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Ingram E, Ledden S, Beardon S, Gomes M, Hogarth S, McDonald H, Osborn DP, Sheringham J. Household and area-level social determinants of multimorbidity: a systematic review. J Epidemiol Community Health 2021; 75:232-241. [PMID: 33158940 PMCID: PMC7892392 DOI: 10.1136/jech-2020-214691] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/16/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND No clear synthesis of evidence examining household and area-level social determinants of multimorbidity exists. This study aimed to systematically review the existing literature on associations between household and area-level social determinants of health (SDoH) and multimorbidity prevalence or incidence in the general population. METHODS Six databases (MedLine, EMBASE, PsychINFO, Web of Science, CINAHL Plus and Scopus) were searched. The search was limited to peer-reviewed studies conducted in high-income countries and published in English between 2010 and 2019. A second reviewer screened all titles with abstracts and a subset of full texts. Study quality was assessed and protocol pre-registered (CRD42019135281). RESULTS 41 studies spanning North America, Europe and Australasia were included. Household income and area-level deprivation were the most explored with fairly consistent findings. The odds of multimorbidity were up to 4.4 times higher for participants with the lowest level of income compared with the highest level. Those living in the most deprived areas had the highest prevalence or incidence of multimorbidity (pooled OR 1.42, 95% CI 1.41 to 1.42). Associations between deprivation and multimorbidity differed by age and multimorbidity type. Findings from the few studies investigating household tenure, household composition and area-level rurality were mixed and contradictory; homeownership and rurality were associated with increased and decreased multimorbidity, while living alone was found to be associated with a higher risk of multimorbidity and not associated. CONCLUSION Improving our understanding of broader social determinants of multimorbidity-particularly at the household level-could help inform strategies to tackle multimorbidity.
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Affiliation(s)
- Elizabeth Ingram
- Department of Applied Health Research, University College London, London, UK
| | - Sarah Ledden
- Division of Psychiatry, University College London, London, UK
| | - Sarah Beardon
- Department of Applied Health Research, University College London, London, UK
| | - Manuel Gomes
- Department of Applied Health Research, University College London, London, UK
| | - Sue Hogarth
- London Boroughs of Camden and Islington, London, UK
| | - Helen McDonald
- London School of Hygiene and Tropical Medicine, London, UK
| | - David P Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Jessica Sheringham
- Department of Applied Health Research, University College London, London, UK
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Kumah E, Abuosi AA, Ankomah SE, Anaba C. Self-management Education Program: The Case of Glycemic Control of Type 2 Diabetes. Oman Med J 2021; 36:e225. [PMID: 33585046 PMCID: PMC7868594 DOI: 10.5001/omj.2021.01] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Accepted: 05/28/2019] [Indexed: 01/05/2023] Open
Abstract
Objectives Self-management education (SME) is recognized globally as a tool that enables patients to achieve optimal glucose control. While factors influencing the effectiveness of self-management interventions have been studied extensively, the impact of program length on clinical endpoints of patients diagnosed with diabetes is underdeveloped. This paper synthesized information from the existing literature to understand the effect of program length on glycated hemoglobin (HbA1C) in adults with type 2 diabetes mellitus. Methods We searched Web of Science, PubMed, Scopus, MEDLINE, EMBASE, PsychINFO, and the Cochrane Central Register of Controlled Trials to identify relevant English language publications on diabetes self-management education published between January 2000 and April 2019. Results The review included 25 randomized controlled trials, with 64.0% reporting significant changes in HbA1C. The studies classified as long-term (lasting one year and above) were associated with the greatest number of interventions achieving statistically significant (87.5% significant vs. 12.5% non-significant) differences in changes in HbA1C between the intervention and the control subjects, recording an overall between-group HbA1C mean difference of 0.6±0.3% (range = 0.2–1.2). Conclusions Our findings suggest that program length may change the effectiveness of educational interventions. Achieving sustained improvements in patients’ HbA1C levels will require long-term, ongoing SME, and support.
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Affiliation(s)
- Emmanuel Kumah
- Policy, Planning, Monitoring, and Evaluation Unit, Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - Aaron Asibi Abuosi
- Department of Public Administration and Health Services Management, University of Ghana Business School, Accra, Ghana
| | | | - Cynthia Anaba
- Department of Administration, St. Dominic Hospital, Akwatia, Eastern Region, Ghana
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González-González AI, Dinh TS, Meid AD, Blom JW, van den Akker M, Elders PJM, Thiem U, Kuellenberg de Gaudry D, Snell KIE, Perera R, Swart KMA, Rudolf H, Bosch-Lenders D, Trampisch HJ, Meerpohl JJ, Flaig B, Kom G, Gerlach FM, Hafaeli WE, Glasziou PP, Muth C. Predicting negative health outcomes in older general practice patients with chronic illness: Rationale and development of the PROPERmed harmonized individual participant data database. Mech Ageing Dev 2021; 194:111436. [PMID: 33460622 DOI: 10.1016/j.mad.2021.111436] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 01/07/2021] [Accepted: 01/07/2021] [Indexed: 12/11/2022]
Abstract
The prevalence of multimorbidity and polypharmacy increases significantly with age and are associated with negative health consequences. However, most current interventions to optimize medication have failed to show significant effects on patient-relevant outcomes. This may be due to ineffectiveness of interventions themselves but may also reflect other factors: insufficient sample sizes, heterogeneity of population. To address this issue, the international PROPERmed collaboration was set up to obtain/synthesize individual participant data (IPD) from five cluster-randomized trials. The trials took place in Germany and The Netherlands and aimed to optimize medication in older general practice patients with chronic illness. PROPERmed is the first database of IPD to be drawn from multiple trials in this patient population and setting. It offers the opportunity to derive prognostic models with increased statistical power for prediction of patient-relevant outcomes resulting from the interplay of multimorbidity and polypharmacy. This may help patients from this heterogeneous group to be stratified according to risk and enable clinicians to identify patients that are likely to benefit most from resource/time-intensive interventions. The aim of this manuscript is to describe the rationale behind PROPERmed collaboration, characteristics of the included studies/participants, development of the harmonized IPD database and challenges faced during this process.
