- Division of Pulmonary, Allergy, and Critical Care Medicine, Lung Health Center, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Rongchang Chen
- Key Laboratory of Respiratory Disease of Shenzhen, Shenzhen Institute of Respiratory Disease, Shenzhen People’s Hospital (Second Affiliated Hospital of Jinan University, First Affiliated Hospital of South University of Science and Technology of China), Shenzhen, People's Republic of China
| | - Shigeo Muro
- Department of Respiratory Medicine, Nara Medical University, Nara, Japan
| | - Tonya Winders
- USA & Global Allergy & Airways Patient Platform, Vienna, Austria
| | - Christopher Blango
- Janssen Pharmaceutical Companies of Johnson & Johnson, Philadelphia, PA, USA
| | | | | | | | | | | | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Amy Couper
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Rupert Jones
- Research and Knowledge Exchange, Plymouth Marjon University, Plymouth, UK
| | - Konstantinos Kostikas
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Respiratory Medicine Department, University of Ioannina School of Medicine, Ioannina, Greece
| | - Ruth Murray
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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19
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Senft JD, Freund T, Wensing M, Schwill S, Poss-Doering R, Szecsenyi J, Laux G. Primary care practice-based care management for chronically ill patients (PraCMan) in German healthcare: Outcome of a propensity-score matched cohort study. Eur J Gen Pract 2021; 27:228-234. [PMID: 34378482 PMCID: PMC8366669 DOI: 10.1080/13814788.2021.1962280] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Background Growing prevalence of chronic diseases is a rising challenge for healthcare systems. The Primary Care Practice-Based Care Management (PraCMan) programme is a comprehensive disease management intervention in primary care in Germany aiming to improve medical care and to reduce potentially avoidable hospitalisations for chronically ill patients. Objectives This study aimed to assess the effect of PraCMan on hospitalisation rate and related costs. Methods A retrospective propensity-score matched cohort study was performed. Reimbursement data related to patients treated in general practices between 1st July 2013 and 31st December 2017 were supplied by a statutory health insurance company (AOK Baden-Wuerttemberg, Germany) to compare hospitalisation rate and direct healthcare costs between patients participating in the PraCMan intervention and propensity-score matched controls following usual care. Outcomes were determined for the one-year-periods before and 12 months after beginning of participation in the intervention. Results In total, 6148 patients participated in the PraCMan intervention during the observation period and were compared to a propensity-score matched control group of 6148 patients from a pool of 63,446 eligible patients. In the one-year period after the intervention, the per-patient hospitalisation rate was 8.3% lower in the intervention group compared to control (p = 0.0004). Per-patient hospitalisation costs were 9.4% lower in favour of the intervention group (p = 0.0002). Conclusion This study showed that the PraCMan intervention may be associated with a lower rate of hospital admissions and hospitalisation costs than usual care. Further studies may assess long-term effects of PraCMan and its efficacy in preventing known complications of chronic diseases.
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Affiliation(s)
- Jonas D Senft
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Tobias Freund
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Simon Schwill
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Regina Poss-Doering
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Gunter Laux
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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20
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Wangler J, Jansky M. Attitudes to and experience of disease management programs in primary care-an exploratory survey of general practitioners in Germany. Wien Med Wochenschr 2021; 171:310-320. [PMID: 34338907 PMCID: PMC8484225 DOI: 10.1007/s10354-021-00867-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
Background Disease management programs (DMPs) were set up in Germany in 2003 to improve outpatient care of chronically ill patients. The present study looks at the attitudes and experiences of general practitioners (GPs) in relation to DMPs, how they rate them almost 20 years after their introduction and where they see a need for improvement. Methods A total of 1504 GPs in the Federal States of Rhineland Palatinate, Saarland and Hesse were surveyed between December 2019 and March 2020 using a written questionnaire. Results In total, 58% of respondents rate DMPs positively and regard them as making a useful contribution to primary care. The guarantee of regular, structured patient care and greater compliance are regarded as particularly positive aspects. It was also established that diagnostic and therapeutic knowledge was expanded through participation in DMPs. 57% essentially follow the DMP recommendations for (drug) treatment. Despite positive experiences of DMPs in patient care, the GPs surveyed mention various challenges (documentation requirements, frequent changes to the programmes, inflexibility). Univariant linear regression analysis revealed factors influencing the satisfaction with DMPs, such as improvement of compliance and clearly defined procedures in medical care. Conclusion Most of the GPs surveyed consider the combination of continuous patient care and evidence-based diagnosis and treatment to be a great advantage. To better adapt DMPs to the conditions of primary care, it makes sense to simplify the documentation requirements, to regulate cooperation with other healthcare levels more clearly and to give GPs more decision-making flexibility. Increased inclusion of GP experience in the process of developing and refining DMPs can be helpful. Supplementary Information The online version of this article (10.1007/s10354-021-00867-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Julian Wangler
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Am Pulverturm 13, 55131 Mainz, Germany
| | - Michael Jansky
- Centre for General and Geriatric Medicine, University Medical Centre Mainz, Am Pulverturm 13, 55131 Mainz, Germany
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21
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Paciocco S, Kothari A, Licskai CJ, Ferrone M, Sibbald SL. Evaluating the implementation of a chronic obstructive pulmonary disease management program using the Consolidated Framework for Implementation Research: a case study. BMC Health Serv Res 2021; 21:717. [PMID: 34289847 PMCID: PMC8293496 DOI: 10.1186/s12913-021-06636-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/14/2021] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a prevalent chronic disease that requires comprehensive approaches to manage; it accounts for a significant portion of Canada's annual healthcare spending. Interprofessional teams are effective at providing chronic disease management that meets the needs of patients. As part of an ongoing initiative, a COPD management program, the Best Care COPD program was implemented in a primary care setting. The objectives of this research were to determine site-specific factors facilitating or impeding the implementation of a COPD program in a new setting, while evaluating the implementation strategy used. METHODS A qualitative case study was conducted using interviews, focus groups, document analysis, and site visits. Data were deductively analyzed using the Consolidated Framework for Implementation Research (CFIR) to assess the impact of each of its constructs on Best Care COPD program implementation at this site. RESULTS Eleven CFIR constructs were determined to meaningfully affect implementation. Five were identified as the most influential in the implementation process. Cosmopolitanism (partnerships with other organizations), networks and communication (amongst program providers), engaging (key individuals to participate in program implementation), design quality and packaging (of the program), and reflecting and evaluating (throughout the implementation process). A peer-to-peer implementation strategy included training of registered respiratory therapists (RRT) as certified respiratory educators and the establishment of a communication network among RRTs to discuss experiences, collectively solve problems, and connect with the program lead. CONCLUSIONS This study provides a practical example of the various factors that facilitated the implementation of the Best Care COPD program. It also demonstrates the potential of using a peer-to-peer implementation strategy. Focusing on these factors will be useful for informing the continued spread and success of the Best Care COPD program and future implementation of other chronic care programs.
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Affiliation(s)
- Stefan Paciocco
- Health and Rehabilitation Sciences, Western University, London, Canada
| | - Anita Kothari
- School of Health Studies, Faculty of Health Sciences, Western University, London, Canada
| | - Christopher J Licskai
- Department of Family Medicine, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | | | - Shannon L Sibbald
- School of Health Studies, Faculty of Health Sciences, Department of Family Medicine, Schulich School of Medicine and Dentistry, The Schulich Interfaculty Program in Public Health, Schulich School of Medicine and Dentistry, Western University, London, Canada.
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22
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Perumal SD. Renewed vision on pulmonary rehabilitation service delivery for chronic obstructive pulmonary disease management beyond COVID-19. Chronic Dis Transl Med 2021; 7:107-116. [PMID: 34136770 PMCID: PMC8180444 DOI: 10.1016/j.cdtm.2021.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Indexed: 12/22/2022] Open
Abstract
Pulmonary rehabilitation (PR) is a cornerstone management for chronic obstructive pulmonary disease (COPD). International respiratory societies defined PR is more than "just an exercise program"; it is a comprehensive care delivered by a team of dedicated healthcare professionals with a strong emphasis on long-term health-enhancing Behaviors. However, "Uncertainty" exists with varied reasons for the political and geographical barriers of referral, uptake, attendance, and completion of PR in both primary and secondary care. Besides, COVID-19 pandemic has sparked many global controversies and challenges on pulmonary rehabilitation service delivery. Post-COVID-19 guidelines emphasize on integrated care rehabilitation for patients with COPD. Thus, this concise review intends to understand the gaps in United Kingdom healthcare policies, practices, and PR services resources. To date, there is no clear consensus on PR integrated care model pathway to address the unmet needs, measure the health and social care disparities; adds to the disease burden of COPD. Based on the culmination of evidence, this perspective offers a theoretical framework of PR integrated service model, a pathway to deliver high-value personalized care to patients with COPD.
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23
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Roh JA, Kim KI, Jung HJ. The efficacy of manual therapy for chronic obstructive pulmonary disease: A systematic review. PLoS One 2021; 16:e0251291. [PMID: 34003822 PMCID: PMC8130973 DOI: 10.1371/journal.pone.0251291] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 04/25/2021] [Indexed: 11/18/2022] Open
Abstract
Background Manual therapy (MT) can be beneficial in the management of chronic obstructive pulmonary disease (COPD). However, evidence of the efficacy of MT for COPD is not clear. Therefore, we aimed to review the effects of MT, including Chuna, in people diagnosed with COPD. Methods MEDLINE via PubMed, EMBASE, The Cochrane Central Register of Controlled Trials (CENTRAL), China National Knowledge Database (CNKI), KoreaMed, Korean Medical Database (KMbase), and Oriental Medicine Advanced Searching Integrated System (OASIS) were searched. Randomized controlled trials (RCTs) and crossover RCTs were included. The main inclusion criteria were COPD diagnosis (forced expiratory volume in the first second [FEV1]/forced vital capacity [FVC] < 0.70). The primary outcomes were lung function and exercise capacity. The secondary outcomes were symptoms, quality of life (QoL), and adverse event (AE)s. Studies reporting one or both of the primary outcomes were included. The Cochrane RoB 2.0 tool was used to assess the risk of bias. Data synthesis and analysis were conducted according to the trial design. Results Of the 2564 searched articles, 13 studies were included. For the primary outcomes, the effect of MT on pulmonary function and exercise capacity in COPD was partly significant but could not be confirmed due to the limited number of studies included in the subgroups. For the secondary outcomes, no definitive evidence regarding the improvement of symptoms and QoL was found, and some minor adverse effects were reported. Conclusions There is insufficient evidence to support the role of MT in the management of COPD. High-quality studies are needed to thoroughly evaluate the effect of MT on COPD.
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Affiliation(s)
- Ji-Ae Roh
- Department of Clinical Korean Medicine, Graduate School of Kyung Hee University, Seoul, Republic of Korea
- Division of Allergy, Department of Internal Medicine, Immune and Respiratory System, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Kwan-Il Kim
- Department of Clinical Korean Medicine, Graduate School of Kyung Hee University, Seoul, Republic of Korea
- Division of Allergy, Department of Internal Medicine, Immune and Respiratory System, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- * E-mail: (KIK); (HJJ)
| | - Hee-Jae Jung
- Department of Clinical Korean Medicine, Graduate School of Kyung Hee University, Seoul, Republic of Korea
- Division of Allergy, Department of Internal Medicine, Immune and Respiratory System, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- * E-mail: (KIK); (HJJ)
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24
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Kjellsdotter A, Andersson S, Berglund M. Together for the Future - Development of a Digital Website to Support Chronic Obstructive Pulmonary Disease Self-Management: A Qualitative Study. J Multidiscip Healthc 2021; 14:757-766. [PMID: 33854327 PMCID: PMC8039434 DOI: 10.2147/jmdh.s302013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 03/05/2021] [Indexed: 12/02/2022] Open
Abstract
Background Symptom burden, impaired functional performance and decreased quality of life are not only consequences of the underlying physiological disorder chronic obstructive pulmonary disease (COPD) but also dependent on a patient’s ability to learn to live with and manage their illness. A digital website may be important for empowering patients with COPD to learn about and self-manage their illness. The aim of this study was to describe a developing process of a digital COPD-web as a part of a self-management education program for persons living with COPD. Methods A qualitative approach with a phenomenological perspective was used. The study was based on group and individual interviews with a multidisciplinary COPD-team and patients who developed the COPD-web. Results The developing process appears as a person-centred and holistic self-care approach both in content and development. Developing a digital COPD-web requires ongoing multidisciplinary collaboration and spawns a sense of pride that reinforces shared responsibility. The phenomenon consists of four constituents: learning by participating in development, the patient perspective as guiding approach, responsibility and motivation as driving forces and digital technology as a knowledge arena. Conclusion The results indicate that constructive collaboration between a multidisciplinary COPD-team and patients as co-creators in an ongoing creative and reflective process is a key concept to develop a digital COPD-web with a holistic approach. Digital resources in the future might create time and space for reflective conversations in a COPD-web with virtual chatrooms.
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Affiliation(s)
- Anna Kjellsdotter
- Research and Development Centre, Skaraborg Hospital, Skövde, Sweden.,School of Health Sciences, Skövde University, Skövde, Sweden
| | - Susanne Andersson
- Department of Health Sciences, University West, Trollhättan, Sweden.,Research, Education, Development & Innovation, Primary Health Care, Region Västra Götaland, Sweden
| | - Mia Berglund
- School of Health Sciences, Skövde University, Skövde, Sweden
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25
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Issac H, Taylor M, Moloney C, Lea J. Exploring Factors Contributing to Chronic Obstructive Pulmonary Disease (COPD) Guideline Non-Adherence and Potential Solutions in the Emergency Department: Interdisciplinary Staff Perspective. J Multidiscip Healthc 2021; 14:767-785. [PMID: 33854328 PMCID: PMC8039430 DOI: 10.2147/jmdh.s276702] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 02/04/2021] [Indexed: 12/01/2022] Open
Abstract
Purpose Acute exacerbations of chronic obstructive pulmonary disease (COPD) have a significant and prolonged impact on health-related quality of life, patient outcomes, and escalation of pulmonary function decline. COPD-X guidelines published in 2003 subsist to facilitate a shift from the emphasis on pharmacological treatment to a more holistic multi-disciplinary interventions approach. Despite the existing comprehensive recommendations, readmission rates have increased in the last decade. Evidence to date has reported sub-optimal COPD guidelines adherence in emergency departments. This qualitative study explored contributing factors to interdisciplinary staff non-adherence and utilisation of COPD-X guidelines in a major Southern Queensland Emergency Department. Methods Semi-structured qualitative interviews with interdisciplinary staff were conducted in an emergency department. A purposive sample of doctors, nurses, physiotherapists, pharmacist and a social worker were recruited. Interviews were digitally recorded, de-identified and transcribed verbatim. Data analysis followed a coding process against the Theoretical Domains Framework (TDF) to examine implementation barriers and potential solutions. Identified factors affecting non-adherence and underutilisation of guidelines were then mapped to the capability, opportunity, motivation, behaviour model (COM-B) and behaviour change wheel (BCW) to inform future implementation recommendations. Results Prominent barriers influencing the clinical uptake of COPD guidelines were identified using TDF analysis and included knowledge, professional role clarity, clinical behaviour regulation, memory, attention, and decision process, beliefs about departmental capabilities, environmental context and resources. Potential interventions included education, training, staffing, funding and time-efficient digitalised referrals and systems management reminders to prevent COPD readmissions, remissions and improve patient health-related quality of life. Conclusion Implementation strategies such as electronic interdisciplinary COPD proforma that facilitates a multimodal approach with appropriate patient/staff resources and referrals prior to discharge from an ED require further exploration. Greater clarity around which components of the COPD X guidelines must be applied in ED settings needs to stem from future research.
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Affiliation(s)
- Hancy Issac
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Australia
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Valentijn PP, Kerkhoven M, Heideman J, Arends R. Cross-sectional study evaluating the association between integrated care and health-related quality of life (HRQOL) in Dutch primary care. BMJ Open 2021; 11:e040781. [PMID: 33811050 PMCID: PMC8023735 DOI: 10.1136/bmjopen-2020-040781] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVES The aim of this study was to evaluate the association between integrated care and health-related quality of life (HRQOL) in a primary care practice population. DESIGN A cross-sectional survey study. SETTING Primary care practice population. PARTICIPANTS A sample (n=5562) of patients in two general practitioner practices in the Netherlands. PRIMARY OUTCOME MEASURES The Rainbow Model of Integrated Care Measurement Tool patient version and EQ-5D was used to assess integrated service delivery and HRQOL. The association between integrated care and HRQOL groups was analysed using multivariate logistic regression. RESULTS Overall, 933 respondents with a mean age of 62 participated (20% response rate) in this study. The multivariate analysis revealed that positive organisational coordination experiences were linked to better HRQOL (OR=1.87, 95% CI 1.18 to 2.95), and less anxiety and depression problems (OR=0.36, 95% CI 0.20 to 0.63). Unemployment was associated with a poor HRQOL (OR=0.15, 95% CI 0.08 to 0.28). Ageing was associated with more mobility (OR=1.06, 95% CI 1.04 to 1.09), self-care (OR=1.06, 95% CI 1.02 to 1.11), usual activity (OR=1.03, 95% CI 1.01 to 1.05) and pain problems (OR=1.02, 95% CI 1.01 to 1.04). Being married improved the overall HRQOL (OR=1.60, 95% CI 1.13 to 2.26) and decreased anxiety and depression (OR=0.47, 95% CI 0.31 to 0.72). Finally, females had a poor overall HRQOL (OR=1.67, 95% CI 0.48 to 0.93) and more pain and discomfort problems (OR=1.47, 95% CI 1.11 to 1.95). CONCLUSION This study shows for the first time that organisational coordination activities are positively associated with HROQL of adult patients in a primary care context, adding to the evidence of an association between integrated care and HRQOL. Also, unemployment, ageing and being female are accumulating risk factors that should be considered when designing integrated primary care programmes. Further research is needed to explore how various integration types relate to HRQOL for people in local communities.
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Affiliation(s)
- Pim P Valentijn
- Department of Health Services Research, Maastricht University, Maastricht, The Netherlands
- Integrated Care Evaluation, Essenburgh Research & Consultancy, Hierden, The Netherlands
| | | | | | - Rosa Arends
- University of Applied Sciences Utrecht, Utrecht, The Netherlands
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Delameillieure A, Dobbels F, Vandekerkhof S, Wuyts WA. Patients' and healthcare professionals' perspectives on the idiopathic pulmonary fibrosis care journey: a qualitative study. BMC Pulm Med 2021; 21:93. [PMID: 33736646 PMCID: PMC7972327 DOI: 10.1186/s12890-021-01431-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/19/2021] [Indexed: 12/24/2022] Open
Abstract
Background Idiopathic pulmonary fibrosis (IPF) highly impacts patients on several life dimensions and challenges healthcare practices in providing high-quality care. Consequently, it is crucial to establish integrated care processes, maximizing patient value and patients’ individual needs. The aim of the study was to shed light on the care trajectory based on the perspectives of patients and healthcare professionals. Methods The study was conducted at a tertiary Belgian IPF centre of excellence. We conducted individual interviews with patients and healthcare professionals, guided by the Chronic Care Model (CCM) as a framework for integrated care. Thematic analysis was used to underpin data analysis. Results Experiences were gathered of nine patients with IPF (aged 57–83 years, of which the informal caregivers were present at five interviews) and nine professionals involved in the IPF care trajectory. Our findings identified pitfalls and suggestions for improvement covering all elements of the CCM, primarily at the level of the individual patient and the care team. We covered suggestions to improve the team-based care and pro-active follow-up of patients’ needs. Self-management support was highlighted as an important area and we identified possibilities, but also challenges regarding the use of patient-reported outcomes and eHealth-tools. Furthermore, the importance of continuous training for professionals and the implementation of guidelines in routine care was pointed out. Also, participants mentioned an opportunity to collaborate with community-based organizations and raised challenges regarding the overall health system. Lastly, the pertaining lack of IPF awareness and the disease burden on patients and their caregivers were covered. Conclusions Our research team has initiated a project aiming to optimize the current care delivery practice for IPF patients at a Belgian centre of excellence. These results will inform the further optimisation of the care program and the development of feasible supportive interventions. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-021-01431-8.