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Affiliation(s)
- Ana I González-González
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany; Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Madrid, Spain.
| | - Truc S Dinh
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany
| | - Andreas D Meid
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Jeanet W Blom
- Department of Public Health and Primary Care, Leiden University Medical Center, 2300RC, Leiden, the Netherlands
| | - Marjan van den Akker
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany; School of CAPHRI, Department of Family Medicine, Maastricht University, 6211 LK, Maastricht, the Netherlands; Academic Centre for General Practice, Department of Public Health and Primary Care, KU, Leuven, Belgium
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Center, 1007 MB, Amsterdam, the Netherlands
| | - Ulrich Thiem
- Chair of Geriatrics and Gerontology, University Clinic Eppendorf, 20246, Hamburg, Germany
| | - Daniela Kuellenberg de Gaudry
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, 79110, Freiburg, Germany
| | - Kym I E Snell
- Centre for Prognosis Research, School of Primary Care Research, Community and Social Care, Keele University, Staffordshire, ST5 5BG, United Kingdom
| | - Rafael Perera
- Nuffield Department of Primary Care, University of Oxford, Oxford, OX2 6GG, United Kingdom
| | - Karin M A Swart
- Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Center, 1007 MB, Amsterdam, the Netherlands
| | - Henrik Rudolf
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, 44780, Bochum, Germany
| | - Donna Bosch-Lenders
- School of CAPHRI, Department of Family Medicine, Maastricht University, 6211 LK, Maastricht, the Netherlands
| | - Hans-Joachim Trampisch
- Department of Medical Informatics, Biometry and Epidemiology, Ruhr University, 44780, Bochum, Germany
| | - Joerg J Meerpohl
- Institute for Evidence in Medicine (for Cochrane Germany Foundation), Medical Center - University of Freiburg, 79110, Freiburg, Germany; Cochrane Germany, Cochrane Germany Foundation, Breisacher Strasse 153, 79110, Freiburg, Germany
| | - Benno Flaig
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany
| | - Ghainsom Kom
- Techniker Krankenkasse (TK), 22765, Hamburg, Germany
| | - Ferdinand M Gerlach
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany
| | - Walter E Hafaeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, University Hospital Heidelberg, 69120, Heidelberg, Germany
| | - Paul P Glasziou
- Centre for Research in Evidence-Based Practice, Bond University, Robina, QLD, 4226, Australia
| | - Christiane Muth
- Institute of General Practice, Goethe University Frankfurt, 60590, Frankfurt am Main, Germany; Department of General Practice and Family Medicine, Medical Faculty OWL, University of Bielefeld, 33615, Bielefeld, Germany
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Rimmelzwaan LM, Bogerd MJL, Schumacher BMA, Slottje P, Van Hout HPJ, Reinders ME. Multimorbidity in General Practice: Unmet Care Needs From a Patient Perspective. Front Med (Lausanne) 2021; 7:530085. [PMID: 33415113 PMCID: PMC7783195 DOI: 10.3389/fmed.2020.530085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: In the Netherlands, as in many other countries, current clinical guidelines are directed at single diseases. Patients with multiple chronic conditions may benefit from a more patient-tailored approach. Therefore, our objective is to explore the general practice care needs of patients with multimorbidity from a patient perspective. We also assessed their care experiences and the impact of chronic conditions on their daily functioning. Methods: We conducted a qualitative study, using semi-structured interviews complemented with self-report questionnaire assessments for triangulation, with consenting community-dwelling patients with three or more chronic conditions. Participants were identified through purposeful sampling in three general practices. Two researchers independently coded and thematically analyzed the audiotaped and anonymously transcribed interviews using the constant comparative method. The self-report questionnaire assessments were used to describe the patient characteristics and for triangulation of the data retrieved from the semi-structured interviews. Results: After 12 interviews, saturation was achieved. Overall, most participants were positive about their relationship with the general practitioner (GP) and practice nurse (PN) as well as the care they received in general practice. However, several unmet care need themes were observed: firstly, lack of a holistic approach (by the GP and PN), in particular, insufficient attention to the patient's state of functioning, their limitations in daily life, and their well-being; secondly, they mentioned that personal continuity of care was important to them and sometimes lacking; thirdly, lack of patient-tailored explanations about diseases and treatments. Conclusion: From a community-dwelling multimorbid patient perspective, general practice care could benefit from improving personal continuity of care, attention to personal circumstances and daily functioning, and patient-tailored communication.
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Affiliation(s)
- Lisanne M Rimmelzwaan
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mieke J L Bogerd
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bregitta M A Schumacher
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pauline Slottje
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hein P J Van Hout
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marcel E Reinders
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Heins M, Korevaar J, Schellevis F, Rijken M. Identifying multimorbid patients with high care needs - A study based on electronic medical record data. Eur J Gen Pract 2020; 26:189-195. [PMID: 33337928 PMCID: PMC7751396 DOI: 10.1080/13814788.2020.1854719] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Patients with multimorbidity who frequently contact the general practice, use emergency care or have unplanned hospitalisations, may benefit from a proactive integrated care intervention. General practitioners are not always aware of who these ‘high need’ patients are. Electronic medical records are a potential source to identify them. Objectives To find predictors of high care needs in general practice electronic medical records of patients with multimorbidity and assess their predictive value. Methods General practice electronic medical records of 245,065 patients with ≥2 chronic diseases were linked to hospital claims data. Probit regression analysis was conducted to predict i) having at least 12 general practice contacts per year, ii) emergency department visit(s), and iii) unplanned hospitalisation(s). Predictors were patients’ age, sex, morbidity, health services and medication use in the previous year. Results 11% of multimorbid patients had ≥12 general practice contacts, which could be reliably predicted by the number of contacts in the previous year (PPV 42%). The model containing all predictors had only slightly better predictive value (PPV 44%). Emergency department visits and unplanned hospitalisations (12% and 7% of multimorbid patients, respectively) could be predicted less accurately (PPV 27% and 20%). Those with frequent contact with the general practice hardly overlapped with ED visitors (29%) or persons with unplanned hospitalisations (17%). Conclusion Among multimorbid populations various ‘high need’ groups exist. Patients with high needs for general practice care can be identified by their previous use of general practice care. To identify frequent ED visitors and persons with unplanned hospitalisations, additional information is needed.
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Affiliation(s)
- Marianne Heins
- Nivel (Netherlands Institute for Health Services Research), Department of Primary Care, Utrecht, The Netherlands
| | - Joke Korevaar
- Nivel (Netherlands Institute for Health Services Research), Department of Primary Care, Utrecht, The Netherlands
| | - Francois Schellevis
- Nivel (Netherlands Institute for Health Services Research), Department of Primary Care, Utrecht, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Mieke Rijken
- Nivel (Netherlands Institute for Health Services Research), Department of Primary Care, Utrecht, The Netherlands.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
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Lee YAJ, Xie Y, Lee PSS, Lee ES. Comparing the prevalence of multimorbidity using different operational definitions in primary care in Singapore based on a cross-sectional study using retrospective, large administrative data. BMJ Open 2020; 10:e039440. [PMID: 33318111 PMCID: PMC7737073 DOI: 10.1136/bmjopen-2020-039440] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 11/18/2020] [Accepted: 11/19/2020] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Multimorbidity is a norm in primary care. A consensus on its operational definition remains lacking especially in the list of chronic conditions considered. This study aimed to compare six different operational definitions of multimorbidity previously reported in the literature for the context of primary care in Singapore. DESIGN, SETTING AND PARTICIPANTS This is a retrospective study using anonymised primary care data from a study population of 787 446 patients. We defined multimorbidity as having three or more chronic conditions in an individual. The prevalence of single conditions and multimorbidity with each operational definition was tabulated and standardised prevalence rates (SPRs) were obtained by adjusting for age, sex and ethnicity. We compared the operational definitions based on (1) number of chronic diseases, (2) presence of chronic diseases of high burden and (3) relevance in primary care in Singapore. IBM SPSS V.23 and Microsoft Office Excel 2019 were used for all statistical calculations and analyses. RESULTS The SPRs of multimorbidity in primary care in Singapore varied from 5.7% to 17.2%. The lists by Fortin et al, Ge et al, Low et al and Quah et al included at least 12 chronic conditions, the recommended minimal number of conditions. Quah et al considered the highest proportion of chronic diseases (92.3%) of high burden in primary care in Singapore, with SPRs of at least 1.0%. Picco et al and Subramaniam et al considered the fewest number of conditions of high relevance in primary care in Singapore. CONCLUSIONS Fortin et al's list of conditions is most suitable for describing multimorbidity in the Singapore primary care setting. Prediabetes and 'physical disability' should be added to Fortin et al's list to augment its comprehensiveness. We propose a similar study methodology be performed in other countries to identify the most suitable operational definition in their own context.
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Affiliation(s)
- Yi An Janis Lee
- National Healthcare Group Polyclinics, Clinical Research Unit, National Healthcare Group, Singapore
| | - Ying Xie
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
| | | | - Eng Sing Lee
- National Healthcare Group Polyclinics, Clinical Research Unit, National Healthcare Group, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
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Wan EY, Yu EY, Chen JY, Wong IC, Chan EW, Lam CL. Associations between usual glycated haemoglobin and cardiovascular disease in patients with type 2 diabetes mellitus: A 10-year diabetes cohort study. Diabetes Obes Metab 2020; 22:2325-2334. [PMID: 32744402 DOI: 10.1111/dom.14157] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/07/2020] [Accepted: 07/27/2020] [Indexed: 01/06/2023]
Abstract
AIM To investigate the assocation between glycated haemoglobin (HbA1c) level and cardiovascular disease (CVD) risk among patients with type 2 diabetes. MATERIALS AND METHODS This retrospective cohort study conducted in Hong Kong selected patients aged 45 to 84 years with type 2 diabetes mellitus and without CVD from primary care clinics during the period 2008 to 2010. Usual HbA1c measurement was calculated using a mixed-effects model to minimize regression dilution bias. The association between usual HbA1c and CVD risk was assessed by Cox regression, with adjustment for baseline covariates. Subgroup analyses by patient characteristics were also conducted. RESULTS After a median follow-up period of 8.4 years (1.4 million person-years), 174 028 patients with 34 074 CVD events were observed. A curvilinear association was found between usual HbA1c and total CVD, stroke, heart failure and CVD mortality risk. No significant difference was found among patients with usual HbA1c <53 mmol/mol (7%). A positive linear association was found between usual HbA1c and the risks of outcomes when the usual HbA1c was 53 mmol/mol (7%) or above. The adjusted hazard ratios (HRs) for CVD risk per 1% increment in usual HbA1c >7% was 21% (HR 1.21, 95% confidence interval [CI] 1.18-1.23) (HR for CVD per 1mmol/mol increment in usual HbA1c > 53 mmol/mol was 1.7% (HR 1.017, CI 1.015-1.019)). A similar pattern was identified in a patient subgroup analysis, but the effects of usual HbA1c in younger patients were more prominent than in older patients. CONCLUSIONS Usual HbA1c increments for levels >53 mmol/mol (7.0%) were associated with elevated CVD risk, but no difference was found in the population with usual HbA1c <53 mmol/mol (7.0%), irrespective of patient characteristics. For CVD prevention, strict adherence to an HbA1c target of <53 mmol/mol (7%) should apply to younger patients.