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Affiliation(s)
- Anouk Delameillieure
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium.,Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000, Leuven, Belgium
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000, Leuven, Belgium.
| | - Sarah Vandekerkhof
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven, Kapucijnenvoer 35 blok D-box 7001, 3000, Leuven, Belgium
| | - Wim A Wuyts
- Department of Chronic Diseases and Metabolism, Laboratory of Respiratory Diseases and Thoracic Surgery, KU Leuven, Leuven, Belgium.,Department of Respiratory Diseases, Unit for Interstitial Lung Diseases, University Hospitals Leuven, Leuven, Belgium
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Camus-García E, González-González AI, Heijmans M, Niño de Guzmán E, Valli C, Beltran J, Pardo-Hernández H, Ninov L, Strammiello V, Immonen K, Mavridis D, Ballester M, Suñol R, Orrego C. Self-management interventions for adults living with Chronic Obstructive Pulmonary Disease (COPD): The development of a Core Outcome Set for COMPAR-EU project. PLoS One 2021; 16:e0247522. [PMID: 33647039 PMCID: PMC7920347 DOI: 10.1371/journal.pone.0247522] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 02/09/2021] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND A large body of evidence suggests that self-management interventions (SMIs) may improve outcomes in chronic obstructive pulmonary disease (COPD). However, accurate comparisons of the relative effectiveness of SMIs are challenging, partly due to heterogeneity of outcomes across trials and uncertainty about the importance of these outcomes for patients. We aimed to develop a core set of patient-relevant outcomes (COS) for SMIs trials to enhance comparability of interventions and ensure person-centred care. METHODS We undertook an innovative approach consisting of four interlinked stages: i) Development of an initial catalogue of outcomes from previous EU-funded projects and/or published studies, ii) Scoping review of reviews on patients and caregivers' perspectives to identify outcomes of interest, iii) Two-round Delphi online survey with patients and patient representatives to rate the importance of outcomes, and iv) Face-to-face consensus workshop with patients, patient representatives, health professionals and researchers to develop the COS. RESULTS From an initial list of 79 potential outcomes, 16 were included in the COS plus one supplementary outcome relevant to all participants. These were related to patient and caregiver knowledge/competence, self-efficacy, patient activation, self-monitoring, adherence, smoking cessation, COPD symptoms, physical activity, sleep quality, caregiver quality of life, activities of daily living, coping with the disease, participation and decision-making, emergency room visits/admissions and cost effectiveness. CONCLUSION The development of the COPD COS for the evaluation of SMIs will increase consistency in the measurement and reporting of outcomes across trials. It will also contribute to more personalized health care and more informed health decisions in clinical practice as patients' preferences regarding COPD outcomes are more systematically included.
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Affiliation(s)
- Estela Camus-García
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
| | - Ana Isabel González-González
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Institute of General Practice, Goethe University, Frankfurt, Germany
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre Barcelona, Department of Clinical Epidemiology and Public Health, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Claudia Valli
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Atónoma de Barcelona, Barcelona, Spain
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Jessica Beltran
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau), Barcelona, Spain
| | - Hector Pardo-Hernández
- Iberoamerican Cochrane Centre Barcelona, Biomedical Research Institute San Pau (IIB Sant Pau) - CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | | | | | | | - Dimitris Mavridis
- Department of Primary Education, University of Ioannina, Ioannina, Greece
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Rosa Suñol
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), Universitat Autonòma de Barcelona, Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Spain
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Anderson E, Wiener RS, Resnick K, Elwy AR, Rinne ST. Care coordination for veterans with COPD: a positive deviance study. AMERICAN JOURNAL OF MANAGED CARE 2021; 26:63-68. [PMID: 32059093 DOI: 10.37765/ajmc.2020.42394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Improving chronic obstructive pulmonary disease (COPD) care and reducing hospital readmissions is an urgent healthcare system priority. However, little is known about the organizational factors that underlie intersite variation in readmission rates. Evidence from other chronic diseases points to care coordination as one such factor. STUDY DESIGN To understand whether intersite differences in care coordination may be one of the organizational factors contributing to the variation in readmission rates, we examined provider perspectives on COPD care at Veterans Affairs (VA) sites. METHODS In this mixed-methods positive deviance study, we selected 3 VA sites in the lowest quartile and 3 in the highest quartile for 2016 risk-adjusted COPD readmission rates. During June to October 2017, we conducted semistructured interviews with primary and specialty care providers involved in COPD care at VA sites with low (n = 14) and high (n = 11) readmission rates. RESULTS Although providers at all sites referenced ongoing readmission reduction initiatives, only providers at low-readmission sites described practice environments characterized by high relational coordination (ie, high-quality work relationships and high-quality communication). They also reported fewer significant structural barriers to collaboration in areas like patient volume. CONCLUSIONS The most notable differences between high- and low-readmission sites were related to the quality of relational coordination and the presence of structural barriers to coordination, rather than specific readmission reduction initiatives. Implementing organizational reforms aimed at enhancing relational coordination and removing structural barriers would enhance care for COPD and may improve quality of care for other chronic conditions.
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Affiliation(s)
- Ekaterina Anderson
- Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, 200 Springs Rd, Bldg 70, Bedford, MA 01730.
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Koff PB, Min SJ, Freitag TJ, Diaz DLP, James SS, Voelkel NF, Linderman DJ, Diaz Del Valle F, Zakrajsek JK, Albert RK, Bull TM, Beck A, Stelzner TJ, Ritzwoller DP, Kveton CM, Carwin S, Ghosh M, Keith RL, Westfall JM, Vandivier RW. Impact of Proactive Integrated Care on Chronic Obstructive Pulmonary Disease. CHRONIC OBSTRUCTIVE PULMONARY DISEASES-JOURNAL OF THE COPD FOUNDATION 2021; 8. [PMID: 33238087 DOI: 10.15326/jcopdf.2020.0139] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background Up to 50% of chronic obstructive pulmonary disease (COPD) patients do not receive recommended care for COPD. To address this issue, we developed Proactive Integrated Care (Proactive iCare), a health care delivery model that couples integrated care with remote monitoring. Methods We conducted a prospective, quasi-randomized clinical trial in 511 patients with advanced COPD or a recent COPD exacerbation, to test whether Proactive iCare impacts patient-centered outcomes and health care utilization. Patients were allocated to Proactive iCare (n=352) or Usual Care ( =159) and were examined for changes in quality of life using the St George's Respiratory Questionnaire (SGRQ), symptoms, guideline-based care, and health care utilization. Findings Proactive iCare improved total SGRQ by 7-9 units (p < 0.0001), symptom SGRQ by 9 units (p<0.0001), activity SGRQ by 6-7 units (p<0.001) and impact SGRQ by 7-11 units (p<0.0001) at 3, 6 and 9 months compared with Usual Care. Proactive iCare increased the 6-minute walk distance by 40 m (p<0.001), reduced annual COPD-related urgent office visits by 76 visits per 100 participants (p<0.0001), identified unreported exacerbations, and decreased smoking (p=0.01). Proactive iCare also improved symptoms, the body mass index-airway obstruction-dyspnea-exercise tolerance (BODE) index and oxygen titration (p<0.05). Mortality in the Proactive iCare group (1.1%) was not significantly different than mortality in the Usual Care group (3.8%; p=0.08). Interpretation Linking integrated care with remote monitoring improves the lives of people with advanced COPD, findings that may have been made more relevant by the coronavirus 2019 (COVID-19) pandemic.
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Affiliation(s)
- Patricia B Koff
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Sung-Joon Min
- Division of Health Care Policy and Research, Department of Medicine, University of Colorado Denver, Anschutz Medical Campus, Aurora, Colorado, United States
| | - Tammie J Freitag
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Debora L P Diaz
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Shannon S James
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Norbert F Voelkel
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Derek J Linderman
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Fernando Diaz Del Valle
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Jonathan K Zakrajsek
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Richard K Albert
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Todd M Bull
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
| | - Arne Beck
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States
| | - Thomas J Stelzner
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States
| | - Debra P Ritzwoller
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States
| | - Christine M Kveton
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States
| | - Stephanie Carwin
- Institute for Health Research, Kaiser Permanente Colorado, Denver, Colorado, United States
| | - Moumita Ghosh
- National Jewish Health, Denver, Colorado, United States
| | - Robert L Keith
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States.,Denver Veterans Administration Medical Center, Denver, Colorado, United States
| | - John M Westfall
- Department of Family Medicine, High Plains Research Network, University of Colorado Denver, Anschutz Medical Campus, United States
| | - R William Vandivier
- Division of Pulmonary Sciences and Critical Care Medicine, Colorado Pulmonary Outcomes Research Group, Aurora, Colorado, United States
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Banks J, Stone T, Dodd J. Integrating care between an NHS hospital, a community provider and the role of commissioning: the experience of developing an integrated respiratory service. BMJ Open 2020; 10:e040267. [PMID: 33371025 PMCID: PMC7754656 DOI: 10.1136/bmjopen-2020-040267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 08/27/2020] [Accepted: 11/14/2020] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES An integrated respiratory service was commissioned in 2016 in a UK region to support patients with chronic obstructive pulmonary disease. The service brought together the respiratory department of a National Health Service hospital and a not-for-profit community provider. This paper evaluates: (1) the perceived efficacy of integrated working between the organisations from the perspective of staff and (2) the relationship between commissioning and integration of the services. DESIGN Semistructured interviews with staff from the three organisations involved in the integrated respiratory service. Staff were purposefully sampled. The interviews were audio recorded, transcribed and analysed thematically. SETTING Secondary care respiratory unit; community provider of respiratory care; and a clinical commissioning group. PARTICIPANTS Nineteen interview participants: nine from the community provider; eight from the hospital and two from the clinical commissioning group. RESULTS Staff identified lack of integration between the organisations characterised by: poor communication, lack of trust, absence of shared information technology and ineffective integrative initiatives. The commissioning process created barriers to integration including: contractual limitations which prevented pathway development, absence of agreed clinical governance arrangements and lack of recognition of community work undertaken by hospital staff. Positive working relationships were established over time as staff recognised the skills that each had to offer. CONCLUSIONS The commissioning process underpinned the relationship between the organisations and contributed to distrust and negative perceptions of the 'other'. Commissioning an integrated service should incorporate dialogue with stakeholders as early as possible and before the contract is finalised to develop a bedrock of trust.