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Affiliation(s)
- Eric Yf Wan
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong
- Department of Pharmacology and Pharmacy, the University of Hong Kong, Hong Kong
| | - Esther Yt Yu
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong
| | - Julie Y Chen
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong
| | - Ian Ck Wong
- Department of Pharmacology and Pharmacy, the University of Hong Kong, Hong Kong
- Research Department of Practice and Policy, School of Pharmacy, University College London, London, UK
| | - Esther Wy Chan
- Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, the University of Hong Kong, Hong Kong
| | - Cindy Lk Lam
- Department of Family Medicine and Primary Care, University of Hong Kong, Hong Kong
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A prognostic model predicted deterioration in health-related quality of life in older patients with multimorbidity and polypharmacy. J Clin Epidemiol 2020; 130:1-12. [PMID: 33065164 DOI: 10.1016/j.jclinepi.2020.10.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/12/2020] [Accepted: 10/07/2020] [Indexed: 01/07/2023]
Abstract
OBJECTIVES To develop and validate a prognostic model to predict deterioration in health-related quality of life (dHRQoL) in older general practice patients with at least one chronic condition and one chronic prescription. STUDY DESIGN AND SETTING We used individual participant data from five cluster-randomized trials conducted in the Netherlands and Germany to predict dHRQoL, defined as a decrease in EQ-5D-3 L index score of ≥5% after 6-month follow-up in logistic regression models with stratified intercepts to account for between-study heterogeneity. The model was validated internally and by using internal-external cross-validation (IECV). RESULTS In 3,582 patients with complete data, of whom 1,046 (29.2%) showed deterioration in HRQoL, and 12/87 variables were selected that were related to single (chronic) conditions, inappropriate medication, medication underuse, functional status, well-being, and HRQoL. Bootstrap internal validation showed a C-statistic of 0.71 (0.69 to 0.72) and a calibration slope of 0.88 (0.78 to 0.98). In the IECV loop, the model provided a pooled C-statistic of 0.68 (0.65 to 0.70) and calibration-in-the-large of 0 (-0.13 to 0.13). HRQoL/functionality had the strongest prognostic value. CONCLUSION The model performed well in terms of discrimination, calibration, and generalizability and might help clinicians identify older patients at high risk of dHRQoL. REGISTRATION PROSPERO ID: CRD42018088129.
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González-González AI, Perestelo-Pérez L, Koatz D, Ballester M, Pacheco-Huergo V, Ramos-García V, Torres-Castaño A, Rivero-Santana A, Toledo-Chávarri A, Valcárcel-Nazco C, Mateos-Rodilla J, Obaya-Rebollar JC, García-García J, Díaz-Sánchez S, Morales-Cobos L, Bosch-Fontcuberta JM, Vallejo-Camazón N, Rodríguez-Almodovar A, Del Castillo JC, Muñoz-Balsa M, Del Rey-Granado Y, Garrido-Elustondo S, Tello-Bernabé ME, Ramírez-Puerta AB, Orrego C. Effectiveness and cost-effectiveness of a virtual community of practice to improve the empowerment of patients with ischaemic heart disease: study protocol of a randomised controlled trial. BMJ Open 2020; 10:e037374. [PMID: 33046465 PMCID: PMC7552830 DOI: 10.1136/bmjopen-2020-037374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 08/17/2020] [Accepted: 08/26/2020] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION Virtual Communities of Practice (VCoP) or knowledge-sharing virtual communities offer ubiquitous access to information and exchange possibilities for people in similar situations, which might be especially valuable for the self-management of patients with chronic diseases. In view of the scarce evidence on the clinical and economic impact of these interventions on chronic conditions, we aim to evaluate the effectiveness and cost-effectiveness of a VCoP in the improvement of the activation and other patient empowerment measures in patients with ischaemic heart disease (IHD). METHODS AND ANALYSIS A pragmatic randomised controlled trial will be performed in Catalonia, Madrid and Canary Islands, Spain. Two hundred and fifty patients with a recent diagnosis of IHD attending the participating centres will be selected and randomised to the intervention or control group. The intervention group will be offered participation for 12 months in a VCoP based on a gamified web 2.0 platform where there is interaction with other patients and a multidisciplinary professional team. Intervention and control groups will receive usual care. The primary outcome will be measured with the Patient Activation Measure questionnaire at baseline, 6, 12 and 18 months. Secondary outcomes will include: clinical variables; knowledge (Questionnaire of Cardiovascular Risk Factors), attitudes (Self-efficacy Managing Chronic Disease Scale), adherence to the Mediterranean diet (Mediterranean Diet Questionnaire), level of physical activity (International Physical Activity Questionnaire), depression (Patient Health Questionnaire), anxiety (Hospital Anxiety Scale-A), medication adherence (Adherence to Refill Medication Scale), quality of life (EQ-5D-5L) and health resources use. Data will be collected from self-reported questionnaires and electronic medical records. ETHICS AND DISSEMINATION The trial was approved by Clinical Research Ethics Committee of Gregorio Marañón University Hospital in Madrid, Nuestra Señora de Candelaria University Hospital in Santa Cruz de Tenerife and IDIAP Jordi Gol in Barcelona. The results will be disseminated through workshops, policy briefs, peer-reviewed publications, local/international conferences. TRIAL REGISTRATION NUMBER ClinicalTrials.gov Registry (NCT03959631). Pre-results.
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Affiliation(s)
- Ana Isabel González-González
- Goethe-Universitat Frankfurt am Main Institut fur Allgemeinmedizin, Frankfurt am Main, Hessen, Germany
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Gerencia Asistencial de Atención Primaria, Servicio Madrileño de Madrid, Madrid, Spain
| | - Lilisbeth Perestelo-Pérez
- Servicio de Evaluación y Planificación del Servicio Canario de la Salud, Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain
| | - Débora Koatz
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
| | - Valeria Pacheco-Huergo
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Centro de Atención Primaria Turó, Instituto Catalán de la Salud, Barcelona, Spain
| | - Vanesa Ramos-García
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
| | | | - Amado Rivero-Santana
- Servicio de Evaluación y Planificación del Servicio Canario de la Salud, Tenerife, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain
| | - Ana Toledo-Chávarri
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Tenerife, Spain
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FISC), Tenerife, Spain
| | | | - Juana Mateos-Rodilla
- Escuela Madrileña de Salud, Dirección General de Humanización y Atención al Paciente, Madrid, Spain
| | | | - Javier García-García
- Unidad de Calidad y Seguridad del Paciente. Hospital Universitario Nuestra Señora de Candelaria, Tenerife, Spain
| | | | - Luis Morales-Cobos
- Centro de Salud Las Américas, Gerencia Asistencial de Atención Primaria, Madrid, Spain
| | - Josep María Bosch-Fontcuberta
- Centro de Atención Primaria Encants, Instituto Catalán de la Salud, Barcelona, Spain
- Departament de Medicina Area de Medicina, Universitat Autonoma de Barcelona, Barcelona, Catalunya, Spain
| | | | | | | | - Marcos Muñoz-Balsa
- Unidad de Apoyo Técnico, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Yolanda Del Rey-Granado
- Unidad de Apoyo Técnico, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Sofía Garrido-Elustondo
- Centre Family and Community Care Teaching Multiprofessional Unit, Comunidad de Madrid Consejeria de Sanidad, Madrid, Spain
| | - María-Eugenia Tello-Bernabé
- Centro de Salud El Naranjo, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Ana Belén Ramírez-Puerta
- Unidad de Apoyo Técnico, Gerencia Asistencial Atención Primaria, Servicio Madrileño de Salud, Madrid, Spain
| | - Carola Orrego
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Barcelona, Spain
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60
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Slobbe LCJ, Füssenich K, Wong A, Boshuizen HC, Nielen MMJ, Polder JJ, Feenstra TL, van Oers HAM. Estimating disease prevalence from drug utilization data using the Random Forest algorithm. Eur J Public Health 2020; 29:615-621. [PMID: 30608539 PMCID: PMC6660107 DOI: 10.1093/eurpub/cky270] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Background Aggregated claims data on medication are often used as a proxy for the prevalence of diseases, especially chronic diseases. However, linkage between medication and diagnosis tend to be theory based and not very precise. Modelling disease probability at an individual level using individual level data may yield more accurate results. Methods Individual probabilities of having a certain chronic disease were estimated using the Random Forest (RF) algorithm. A training set was created from a general practitioners database of 276 723 cases that included diagnosis and claims data on medication. Model performance for 29 chronic diseases was evaluated using Receiver-Operator Curves, by measuring the Area Under the Curve (AUC). Results The diseases for which model performance was best were Parkinson’s disease (AUC = .89, 95% CI = .77–1.00), diabetes (AUC = .87, 95% CI = .85–.90), osteoporosis (AUC = .87, 95% CI = .81–.92) and heart failure (AUC = .81, 95% CI = .74–.88). Five other diseases had an AUC >.75: asthma, chronic enteritis, COPD, epilepsy and HIV/AIDS. For 16 of 17 diseases tested, the medication categories used in theory-based algorithms were also identified by our method, however the RF models included a broader range of medications as important predictors. Conclusion Data on medication use can be a useful predictor when estimating the prevalence of several chronic diseases. To improve the estimates, for a broader range of chronic diseases, research should use better training data, include more details concerning dosages and duration of prescriptions, and add related predictors like hospitalizations.
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Affiliation(s)
- Laurentius C J Slobbe
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Tilburg University, Department Tranzo, Tilburg, The Netherlands
| | - Koen Füssenich
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Groningen University, University Medical Center, Department of Epidemiology, Groningen, The Netherlands
| | - Albert Wong
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Hendriek C Boshuizen
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Wageningen University and Research, Wageningen, The Netherlands
| | - Markus M J Nielen
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
| | - Johan J Polder
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Tilburg University, Department Tranzo, Tilburg, The Netherlands
| | - Talitha L Feenstra
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Groningen University, University Medical Center, Department of Epidemiology, Groningen, The Netherlands
| | - Hans A M van Oers
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.,Tilburg University, Department Tranzo, Tilburg, The Netherlands
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61
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Jiménez-Muñoz L, Gutiérrez-Rojas L, Porras-Segovia A, Courtet P, Baca-García E. Mobile applications for the management of chronic physical conditions: A systematic review. Intern Med J 2020; 52:21-29. [PMID: 33012045 DOI: 10.1111/imj.15081] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 08/21/2020] [Accepted: 09/09/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chronic physical conditions (CPCs) decrease the quality of life of millions of people. In the absence of curative treatments, maintaining healthy lifestyle habits is one of the main pillars in their clinical management. Mobile-based interventions may help patients take care of their health and follow medical recommendations. The purpose of this review is to summarize the latest evidence about mobile phone applications (apps) for the management of CPC. METHODS We performed a systematic search of the PubMed and EMBASE databases to identify articles that explored apps for the management of CPCs, testing the apps empirically, and providing clear outputs on effectiveness and/or feasibility. 3528 articles were identified in the initial search. Following screening and selection process, 20 articles were finally included in the review. RESULTS Mobile apps for CPC are very heterogeneous. The condition with the greater number of apps available was diabetes, followed by cardiovascular diseases. Results of feasibility were generally positive, with high rates of study completion and user engagement. Some studies used incentives, monetary of otherwise. Some of the apps have been tested in randomized clinical trials showing effectiveness in improving symptoms and/or controlling analytical parameters. CONCLUSIONS Mobile apps are promising tools for the management of CPCs. Some apps have been sufficiently tested to propose their implementation in clinical practice. However, several barriers exist that can slow down the routine use of new technologies in healthcare settings. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Laura Jiménez-Muñoz
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, Jimenez Diaz Foundation Health Research Institute (IIS), Madrid, Spain.,Madrid Autonomous University, Madrid, Spain
| | | | - Alejandro Porras-Segovia
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, Jimenez Diaz Foundation Health Research Institute (IIS), Madrid, Spain
| | - Philippe Courtet
- University of Montpellier, France.,Department of Psychiatric Emergency and Acute Care, Lapeyronie Hospital, Montpellier, France
| | - Enrique Baca-García
- Department of Psychiatry, University Hospital Jimenez Diaz Foundation, Madrid, Spain.,Department of Psychiatry, Jimenez Diaz Foundation Health Research Institute (IIS), Madrid, Spain.,Psychiatry Department, University of Granada, Spain.,CIBERSAM (Centro de Investigación en Salud Mental), Carlos III Institute of Health, Madrid, Spain.,Universidad Católica del Maule, Talca, Chile.,Department of Psychiatry, University Hospital Rey Juan Carlos, Mostoles, Spain.,Department of Psychiatry, General Hospital of Villalba, Madrid, Spain.,Deparment of Psychiatry, University Hospital Infanta Elena, Valdemoro, Spain
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62
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Lopez-Rodriguez JA, Rogero-Blanco E, Aza-Pascual-Salcedo M, Lopez-Verde F, Pico-Soler V, Leiva-Fernandez F, Prados-Torres JD, Prados-Torres A, Cura-González I. Potentially inappropriate prescriptions according to explicit and implicit criteria in patients with multimorbidity and polypharmacy. MULTIPAP: A cross-sectional study. PLoS One 2020; 15:e0237186. [PMID: 32785232 PMCID: PMC7423095 DOI: 10.1371/journal.pone.0237186] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/21/2020] [Indexed: 01/25/2023] Open
Abstract
Background Multimorbidity is a global health challenge that is associated with polypharmacy, increasing the risk of potentially inappropriate prescribing (PIP). There are tools to improve prescription, such as implicit and explicit criteria. Objective To estimate the prevalence of PIP in a population aged 65 to 74 years with multimorbidity and polypharmacy, according to American Geriatrics Society Beers Criteria® (2015, 2019), the Screening Tool of Older Person’s Prescription -STOPP- criteria (2008, 2014), and the Medication Appropriateness Index -MAI- criteria in primary care. Methods This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling elderly aged 65 to 74 years, with multimorbidity and polypharmacy, who participated in the MULTIPAP trial. Socio-demographic, clinical, professional, and pharmacological-treatment variables were recorded. Potentially inappropriate prescribing was detected by computerized prescription assistance system, and family doctors evaluated the MAI. The MAI-associated factors were analysed using a logistic regression model. Results A total of 4,386 prescriptions were evaluated. The mean number of drugs was 7.4 (2.4 SD). A total of 94.1% of the patients in the study had at least one criterion for drug inappropriateness according to the MAI. Potentially inappropriate prescribing was detected in 57.7%, 43.6%, 68.8% and 71% of 50 patients according to the explicit criteria STOPP 2014, STOPP 2008, Beers 2019 and Beers 2015 respectively. For every new drug taken by a patient, the MAI score increased by 2.41 (95% CI 1.46; 3.35) points. Diabetes, ischaemic heart disease and asthma were independently associated with lower summated MAI scores. Conclusions The prevalence of potentially inappropriate prescribing detected in the sample was high and in agreement with previous literature for populations with multimorbidity and polypharmacy. The MAI criteria detected greater inappropriateness than did the explicit criteria, but their application was more complex and difficult to automate.