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Affiliation(s)
- Jonathan Banks
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tracey Stone
- The National Institute for Health Research, Applied Research Collaboration West (NIHR ARC West), University Hospitals Bristol NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - James Dodd
- Academic Respiratory Unit, Translational Health Sciences, University of Bristol, Southmead Hospital, Bristol, UK
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[Integrated care management for older people with chronic diseases in domesticity: evidence from Cochrane reviews]. Z Gerontol Geriatr 2020; 54:54-60. [PMID: 33044620 PMCID: PMC7835300 DOI: 10.1007/s00391-020-01796-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/14/2020] [Indexed: 11/05/2022]
Abstract
Hintergrund Die Anzahl multipel chronisch erkrankter Älterer steigt, und Multimorbidität geht mit hoher Inanspruchnahme von Gesundheitsleistungen einher. Um Selbstständigkeit und Verbleib in der Häuslichkeit zu erhalten, wird zunehmend ein integriertes Versorgungsmanagement eingesetzt. Zur Wirksamkeit in der Zielgruppe der multipel chronisch erkrankten Älteren liegen aber kaum belastbare Daten vor. Ziel der Arbeit Bewertung der Wirksamkeit von integriertem Versorgungsmanagement bei Erwachsenen und Abschätzung der Übertragbarkeit auf ältere, multimorbide Personen in Deutschland. Methoden Systematische Literaturrecherche in der Cochrane Library mit Einschluss von Cochrane-Reviews (CR) zu (a) den 13 häufigsten Gesundheitsproblemen im Alter, mit (b) Komponenten des integrierten Versorgungsmanagements bei (c) Erwachsenen jeden Alters. Experten schätzten die Übertragbarkeit der eingeschlossenen CR auf multipel chronisch erkrankte Ältere in Deutschland ein. Ergebnisse Aus 1412 Treffern wurden 126 CR eingeschlossen. Zur Endpunktkategorie Selbstständigkeit und funktionale Gesundheit zeigten 25 CR klinisch relevante Ergebnisse mit moderater Evidenzqualität. Folgende Interventionskomponenten wurden – unter Berücksichtigung identifizierter Barrieren – als übertragbar eingeschätzt und könnten für ein effektives, indikationsspezifisch integriertes Versorgungsmanagement multipel chronisch erkrankter Älterer herangezogen werden: (1) körperliche Aktivierung, (2) multidisziplinäre Interventionen, (3) das Selbstmanagement verstärkende Interventionen, (4) kognitive Therapieverfahren, (5) telemedizinische Interventionen und (6) Disease-Management-Programme. Schlussfolgerungen Die identifizierten Komponenten sollten in versorgungs- und patientennahen randomisierten kontrollierten Studien auf Wirksamkeit bei gebrechlichen Älteren geprüft werden. Zusatzmaterial online Zusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-020-01796-1) enthalten.
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Cheung NW, Crampton M, Nesire V, Hng TM, Chow CK. Model for integrated care for chronic disease in the Australian context: Western Sydney Integrated Care Program. AUST HEALTH REV 2020; 43:565-571. [PMID: 30862349 DOI: 10.1071/ah18152] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 10/11/2018] [Indexed: 11/23/2022]
Abstract
Objective To describe the implementation of a model of integrated care for chronic disease in Western Sydney. This model was established on the basis of a partnership between the Local Health District and the Primary Health Network. Methods The Western Sydney Integrated Care Program (WSICP) focuses on people with type 2 diabetes, chronic obstructive pulmonary disease and coronary artery disease or congestive cardiac failure. We describe the design of the program, the processes involved and some of the challenges and barriers to integration. Results Early data indicate a high uptake of services, with some evidence of a reduction in hospital admissions and presentations to the emergency department. Conclusion A model of integrated care has been successfully implemented and embedded into local practices. Preliminary data suggest that this is having an impact on the utilisation of hospital services. What is known about the topic? There is evidence that integrated models can improve cost-effectiveness and the quality of clinical care for people with chronic disease. However, most integrated models are small scale, focus on very specific populations and generally do not engage both primary care and acute hospitals. What does this paper add? This paper describes an effective partnership between state-funded hospital services in the WSLHD and the federally funded local Primary Health Network (PHN) of general practitioners. The paper outlines the design of the program and the structural, governance and clinical steps taken to embed integrated care into everyday clinical practice. In addition, preliminary results indicate a reduction in the use of hospital services by people who have received integrated care services. What are the implications for practitioners? Involvement of both primary care and the public hospital system is important for a successful and sustainable integrated care program. This is a long and challenging process, but it can lead to positive effects not just for individuals, but also for the health system as a whole.
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Affiliation(s)
- N Wah Cheung
- Department of Diabetes and Endocrinology, Westmead Hospital, Western Sydney Local Health District, Hawkesbury Road, Westmead, NSW 2145, Australia; and Faculty of Medicine and Health, University of Sydney, City Road, University of Sydney, NSW 2006, Australia. ; and Corresponding author.
| | - Michael Crampton
- Integrated and Community Health, Western Sydney Local Health District, 18 Blacktown Road, Blacktown, NSW 2148, Australia. ; ; and Western Sydney Primary Health Network, Level 1, 85 Flushcombe Road, Blacktown, NSW 2148, Australia
| | - Victoria Nesire
- Integrated and Community Health, Western Sydney Local Health District, 18 Blacktown Road, Blacktown, NSW 2148, Australia. ;
| | - Tien-Ming Hng
- Department of Diabetes and Endocrinology, Blacktown Mt Druitt Hospital, Western Sydney Local Health District, 18 Blacktown Road, Blacktown, NSW 2148, Australia. ; and Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia
| | - Clara K Chow
- Faculty of Medicine and Health, University of Sydney, City Road, University of Sydney, NSW 2006, Australia. ; and Department of Cardiology, Westmead Hospital, Western Sydney Local Health District, Hawkesbury Road, Westmead, NSW 2145, Australia
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Pagano L, McKeough Z, Wootton S, Crone S, Pallavicini D, Chan ASL, Mahadev S, Zwar N, Dennis S. The feasibility of an innovative GP-physiotherapist partnership to identify and manage chronic obstructive pulmonary disease (INTEGRATED): study protocol. Pilot Feasibility Stud 2020; 6:138. [PMID: 32983555 PMCID: PMC7513496 DOI: 10.1186/s40814-020-00680-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 09/08/2020] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) contributes significantly to mortality, hospitalisations and health care costs worldwide. There is evidence that the detection, accurate diagnosis and management of COPD are currently suboptimal in primary care. Physiotherapists are well-trained in cardiorespiratory management and chronic care but are currently underutilised in primary care. A cardiorespiratory physiotherapist working in partnership with general practitioners (GPs) has the potential to improve quality of care for people with COPD. METHODS A prospective pilot study will test the feasibility of an integrated model of care between GPs and physiotherapists to improve the diagnosis and management of people with COPD in primary care. Four general practices will be selected to work in partnership with four physiotherapists from their local health district. Patients at risk of developing COPD or those with a current diagnosis of COPD will be invited to attend a baseline assessment with the physiotherapist, including pre- and post-bronchodilator spirometry to identify new cases of COPD or confirm a current diagnosis and stage of COPD. The intervention for those with COPD will involve the physiotherapist and GP working in partnership to develop and implement a care plan involving the following tailored to patient need: referral to pulmonary rehabilitation (PR), physical activity counselling, medication review, smoking cessation, review of inhaler technique and education. Process outcomes will include the number of people invited and reviewed at the practice, the proportion with a new diagnosis of COPD, the number of patients eligible and referred to PR and the number who attended PR. Patient outcomes will include changes in symptoms, physical activity levels, smoking status and self-reported exacerbations. DISCUSSION If feasible, we will test the integration of physiotherapists within the primary care setting in a cluster randomised controlled trial. If the model improves health outcomes for the growing numbers of people with COPD, then it may provide a GP-physiotherapist model of care that could be tested for other chronic conditions. TRIAL REGISTRATION ANZCTR, ACTRN12619001127190. Registered on 12 August 2019-retrospectively registered.