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Affiliation(s)
- Juan A. Lopez-Rodriguez
- Primary Healthcare Center General Ricardos, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, University Rey Juan Carlos Alcorcón, Madrid, Spain
- Research Support Unit, Primary Care Management, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Eloísa Rogero-Blanco
- Primary Healthcare Center General Ricardos, Madrid, Spain
- Medical Specialties and Public Health Department, School of Health Sciences, University Rey Juan Carlos Alcorcón, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- * E-mail:
| | | | - Fernando Lopez-Verde
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Distrito Málaga/Guadalhorce, Málaga, Spain
- Primary Healthcare Center Las Delicias, Málaga, Spain
| | - Victoria Pico-Soler
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- EpiChron Research Group, IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- Primary Healthcare Center Torrero-La Paz, Zaragoza, Spain
| | - Francisca Leiva-Fernandez
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Distrito Málaga/Guadalhorce, Málaga, Spain
- Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - J. Daniel Prados-Torres
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria Distrito Málaga/Guadalhorce, Málaga, Spain
- Biomedical Research Institute of Malaga (IBIMA), Malaga, Spain
| | - Alexandra Prados-Torres
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
- EpiChron Research Group, IIS Aragón, Aragon Health Sciences Institute, Zaragoza, Spain
- Miguel Servet University Hospital, Zaragoza, Spain
| | - Isabel Cura-González
- Medical Specialties and Public Health Department, School of Health Sciences, University Rey Juan Carlos Alcorcón, Madrid, Spain
- Research Support Unit, Primary Care Management, Madrid, Spain
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
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Ollé-Espluga L, Vargas I, Mogollón-Pérez A, Soares-de-Jesus RPF, Eguiguren P, Cisneros AI, Muruaga MC, Huerta A, Bertolotto F, Vázquez ML. Care continuity across levels of care perceived by patients with chronic conditions in six Latin-American countries. GACETA SANITARIA 2020; 35:411-419. [PMID: 32654876 DOI: 10.1016/j.gaceta.2020.02.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Revised: 01/17/2020] [Accepted: 02/17/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE To analyse the care continuity across levels of care perceived by patients with chronic conditions in public healthcare networks in six Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and to explore associated factors. METHOD Cross-sectional study by means of a survey conducted to a random sample of chronic patients in primary care centres of the study networks (784 per country) using the questionnaire Cuestionario de Continuidad Asistencial Entre Niveles de Atención (CCAENA)©. Patients had at least one chronic condition and had used two levels of care in the 6 months prior to the survey for the same medical condition. Descriptive analysis and multivariable logistic regression were carried out. RESULTS Although there are notable differences between the networks analysed, the results show that chronic patients perceive significant discontinuities in the exchange of clinical information between primary care and secondary care doctors and in access to secondary care following a referral; as well as, to a lesser degree, regarding clinical coherence across levels. Relational continuity with primary care and secondary care doctors and information transfer are positively associated with care continuity across levels; no individual factor is systematically associated with care continuity. CONCLUSIONS Main perceived discontinuities relate to information transfer and access to secondary care after a referral. The study indicates the importance of organisational factors to improve chronic patients' quality of care.
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Affiliation(s)
- Laia Ollé-Espluga
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain; Department of Sociology, University of Graz, Graz, Austria
| | - Ingrid Vargas
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain.