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Affiliation(s)
- Lisa Pagano
- Discipline of Physiotherapy, University of Sydney, Sydney, Australia
| | - Zoe McKeough
- Discipline of Physiotherapy, University of Sydney, Sydney, Australia
| | - Sally Wootton
- Discipline of Physiotherapy, University of Sydney, Sydney, Australia
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, St Leonards, Australia
| | - Stephen Crone
- Chronic Disease Community Rehabilitation Service, Northern Sydney Local Health District, St Leonards, Australia
| | | | - Andrew S. L. Chan
- Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Sriram Mahadev
- Royal North Shore Hospital, St Leonards, Australia
- Northern Clinical School, University of Sydney, Sydney, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Sarah Dennis
- Discipline of Physiotherapy, University of Sydney, Sydney, Australia
- Ingham Institute for Applied Medical Research, Liverpool, Australia
- South Western Sydney Local Health District, Liverpool, Australia
- Faculty of Health Sciences, The University of Sydney, 75 East Street, Lidcombe, NSW 2141 Australia
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Dummer J, Stokes T. Improving continuity of care of patients with respiratory disease at hospital discharge. Breathe (Sheff) 2020; 16:200161. [PMID: 33447276 PMCID: PMC7792832 DOI: 10.1183/20734735.0161-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 08/04/2020] [Indexed: 11/06/2022] Open
Abstract
Continuity of care refers to the delivery of coherent, logical and timely care to an individual. It is threatened during the transition of care at hospital discharge, which can contribute to worse patient outcomes. In a traditional acute care model, the roles of hospital and community healthcare providers do not overlap and this can be a barrier to continuity of care at hospital discharge. Furthermore, the transition from inpatient to outpatient care is associated with a transition from acute to chronic disease management and, in a busy hospital, attention to this can be crowded out by the pressures of providing acute care. This model is suboptimal for the large proportion of patients admitted to hospital with acute-on-chronic respiratory disease. In a chronic care model, the healthcare system is designed to give adequate priority to care of chronic disease. Integrated care for the patient with respiratory disease fits the chronic care model and responds to the fragmentation of care in a traditional acute care model: providers integrate their respiratory services to provide continuous, holistic care tailored to individuals. This promotes greater continuity of care for individuals, and can improve patient outcomes both at hospital discharge and more widely. EDUCATIONAL AIMS To understand the concept of continuity of care and its effect at the transition between inpatient and outpatient care.To understand the difference between the acute and chronic models of healthcare.To understand the effect of integration of care on continuity of care for patients with respiratory disease and their health outcomes.
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Affiliation(s)
- Jack Dummer
- Dept of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Tim Stokes
- Dept of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Arnold MT, Dolezal BA, Cooper CB. Pulmonary Rehabilitation for Chronic Obstructive Pulmonary Disease: Highly Effective but Often Overlooked. Tuberc Respir Dis (Seoul) 2020; 83:257-267. [PMID: 32773722 PMCID: PMC7515680 DOI: 10.4046/trd.2020.0064] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 08/06/2020] [Indexed: 12/16/2022] Open
Abstract
Patients with chronic obstructive pulmonary disease receive a range of treatments including but not limited to inhaled bronchodilators, inhaled and systemic corticosteroids, supplemental oxygen, and pulmonary rehabilitation. Pulmonary rehabilitation is a multidisciplinary intervention that seeks to combine patient education, exercise, and lifestyle changes into a comprehensive program. Programs 6 to 8 weeks in length have been shown to improve health, reduce dyspnea, increase exercise capacity, improve psychological well-being, and reduce healthcare utilization and hospitalization. Although the use of pulmonary rehabilitation is widely supported by the literature, controversy still exists regarding what should be included in the programs. The goal of this review was to summarize the evidence for pulmonary rehabilitation and identify the areas that hold promise in improving its utilization and effectiveness.
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Affiliation(s)
- Michael T Arnold
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Brett A Dolezal
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Christopher B Cooper
- Exercise Physiology Research Laboratory, Departments of Medicine and Physiology, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
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Sibbald S, Schouten K, Sedig K, Maskell R, Licskai C. Key characteristics and critical junctures for successful Interprofessional networks in healthcare - a case study. BMC Health Serv Res 2020; 20:700. [PMID: 32727464 PMCID: PMC7391486 DOI: 10.1186/s12913-020-05565-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 07/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background The use of networks in healthcare has been steadily increasing over the past decade. Healthcare networks reduce fragmented care, support coordination amongst providers and patients, improve health system efficiencies, support better patient care and improve overall satisfaction of both patients and healthcare professionals. There has been little research to date on the implementation, development and use of small localized networks. This paper describes lessons learned from a successful small localized primary care network in Southwestern Ontario that developed and implemented a regional respiratory care program (The ARGI Respiratory Health Program - ARGI is a not-for-profit corporation leading the implementation and evaluation of a respiratory health program. Respiratory therapists (who have a certified respiratory educators designation), care for patients from all seven of the network’s FHTs. Patients rostered within the network of FHTs that have been diagnosed with a chronic respiratory disease are referred by their family physicians to the program. The RTs are integrated into the FHTs, and work in a triad along with patients and providers to educate and empower patients in self-management techniques, create exacerbation action plans, and act as a liaison between the patient’s care providers. ARGI uses an eTool designed specifically for use by the network to assist care delivery, choosing education topics, and outcome tracking. RTs are hired by ARGI and are contracted to the participating FHTs in the network.). Methods This study used an exploratory case study approach. Data from four participant groups was collected using focus groups, observations, interviews and document analysis to develop a rich understanding of the multiple perspectives associated with the network. Results This network’s success can be described by four characteristics (growth mindset and quality improvement focus; clear team roles that are strengths-based; shared leadership, shared success; and transparent communication); and five critical junctures (acknowledge a shared need; create a common vision that is flexible and adaptable depending on the context; facilitate empowerment; receive external validation; and demonstrate the impacts and success of their work). Conclusions Networks are used in healthcare to act as integrative, interdisciplinary tools to connect individuals with the aim of improving processes and outcomes. We have identified four general lessons to be learned from a successful small and localized network: importance of clear, flexible, and strengths-based roles; need for shared goals and vision; value of team support and empowerment; and commitment to feedback and evaluations. Insight from this study can be used to support the development and successful implementation of other similar locally developed networks.
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Affiliation(s)
- Shannon Sibbald
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada. .,Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada. .,Western Center for Public Health and Family Medicine, 1465 Richmond Street, London, Ontario, N6G 2M1, Canada.
| | - Karen Schouten
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Kimia Sedig
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Rachelle Maskell
- Faculty of Health Sciences, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
| | - Christopher Licskai
- Schulich School of Medicine and Dentistry, Western University, 1151 Richmond Street, London, Ontario, N6A 3K7, Canada
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Ramer SJ, Baddour NA, Siew ED, Salat H, Bian A, Stewart TG, Wong SPY, Jhamb M, Abdel-Kader K. Nephrology Provider Surprise Question Response and Hospitalizations in Older Adults with Advanced CKD. Am J Nephrol 2020; 51:641-649. [PMID: 32721980 PMCID: PMC7789871 DOI: 10.1159/000509046] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 05/13/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Older adults with advanced non-dialysis-dependent chronic kidney disease (NDD-CKD) face a high risk of hospitalization and related adverse events. METHODS This prospective cohort study followed nephrology clinic patients ≥60 years old with NDD-CKD stages 4-5. After an eligible patient's office visit, study staff asked the patient's provider to rate the patient's risk of death within the next year using the surprise question ("Would you be surprised if this patient died in the next 12 months?") with a 5-point Likert scale response (1, "definitely not surprised" to 5, "very surprised"). We used a statewide database to ascertain hospitalization during follow-up. RESULTS There were 488 patients (median age 72 years, 51% female, 17% black) with median estimated glomerular filtration rate 22 mL/min/1.73 m2. Over a median follow-up of 2.1 years, the rates of hospitalization per 100 person-years in the respective response groups were 41 (95% confidence interval [CI]: 34-50), "very surprised"; 65 (95% CI: 55-76), "surprised"; 98 (95% CI: 85-113), "neutral"; 125 (95% CI: 107-144), "not surprised"; and 120 (95% CI: 94-151), "definitely not surprised." In a fully adjusted cumulative probability ordinal regression model for proportion of follow-up time spent hospitalized, patients whose providers indicated that they would be "definitely not surprised" if they died spent a greater proportion of follow-up time hospitalized compared with those whose providers indicated that they would be "very surprised" (odds ratio 2.4, 95% CI: 1.0-5.7). There was a similar association for time to first hospitalization. CONCLUSION Nephrology providers' responses to the surprise question for older patients with advanced NDD-CKD were independently associated with proportion of future time spent hospitalized and time to first hospitalization. Additional studies should examine how to use this information to provide patients with anticipatory guidance on their possible clinical trajectory and to target potentially preventable hospitalizations.
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Affiliation(s)
- Sarah J Ramer
- Division of Geriatrics and Palliative Medicine, Department of Medicine, Weill Cornell Medical Center, New York, New York, USA
| | - Nicolas A Baddour
- Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Edward D Siew
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA
| | - Huzaifah Salat
- Department of Medicine, St. Barnabas Hospital Health System, Bronx, New York, USA
| | - Aihua Bian
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Thomas G Stewart
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Susan P Y Wong
- Health Service Research and Development Center, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, USA
- Division of Nephrology, Department of Medicine, University of Washington School of Medicine, Seattle, Washington, USA
| | - Manisha Jhamb
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Khaled Abdel-Kader
- Division of Nephrology and Hypertension, Vanderbilt University Medical Center, Nashville, Tennessee, USA,
- Vanderbilt Center for Kidney Disease, Nashville, Tennessee, USA,
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Issac H, Moloney C, Taylor M, Lea J. Mapping of modifiable barriers and facilitators with interdisciplinary chronic obstructive pulmonary disease (COPD) guidelines concordance within hospitals to the Theoretical Domains Framework: a mixed methods systematic review protocol. BMJ Open 2020; 10:e036060. [PMID: 32690740 PMCID: PMC7375635 DOI: 10.1136/bmjopen-2019-036060] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Multifarious chronic obstructive pulmonary disease (COPD) guidelines have been published by local, national and global respiratory societies. These guidelines subsume holistic evidence based on recommendations to diagnose, treat, prevent and manage acute exacerbation with COPD. Despite the existing comprehensive recommendations, readmission rates and hospitalisations have increased in the last decade. Evidence to date has reported suboptimal clinical guidelines concordance. Acute exacerbations of COPD (AECOPD) is a common hospital presentation due to varied causes such as infective exacerbations, worsening disease condition, medication non-adherence, lack of education and incomprehensive discharge planning. AECOPD directly and indirectly causes economic burden, disrupts health-related quality of life (HRQol), hasten lung function decline and increases overall morbidity and mortality. COPD being a multimodal chronic disease, consistent interdisciplinary interventions from the time of admission to discharge may reduce readmissions and enhance HRQol among these patients and their families. METHODS AND ANALYSIS This protocol adheres to the Joanna Briggs Institute methodology for mixed methods systematic reviews and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews reporting guidelines. Qualitative, quantitative and mixed methods studies will append this study to explore determinants of COPD guidelines concordance. Comprehensive three-tier search strategies will be used to search nine databases (COCHRANE, EBSCO HOST, MEDLINE, SCIENCE DIRECT, JBI, SCOPUS, WEB OF SCIENCE, WILEY and DARE) in May 2020. Two independent reviewers will screen abstracts and full-text articles in consonance with inclusion criteria. The convergent integrative method narrative review will contribute a deeper understanding of any discrepancies found in the existing evidence. Quality of the studies will be reported and Theoretical Domains Framework (TDF) will be used as a priori to synthesis data. Identified barriers, facilitators and corresponding clinical behavioural change solutions will be categorised using TDF indicators to provide future research and implementation recommendations. ETHICS AND DISSEMINATION Ethical approval is not required and results dissemination will occur through peer-reviewed publication.