| | - Amparo Mogollón-Pérez
- Escuela de Medicina y Ciencias de la Salud, Universidad del Rosario, Bogotá, Colombia
| | | | - Pamela Eguiguren
- Escuela de Salud Pública Dr. Salvador Allende Gossens, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile
| | | | | | - Adriana Huerta
- Área de Investigación, Secretaría de Salud Pública Municipal, Rosario, Argentina
| | | | - María-Luisa Vázquez
- Health Policy and Health Services Research Group, Health Policy Research Unit, Consortium for Health Care and Social Services of Catalonia, Barcelona, Spain
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van Erp NF, Helsper CW, Slottje P, Brandenbarg D, Büchner FL, van Asselt KM, Muris JWM, Kortekaas MF, Peeters PHM, de Wit NJ. Time to diagnosis of symptomatic gastric and oesophageal cancer in the Netherlands: Where is the room for improvement? United European Gastroenterol J 2020; 8:607-620. [PMID: 32250202 PMCID: PMC7268938 DOI: 10.1177/2050640620917804] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Accepted: 03/02/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND An efficient diagnostic pathway and early stage diagnosis for cancer patients is widely pursued. This study aims to chart the duration of the diagnostic pathway for patients with symptomatic oesophageal and gastric cancer, to identify factors associated with long duration and to assess the association of duration with tumour stage at diagnosis. METHODS This was a retrospective cohort study, using electronic health records of six routine primary care databases covering about 640,000 patients, partly linked to the Netherlands Cancer Registry. Symptomatic patients with oesophageal and gastric cancer (2010-2015) that presented in primary care were included. Duration of four diagnostic intervals was determined: patient interval; first symptoms to primary care consultation, primary care interval; consultation to referral, secondary care interval; referral to diagnosis, and the diagnostic interval; consultation to diagnosis. Characteristics associated with 'long duration' (≥P75 duration) were assessed using log-binomial regression. Median durations were stratified for tumour stages. RESULTS Among 312 symptomatic patients with upper gastrointestinal cancer, median durations were: patient interval: 29 days (interquartile interval 15-73), primary care interval: 12 days (interquartile interval 1-43), secondary care interval: 13 days (interquartile interval 6-29) and diagnostic interval: 31 days (11-74). Patient interval duration was comparable for patients with and without alarm symptoms. Absence of cancer-specific alarm symptoms was associated with 'long duration' of primary care interval and secondary care interval: relative risk 5.0 (95% confidence interval 2.7-9.1) and 2.1 (95% confidence interval 1.3-3.7), respectively. Median diagnostic interval duration for local stage disease was 51 days (interquartile interval 13-135) versus 27 days (interquartile interval 11-71) for advanced stage (p = 0.07). CONCLUSION In the diagnostic pathway of upper gastrointestinal cancers, the longest interval is the patient interval. Reducing time to diagnosis may be achieved by improving patients' awareness of alarm symptoms and by diagnostic strategies which better identify cancer patients despite low suspicion.
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Affiliation(s)
- NF van Erp
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - CW Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - P Slottje
- Department of General Practice and Elderly Care Medicine, VU University Medical Centre, Amsterdam, the Netherlands
| | - D Brandenbarg
- Department of General Practice and Elderly Care Medicine, University of Groningen, Groningen, the Netherlands
| | - FL Büchner
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands
| | - KM van Asselt
- Department of General Practice, Amsterdam UMC, Amsterdam, the Netherlands
| | - JWM Muris
- Department of Family Medicine, Maastricht University, Maastricht, the Netherlands
| | - MF Kortekaas
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - PHM Peeters
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - NJ de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
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Stirland LE, Gregory S, Russ TC, Ritchie CW, Muniz-Terrera G. Associations between midlife chronic conditions and medication use with anxiety and depression: A cross-sectional analysis of the PREVENT Dementia study. JOURNAL OF COMORBIDITY 2020; 10:2235042X20920443. [PMID: 32426293 PMCID: PMC7218309 DOI: 10.1177/2235042x20920443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 02/24/2020] [Accepted: 03/26/2020] [Indexed: 11/16/2022]
Abstract
Background Multimorbidity including physical and mental illness is increasing in prevalence. We aimed to investigate the associations between physical conditions and medication use with anxiety and depression in midlife. Methods We conducted an observational cross-sectional study of volunteers in the PREVENT Dementia study. Using logistic and linear regression, we investigated the association between increasing numbers of self-reported chronic physical conditions and medications with self-reported depression and anxiety disorder, and scores on the Center for Epidemiologic Studies Depression (CES-D) scale and Spielberger State-Trait Anxiety Inventory (STAI) state subtest. Results Of the 210 participants, 148 (71%) were women and 188 (90%) Caucasian. The mean age was 52 (standard deviation (SD) = 5.5) years. The mean number of physical conditions was 2.2 (SD = 1.9) and medications 1.7 (SD = 2.2). Each additional physical condition was associated with increased odds of self-reported depression (odds ratio (OR) 1.41, 95% confidence interval (CI) 1.11-1.80; p = 0.004, adjusted for age and gender) and anxiety disorder (OR 1.70, 95% CI 1.30-2.37; p < 0.001). Increasing medication use was associated with self-reported depression (adjusted OR per additional medication 1.35, 95% CI 1.08-1.71; p = 0.008) but not anxiety disorder. For each additional condition, CES-D scores increased by 0.72 (95% CI 0.11-1.33; p = 0.020) and for each extra medication, by 0.88 (95% CI 0.32-1.44; p = 0.002). There was no significant association between increasing conditions and medications with STAI scores. In models accounting for antidepressant use, all associations were attenuated. Conclusions Having more physical conditions is associated with anxiety and depression in midlife, and taking more medications is associated with depression but not anxiety.
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Affiliation(s)
- Lucy E Stirland
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Sarah Gregory
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Tom C Russ
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Alzheimer Scotland Dementia Research Centre, University of Edinburgh, Edinburgh, UK.,Psychiatry of Old Age, NHS Lothian, Edinburgh, UK
| | - Craig W Ritchie
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
| | - Graciela Muniz-Terrera
- Edinburgh Dementia Prevention, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK.,Division of Psychiatry, Centre for Clinical Brain Sciences, University of Edinburgh, Edinburgh, UK
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Rijken M, Valderas JM, Heins M, Schellevis F, Korevaar J. Identifying high-need patients with multimorbidity from their illness perceptions and personal resources to manage their health and care: a longitudinal study. BMC FAMILY PRACTICE 2020; 21:75. [PMID: 32349683 PMCID: PMC7191697 DOI: 10.1186/s12875-020-01148-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 04/22/2020] [Indexed: 01/15/2023]
Abstract
Background A proactive person-centred care process is advocated for people with multimorbidity. To that aim, general practitioners may benefit from support in the identification of high-need patients, i.e. patients who are high or suboptimal users of health services and/or have a poor quality of life. To develop such support, we examined whether knowledge about patients’ illness perceptions and personal resources to manage their health and care is useful to identify high-need patients among multimorbid general practice populations. Methods Survey data, collected in 2016 and 2017, of 601 patients with two or more chronic diseases (e.g. COPD, diabetes, Parkinson’s disease) registered with 40 general practices in the Netherlands were analysed by logistic regression analysis to predict frequent contact with the general practice, contact with general practice out-of-office services, unplanned hospitalisations and poor health related quality of life. Patients’ illness perceptions and personal resources (education, health literacy, mastery, mental health status, financial resources, social support) were included as predictors. Results The four outcomes were only weakly associated among themselves (Phi .07–.19). Patients’ illness perceptions and personal resources were of limited value to predict potentially suboptimal health service use, but they were important predictors of health related quality of life. Patients with a poor health related quality of life could be identified by their previously reported illness perceptions (attributing many symptoms to their chronic conditions (B = 1.479, P < .001), a high level of concern (B = 0.844, P = .002) and little perceived control over their illness (B = -0.728, P = .006)) combined with an experienced lack of social support (B = -0.527, P = .042) and a poor mental health status (B = -0.966, P = .001) (sensitivity 80.7%; specificity 68.1%). Conclusions Multimorbid patients who frequently contact the general practice, use general practice out-of-office services, have unplanned hospitalisations or a poor health related quality of life are largely distinct high-need subgroups. Multimorbid patients at risk of developing a poor quality of life can be identified from specific illness beliefs, a poor mental health status and unmet social needs.