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Affiliation(s)
- Hancy Issac
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Melissa Taylor
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Jackie Lea
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
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Meijer E, van Eeden AE, Kruis AL, Boland MRS, Assendelft WJJ, Tsiachristas A, Rutten-van Mölken MPMH, Kasteleyn MJ, Chavannes NH. Exploring characteristics of COPD patients with clinical improvement after integrated disease management or usual care: post-hoc analysis of the RECODE study. BMC Pulm Med 2020; 20:176. [PMID: 32552784 PMCID: PMC7302138 DOI: 10.1186/s12890-020-01213-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 06/10/2020] [Indexed: 11/23/2022] Open
Abstract
Background The cluster randomized controlled trial on (cost-)effectiveness of integrated chronic obstructive pulmonary disease (COPD) management in primary care (RECODE) showed that integrated disease management (IDM) in primary care had no effect on quality of life (QOL) in COPD patients compared with usual care (guideline-supported non-programmatic care). It is possible that only a subset of COPD patients in primary care benefit from IDM. We therefore examined which patients benefit from IDM, and whether patient characteristics predict clinical improvement over time. Method Post-hoc analyses of the RECODE trial among 1086 COPD patients. Logistic regression analyses were performed with baseline characteristics as predictors to examine determinants of improvement in QOL, defined as a minimal decline in Clinical COPD Questionnaire (CCQ) of 0.4 points after 12 and 24 months of IDM. We also performed moderation analyses to examine whether predictors of clinical improvement differed between IDM and usual care. Results Regardless of treatment type, more severe dyspnea (MRC) was the most important predictor of clinically improved QOL at 12 and 24 months, suggesting that these patients have most room for improvement. Clinical improvement with IDM was associated with female gender (12-months) and being younger (24-months), and improvement with usual care was associated with having a depression (24-months). Conclusions More severe dyspnea is a key predictor of improved QOL in COPD patients over time. More research is needed to replicate patient characteristics associated with clinical improvement with IDM, such that IDM programs can be offered to patients that benefit the most, and can potentially be adjusted to meet the needs of other patient groups as well. Trial registration Netherlands Trial Register, NTR2268. Registered 31 March 2010.
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Affiliation(s)
- Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands.
| | - Annelies E van Eeden
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands
| | - Annemarije L Kruis
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands
| | - Melinde R S Boland
- Institute of Health, Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, Netherlands
| | - Willem J J Assendelft
- Department of Primary and Community Care, Radboud University Medical Centre, 6500 HB, Nijmegen, Netherlands
| | - Apostolos Tsiachristas
- Institute of Health, Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR, Rotterdam, Netherlands.,Health Economics Research Centre, Nuffield Department of Population Health, University of Oxford, Oxford, OX3 7LF, UK
| | | | - Marise J Kasteleyn
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands.,Department of Pulmonology, Leiden University Medical Centre, Leiden, PO Box 9600, 2300 RC, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, PO Box 9600, 2300 RC, Leiden, Netherlands
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Abdulsalim S, Unnikrishnan MK, Manu MK, Alsahali S, Alrasheedy AA, Martin AP, Godman B, Alfadl AA. Impact of a Clinical Pharmacist Intervention on Medicine Costs in Patients with Chronic Obstructive Pulmonary Disease in India. PHARMACOECONOMICS - OPEN 2020; 4:331-342. [PMID: 31368087 PMCID: PMC7248138 DOI: 10.1007/s41669-019-0172-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality, especially in low- and middle-income countries (LMICs) such as India. Medicine costs are a key issue in LMICs, with typically high patient co-payments. In addition, pharmacists are underutilised in LMICs, including India. However, pharmacist-led educational interventions may improve the care of patients with COPD, as well as reduce medicine costs. Consequently, the objective of this study was to assess the effectiveness of a pharmacist-led intervention in reducing medicine costs. METHODOLOGY We assessed the impact of a pharmacist intervention on direct medicine costs in COPD patients (medicine costs and pharmacist time) in a randomised controlled study involving an intervention and control group, conducted at a tertiary care teaching hospital in India. RESULTS The 6-monthly cost of medicines at baseline increased with disease severity, from a maximum of US$29.46 for those with mild COPD to US$63.28 for those with very severe COPD. Substantial savings in medical costs were achieved with the pharmacist-led programme, to a maximum of US$20.49 over 6 months for very severe patients. This equates to a reduction of 30.6% in medicine costs (p < 0.001), reduced to 26.1% when pharmacists' time (US$3.00/patient) was included. CONCLUSION There could be a key role for pharmacists as educators for COPD patients in LMICs, to improve care and reduce costs, including patient co-payments.
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Affiliation(s)
- Suhaj Abdulsalim
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
- MCOPS, Manipal Academy of Higher Education, Manipal, India
| | | | - Mohan K. Manu
- Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, India
| | - Saud Alsahali
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
| | | | - Antony P. Martin
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- HCD Economics, The Innovation Centre, Daresbury, WA4 4FS UK
| | - Brian Godman
- Health Economics Centre, University of Liverpool Management School, Liverpool, UK
- Strathclyde Institute of Pharmacy and Biomedical Sciences, University of Strathclyde, Glasgow, G4 0RE UK
- Division of Clinical Pharmacology, Karolinska Institute, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden
- School of Pharmaceutical Sciences, Universiti Sains Malaysia, 11800 USM Penang, Malaysia
| | - Abubakr A. Alfadl
- Unaizah College of Pharmacy, Qassim University, Qassim, Saudi Arabia
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Schmid-Mohler G, Clarenbach C, Brenner G, Kohler M, Horvath E, Spielmanns M, Petry H. Advanced nursing practice in COPD exacerbations: the solution for a gap in Switzerland? ERJ Open Res 2020; 6:00354-2019. [PMID: 32577416 PMCID: PMC7293988 DOI: 10.1183/23120541.00354-2019] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 03/24/2020] [Indexed: 02/06/2023] Open
Abstract
AIM This study aimed to address the need for adaptation of the current model of chronic obstructive pulmonary disease (COPD) care in Switzerland, particularly in regard to acute exacerbations, and how far an integrated approach involving advanced nursing practice can meet those needs. METHODS A state analysis guided by the PEPPA framework was initiated by the Pulmonology Clinic of University Hospital Zürich. Literature describing the current provision of COPD care regarding exacerbations in Switzerland and international qualitative studies describing the patient perspective were systematically searched and summarised. The health providers' perspective was investigated in three focus-group interviews. RESULTS A lack of systematic and state-of-the-art support for patient self-management in Switzerland was described in literature and confirmed by the health providers interviewed. While care was assessed as being comprehensive and of good quality in each individual sector, such as inpatient, outpatient, rehabilitation and home settings, it was identified as being highly fragmented across sectors. The interview participants described day-to-day examples in which a lack of support in COPD self-management and fragmentation of care negatively affected the patients' disease management. CONCLUSION The necessity of coordinating the transition between healthcare sectors and self-management support and that these organisational boundaries should be addressed by a multi-professional team were identified. Initial evaluation indicates that advanced practice nurses potentially have the skill set to coordinate the team and address patients' self-management needs in complex patient situations. However, the legal foundation and a reimbursement system to ensure long-term implementation is not yet available.
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Affiliation(s)
- Gabriela Schmid-Mohler
- Centre of Clinical Nursing Science, University Hospital Zürich, Zürich, Switzerland
- Division of Pulmonology, University Hospital Zürich, Zürich, Switzerland
- Medical Dept Heart–Vascular–Thorax, University Hospital Zürich, Zürich, Switzerland
| | - Christian Clarenbach
- Division of Pulmonology, University Hospital Zürich, Zürich, Switzerland
- Medical Dept Heart–Vascular–Thorax, University Hospital Zürich, Zürich, Switzerland
| | - Gabi Brenner
- Directorate of Nursing and Allied Health Professionals, University Hospital Zürich, Zürich, Switzerland
| | - Malcolm Kohler
- Division of Pulmonology, University Hospital Zürich, Zürich, Switzerland
- Medical Dept Heart–Vascular–Thorax, University Hospital Zürich, Zürich, Switzerland
| | - Eva Horvath
- Medical Dept Heart–Vascular–Thorax, University Hospital Zürich, Zürich, Switzerland
| | - Marc Spielmanns
- Pulmonary Medicine, Zürcher RehaZentren Klinik Wald, Zürich, Switzerland
- Dept of Pulmonary Medicine, Faculty of Health, University Witten-Herdecke, Witten, Germany
| | - Heidi Petry
- Centre of Clinical Nursing Science, University Hospital Zürich, Zürich, Switzerland
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Dummer J, Tumilty E, Hannah D, McAuley K, Baxter J, Doolan-Noble F, Donlevy S, Stokes T. Health Care Utilisation and Health Needs of People with Severe COPD in the Southern Region of New Zealand: A Retrospective Case Note Review. COPD 2020; 17:136-142. [PMID: 32037897 DOI: 10.1080/15412555.2020.1724275] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We examined health care utilisation and needs of people with severe COPD in the low-population-density setting of the Southern Region of New Zealand (NZ). We undertook a retrospective case note review of patients with COPD coded as having an emergency department attendance and/or admission with at least one acute exacerbation during 2015 to hospitals in the Southern Region of NZ. Data were collected and analysed from 340 case notes pertaining to: demographics, hospital admissions, outpatient contacts, pulmonary rehabilitation, advance care planning and comorbidities. Geometric mean (95%CI) length of stay for hospital admissions in urban and rural hospitals was 3.0 (2.7-3.4) and 4.0 (2.9-5.4) days respectively. More patients were from areas of higher deprivation but median hospital length of stay for patients from the least deprived areas was 2.0 days longer than others (p = 0.04). There was a median of 4 (range 0-16) comorbidities and 10 medications (range 0-25) per person. Of 169 cases where data was available, 26 (15%) were offered, 17 (10%) declined, and 5 (3%) completed, pulmonary rehabilitation at or in the year prior to the index admission. Patients were less likely to be offered pulmonary rehabilitation if they lived >20km away from the hospital where it took place (odds ratio of 0.12 for those living further away [95%CI 0.02-0.93, p = 0.04]). There were deficits in care: provision and uptake of non-pharmacological interventions was suboptimal and unevenly distributed across the region. Further research is needed to develop and evaluate strategies for delivering non-pharmacological interventions in this setting.
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Affiliation(s)
- Jack Dummer
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.,Southern District Health Board, Respiratory Services, Dunedin Hospital, Dunedin, New Zealand
| | - Emma Tumilty
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Debbie Hannah
- Southern District Health Board, Respiratory Services, Dunedin Hospital, Dunedin, New Zealand
| | - Kathryn McAuley
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jo Baxter
- Kōhatu Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Fiona Doolan-Noble
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Simon Donlevy
- Southern District Health Board, Respiratory Services, Dunedin Hospital, Dunedin, New Zealand
| | - Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Mansoor S, Obaida Z, Ballowe L, Campbell AR, Patrie JT, Byrum TD, Shim YM. Clinical Impact of Multidisciplinary Outpatient Care on Outcomes of Patients with COPD. Int J Chron Obstruct Pulmon Dis 2020; 15:33-42. [PMID: 32021142 PMCID: PMC6955613 DOI: 10.2147/copd.s225156] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 12/17/2019] [Indexed: 01/13/2023] Open
Abstract
Purpose Heterogeneous nature of Chronic Obstructive Pulmonary Disease (COPD) must be comprehensively addressed. It is unclear if integrative multidisciplinary disease management (IMDM) can optimize clinical outcomes of patients with COPD. Methods A single-center, retrospective cohort observational study with a historical intervention was conducted in a clinic specialized for COPD care. Patients with a confirmed diagnosis of COPD were administered IMDM with measurement of BODE score on initial and follow-up visits. Primary outcomes were dynamic changes in BODE quartiles after receiving IMDM. Results Of 124 patients, 21% were misdiagnosed with COPD. Patients with a confirmed diagnosis of COPD were 50% female, median age 64 years (IQR 57-70), 43% actively smoking and initial visit median BODE quartile 2 (IQR 1-3). Three subgroups were identified based on the changes in BODE quartiles: worsened (21%), unchanged (55%) and improved (24%). At baseline, mMRC (median [IQR]) was higher in improved subgroup vs worsened and unchanged subgroup (3 [3, 4] vs 2 [1, 2] vs 2 [1, 3], p value 0.002) respectively. Drop in all components of BODE score was noted in worsened group, but significant improvement in mMRC with preservation of spirometry values was noted in the improved group. The incidence of smoking cigarettes changed from 39% to 26% during follow-up. Conclusion Our study demonstrates that IMDM can be potentially effective in a subgroup of COPD patients. In others precipitous drop in lung function, activity tolerance, and subjective symptoms seems inevitable with worsening BODE quartiles.
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Affiliation(s)
- Sahar Mansoor
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Zaid Obaida
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Lorna Ballowe
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - Amanda R Campbell
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
| | - James T Patrie
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Timothy D Byrum
- Rheumatology Associate of North Alabama, Huntsville, AL, USA
- The Joint Commission, Oakbrook Terrace, IL, USA
| | - Yun M Shim
- Division of Pulmonary and Critical Care Medicine, University of Virginia, Charlottesville, VA, USA
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Alí A, Giraldo-Cadavid LF, Karpf E, Quintero LA, Aguirre CE, Rincón E, Vejarano AI, Perlaza I, Torres-Duque CA, Casas A. Frequency of emergency department visits and hospitalizations due to chronic obstructive pulmonary disease exacerbations in patients included in two models of care. BIOMEDICA : REVISTA DEL INSTITUTO NACIONAL DE SALUD 2019; 39:748-758. [PMID: 31860185 PMCID: PMC7363357 DOI: 10.7705/biomedica.4815] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/15/2019] [Indexed: 11/21/2022]
Abstract
INTRODUCTION Exacerbations of chronic obstructive pulmonary disease (COPD) have a huge impact on lung function, quality of life and mortality of patients. Emergency Department visits and hospitalizations due to exacerbations cause a significant economic burden on the health system. OBJECTIVE To describe the differences in the number of emergency visits and hospitalizations due to exacerbations of COPD among patients included in two models of care of the same institution. MATERIALS AND METHODS A historical cohort study in which COPD patients who are users of two models of care were included: COPD integrated care program (CICP) and general consultation of pulmonology (GCP). The first model, unlike the second one, offers additional educational activities, 24/7 telephone service, and priority consultations. The number of emergency visits and hospitalizations due to COPD exacerbations in patients who had completed at least one year of follow-up was evaluated. The multivariable Poisson regression model was used for calculating the incidence rate (IR) and the incidence rate ratio (IRR) with an adjustment for confounding factors. RESULTS We included 316 COPD patients (166 from the CICP and 150 from the GCP). During the year of follow-up, the CICP patients had 50% fewer emergency visits and hospitalizations than patients from the GCP (IRR=0.50, 95%CI: 0.29-0.87, p=0.014). CONCLUSIONS COPD patients in the CICP had fewer emergency visits and hospitalizations due to exacerbations. Prospective clinical studies are required to confirm the results and to evaluate the factors that contribute to the differences.
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Affiliation(s)
- Abraham Alí
- Departamento de Investigación, Fundación Neumológica Colombiana, Bogotá, D.C., Colombia.
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Stokes T, Tumilty E, Latu ATF, Doolan-Noble F, Baxter J, McAuley K, Hannah D, Donlevy S, Dummer J. Improving access to health care for people with severe chronic obstructive pulmonary disease (COPD) in Southern New Zealand: qualitative study of the views of health professional stakeholders and patients. BMJ Open 2019; 9:e033524. [PMID: 31767598 PMCID: PMC6886961 DOI: 10.1136/bmjopen-2019-033524] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Chronic obstructive pulmonary disease (COPD) is a common chronic disease with significant morbidity and mortality, particularly for Māori, which places a large burden on the New Zealand (NZ) health system. We undertook a qualitative study as part of a mixed-methods implementation research project which aimed to determine the barriers and enablers to the provision of accessible high-quality COPD care. SETTING Southern Health Region of NZ (Otago and Southland). PARTICIPANTS Thirteen health professional stakeholders and 23 patients with severe COPD (including one Māori and one Pasifika participant). METHODS Semistructured interviews were undertaken. A thematic analysis using the Levesque conceptual framework for access to healthcare was conducted. RESULTS Health professional stakeholders identified barriers to providing access to health services, in particular: availability (inadequate staffing and resourcing of specialist services and limited geographical availability of pulmonary rehabilitation), affordability (both of regular medication, medication needed for an exacerbation of COPD and the copayment charge for seeing a general practitioner) and appropriateness (a shared model of care across primary and secondary care was needed to facilitate better delivery of key interventions such as pulmonary rehabilitation and advance care planning (ACP). Māori stakeholders highlighted the importance of communication and relationships and the role of whānau (extended family) for support. Patients' accounts showed variable ability to access services through having a limited understanding of what COPD is, a limited knowledge of services they could access, being unable to attend pulmonary rehabilitation (due to comorbidities) and direct (medication and copayment charges) and indirect (transport) costs. CONCLUSIONS People with severe COPD experience multilevel barriers to accessing healthcare in the NZ health system along the pathway of care from diagnosis to ACP. These need to be addressed by local health services if this group of patients are to receive high-quality care.
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Affiliation(s)
- Tim Stokes
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Emma Tumilty
- Institute for Translational Sciences, University of Texas Medical Branch School of Health Professions, Galveston, Texas, USA
| | | | - Fiona Doolan-Noble
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Jo Baxter
- Kōhatu, Centre for Hauora Māori, Division of Health Sciences, University of Otago, Dunedin, New Zealand
| | - Kathryn McAuley
- Department of General Practice and Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Debbie Hannah
- Southern District Health Board, Otago and Southland, Dunedin, New Zealand
| | - Simon Donlevy
- Southern District Health Board, Otago and Southland, Dunedin, New Zealand
| | - Jack Dummer
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
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Lanning E, Longstaff J, Jones T, Roberts C, Neville D, DeVos R, Storrar W, Green B, Brown T, Leung A, Fogg C, Dominey R, Bassett P, Meredith P, Chauhan AJ. Modern Innovative Solutions in Improving Outcomes in Chronic Obstructive Pulmonary Disease (MISSION COPD): Mixed Methods Evaluation of a Novel Integrated Care Clinic. Interact J Med Res 2019; 8:e9637. [PMID: 31573894 PMCID: PMC6774234 DOI: 10.2196/ijmr.9637] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2017] [Revised: 05/26/2018] [Accepted: 06/21/2018] [Indexed: 11/15/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is the second-leading cause of death in the United Kingdom and accounts for 1.7% of bed days in acute hospitals. An estimated two-third of patients with COPD remain undiagnosed. Objective Modern Innovative Solutions in Improving Outcomes in Chronic Obstructive Pulmonary Disease (MISSION COPD) aimed to proactively identify patients from primary care who were undiagnosed or had uncontrolled COPD and to provide a comprehensive integrated multidisciplinary clinic to address the needs of this complex group for improving diagnosis, personalizing therapy, and empowering patients to self-manage their condition. Methods This clinic was led by a respiratory specialist team from Portsmouth Hospitals NHS Trust working with five primary care surgeries in Wessex. A total of 108 patients were reviewed, with 98 patients consenting to provide additional data for research. Diagnoses were changed in 14 patients, and 32 new diagnoses were made. Results Reductions were seen across all aspects of unscheduled care as compared to the prior 12 months, including in emergency general practitioner visits (3.37-0.79 visits per patient, P<.001), exacerbations (2.64-0.56 per patient, P=.01), out-of-hours calls (0.16-0.05 per patient, P=.42), and hospital admissions (0.49-0.12 per patient, P=.48). Improvements were observed in the quality of life and symptom scores in addition to patient activation and patient-reported confidence levels. Conclusions This pilot demonstrates that the MISSION model may be an effective way to provide comprehensive gold-standard care that is valued by patients and to promote integration across sectors.
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Affiliation(s)
| | | | - Thomas Jones
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Claire Roberts
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Daniel Neville
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Ruth DeVos
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Will Storrar
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Ben Green
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | - Thomas Brown
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
| | | | - Carole Fogg
- University of Portsmouth, Portsmouth, United Kingdom
| | - Rachel Dominey
- Wessex Academic Health Science Network, Southampton, United Kingdom
| | | | - Paul Meredith
- Portsmouth Hospitals NHS Trust, Portsmouth, United Kingdom
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Ko FWS, Chan KP, Hui DSC. Comprehensive care for chronic obstructive pulmonary disease. J Thorac Dis 2019; 11:S2181-S2191. [PMID: 31737345 PMCID: PMC6831924 DOI: 10.21037/jtd.2019.09.81] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 09/27/2019] [Indexed: 02/05/2023]
Abstract
Chronic obstructive pulmonary disease (COPD) is a common chronic disease worldwide and incurs heavy utilization of healthcare resources. Many COPD patients have comorbidities and experience exacerbations in the course of the disease. Correct diagnosis and appropriate disease assessment are essential for clinical management. Comprehensive care for patients with different severity of disease aims to offer personalized treatment to suit individual needs. Patients with recent exacerbations also need extra care for the post-acute and rehabilitation phases. Comprehensive care consists of self-management and pulmonary rehabilitation and involves multiple healthcare providers working together closely to provide formal structured programmes for patients. The setting, professionals involved, content and the duration of programme vary a lot among different comprehensive care models. Some randomized controlled trials suggested there was improvement in quality of life, exercise capacity and reduced hospital admissions for participants in comprehensive care programmes compared with controls. However, other studies showed that such programmes might not confer benefits and might even bring harm. The reason for the differences in clinical effect of programmes might be due to differences in study design, components and subjects involved in the studies. Careful evaluation of each programme is thus mandatory. Further research is needed to evaluate the safety and effectiveness of comprehensive care management for COPD patients, both at the stable and post-acute exacerbation state.
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Affiliation(s)
- Fanny Wai San Ko
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - Ka Pang Chan
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
| | - David Shu Cheong Hui
- SH Ho Research Center in Respiratory Diseases, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, China
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Valentijn PP, Pereira F, Sterner CW, Vrijhoef HJM, Ruwaard D, Hegbrant J, Strippoli GFM. Validation of the Rainbow Model of Integrated Care Measurement Tools (RMIC-MTs) in renal care for patient and care providers. PLoS One 2019; 14:e0222593. [PMID: 31536548 PMCID: PMC6752779 DOI: 10.1371/journal.pone.0222593] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 09/03/2019] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Integrated service delivery is considered to be an essential condition for improving the management and health outcomes of people with chronic kidney disease (CKD). However, research on the assessment of integrated care by patients and care providers is hindered by the absence of brief, reliable, and valid measurement tools. OBJECTIVE The aim of this study was to develop survey instruments for healthcare professionals and patients based on the Rainbow Model of Integrated Care (RMIC), and to evaluate their psychometric properties. DESIGN The development process was based on the US Food and Drug Administration guidelines. This included item generation from systematic reviews of existing tools and expert opinion on clarity and content validity, involving renal care providers and chronic kidney patients. A cross-sectional, multi-centre design was used to test for internal consistency and construct validity. SETTING Outpatient clinics in a large renal network. PARTICIPANTS A sample of 30.788 CKD patients, and 8.914 renal care providers. METHODS AND ANALYSIS Both survey instruments were developed using previous qualitative work and published literature. A multidisciplinary expert panel assessed the face and content validity of both instruments and following a pilot study, the psychometric properties of both instruments were explored. Exploratory factor analysis with principal axis factoring and with promax rotation was used to assess the underlying dimensions of both instruments; Cronbach's alpha was used to determine the internal constancy reliability. RESULTS 17.512 patients (response rate: 56.9%) and 8.849 care providers (response rate: 69.5%) responded to the questionnaires. Factor analysis of the patient questionnaire yielded three internally consistent (Cronbach's alpha > 0.7) factors: person-centeredness, clinical coordination, and professional coordination. Factor analysis of the provider questionnaire produced eight internally consistent (Cronbach's alpha > 0.7) factors: person-centeredness, community centeredness, clinical coordination, professional coordination, organisational coordination, system coordination, technical and cultural competence. As hypothesised, care coordination patient and providers scores significantly correlated with questions about quality of care, treatment involvement, reported health, clinics' organisational readiness, and external care coordination capacity. CONCLUSION This study provides evidence for the reliability and validity of the RMIC patient and provider questionnaires as generic tools to assess the experience with or perception of integrated renal care delivery. The instruments are recommended in future applications testing test-retest reliability, convergent and predictive validity, and responsiveness.
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Affiliation(s)
- Pim P. Valentijn
- Department of Patient and Care, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
- Integrated Care Evaluation, Essenburgh, Hierden, The Netherlands
| | | | | | - Hubertus J. M. Vrijhoef
- Department of Patient and Care, Maastricht University Medical Center, Maastricht, The Netherlands
- Department of Family Medicine, Vrije Universiteit Brussel, Brussels, Belgium
- Panaxea, Amsterdam, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Care and Public Health Research Institute (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Jörgen Hegbrant
- Diaverum Medical Scientific Office, Diaverum Sweden AB, Lund, Sweden
| | - Giovanni F. M. Strippoli
- Diaverum Medical Scientific Office, Diaverum Sweden AB, Lund, Sweden
- Sydney School of Public Health, The University of Sydney, Sydney, Australia
- Department of Emergency and Organ Transplantation, University of Bari, Bari, Italy
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Moloney C, Sneath E, Phillips T, Issac H, Beccaria G, Mullens A. Recommendations and practices for holistic chronic obstructive pulmonary disease (COPD) assessment and optimal referral patterns in emergency department presentations: a scoping review protocol. BMJ Open 2019; 9:e030358. [PMID: 31439609 PMCID: PMC6707709 DOI: 10.1136/bmjopen-2019-030358] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Chronic obstructive pulmonary disease (COPD) is a common respiratory condition that causes persistent respiratory symptoms and decline in lung function over many years. This chronic disease significantly affects health-related quality of life and is known to contribute to frequent emergency department (ED) presentations. Multidimensional management of these patients, including interconnecting health disciplinarians will allow holistic care provision in the ED. The purpose of this scoping review is to synthesise current evidence on holistic management and assessment, and referral practices stemming from acute COPD presentation in the ED. Specifically, to determine: (1) What are the known causal factors associated with COPD ED presentations and (2) Is there an identified connection with appropriate healthcare professional assessment within ED presentations and reported referral pathways? METHODS AND ANALYSIS The iterative stages of the Arskey and O'Malley, and Levac advanced scoping review framework informs this review. Using published and unpublished studies in English, a three-tiered search strategy will be applied. After duplicates are removed, screen 1 (title and abstract) and screen 2 (full-text) will be conducted by two independent reviewers to determine eligibility of articles. Disputes will be settled through discussion or by using a third reviewer. A data collection tool developed by the authors will inform the data extraction process. Schematic tabular format of results with a narrative summary will depict how the results link with the scoping review objectives. Categorisation of results will be narrowed down as key conceptual findings and will align with the strategic intent of this review. ETHICS AND DISSEMINATION Ethics approval was not required for this study. A multidisciplinary team of authors will participate in dissemination activities (publications, reports, conference presentations, framework development).
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Affiliation(s)
- Clint Moloney
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Emily Sneath
- The Prince Charles Hospital, Queensland Health, Brisbane, Queensland, Australia
| | - Tania Phillips
- Centre for Health, Informatics and Economic Research (Research), University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Hancy Issac
- School of Nursing and Midwifery, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Gavin Beccaria
- School of Psychology and Counselling, University of Southern Queensland, Toowoomba, Queensland, Australia
| | - Amy Mullens
- School of Psychology and Counselling, University of Southern Queensland, Toowoomba, Queensland, Australia
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