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Affiliation(s)
- Mieke Rijken
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands. .,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland.
| | - José Maria Valderas
- Health Services & Policy Research, Exeter Collaboration for Academic Primary Care (APEx), NIHR PenCLAHRC, University of Exeter, Exeter, UK
| | - Marianne Heins
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands
| | - Francois Schellevis
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands.,Department of General Practice and Elderly Care Medicine, Amsterdam UMC, Amsterdam, The Netherlands
| | - Joke Korevaar
- Nivel (Netherlands Institute for Health Services Research), PO Box 1568, 3500, BN, Utrecht, The Netherlands
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van Mastrigt GAPG, van Eeden M, van Heugten CM, Tielemans N, Schepers VPM, Evers SMAA. A trial-based economic evaluation of the Restore4Stroke self-management intervention compared to an education-based intervention for stroke patients and their partners. BMC Health Serv Res 2020; 20:294. [PMID: 32268896 PMCID: PMC7140323 DOI: 10.1186/s12913-020-05103-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Accepted: 03/11/2020] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Since stroke survivors are increasingly responsible for managing stroke-related changes in their own health and lifestyle, self-management skills are required. In a recent randomised controlled trial a self-management intervention based on proactive coping action planning (SMI) in comparison with an education-based intervention (EDU) in stroke patients was investigated. However, no relevant treatment effects on the Utrecht Proactive Coping Competence scale (UPCC) and the Utrecht Scale for Evaluation of Rehabilitation Participation (USER-Participation) were found. The current study is a trial-based economic evaluation from a societal perspective comparing the same interventions (SMI versus EDU). METHODS UPCC, USER-Participation and EuroQol (EQ-5D-3 L) and costs were measured at baseline, three, six and twelve months after treatment. For the cost-effectiveness analyses, incremental cost effectiveness ratios (ICERs) were calculated for UPCC and USER-Participation. For the cost-utility analyses the incremental cost utility ratio (ICUR) was expressed in cost per Quality Adjusted Life Years (QALYs). Outcomes were tested by means of AN(C)OVA analyses and costs differences by means of bootstrapping. Bootstrapping, sensitivity analyses and a subgroup analysis were performed to test the robustness of the findings. RESULTS One hundred thirteen stroke patients were included in this study. The mean differences in USER-Participation scores (95%CI:-13.08,-1.61, p-value = .013) were significant different between the two groups, this does not account for UPCC scores (95%CI:-.267, .113, p-value = not significant) and QALYs (p-value = not significant) at 12 months. The average total societal costs were not significantly different (95%CI:€-3380,€7099) for SMI (€17,333) in comparison with EDU (€15,520). Cost-effectiveness analyses showed a mean ICER of 26,514 for the UPCC and 346 for the USER-Participation. Cost-utility analysis resulted in an ICUR of €44,688 per QALY. Assuming a willingness to pay (WTP) threshold of €50,000 per QALY, the probability that SMI will be cost-effective is 52%. Sensitivity analyses and subgroup analysis showed the robustness of the results. CONCLUSIONS SMI is probably not a cost-effective alternative in comparison with EDU. Based on the current results, the value of implementing SMI for a stroke population is debatable. We recommend further exploration of the potential cost-effectiveness of stroke-specific self-management interventions focusing on different underlying mechanisms and using different control treatments.
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Affiliation(s)
- Ghislaine A. P. G. van Mastrigt
- CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Mitchel van Eeden
- CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- MHeNS, School for Mental Health and Neuroscience; Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Caroline M. van Heugten
- MHeNS, School for Mental Health and Neuroscience; Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- Department of Neuropsychology and Psychopharmacology, Faculty of Psychology and Neuroscience, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
| | - Nienke Tielemans
- MHeNS, School for Mental Health and Neuroscience; Department of Psychiatry and Neuropsychology, Faculty of Health, Medicine and Life Sciences Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Vera P. M. Schepers
- Center of Excellence in Rehabilitation Medicine, Brain Center Rudolf Magnus, University Medical Center Utrecht, and De Hoogstraat Rehabilitation, Utrecht, The Netherlands
| | - Silvia M. A. A. Evers
- CAPHRI, School for Public Health and Primary Care, Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, P.O. Box 616, 6200 MD Maastricht, the Netherlands
- Department of Public Mental Healthcare, Trimbos Institute, Netherlands Institute of Mental Health and Addiction, Postbus 725, 3500 AS Utrecht, The Netherlands
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Kaneko M, Van Boven K, Takayanagi H, Kusaba T, Yamada T, Matsushima M. Multicentre descriptive cross-sectional study of Japanese home visit patients: reasons for encounter, health problems and multimorbidity. Fam Pract 2020; 37:227-233. [PMID: 31586446 DOI: 10.1093/fampra/cmz056] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND GP in Japan are encouraged to conduct home visits for older adults. However, most previous studies on home visits were based on secondary analyses of billing data that did not include reasons for the encounter. OBJECTIVES This study aimed to describe home visit care by GP in Japan, including reasons for encounter, health problems, episodes of care, comprehensiveness and multimorbidity. METHODS This multicentre descriptive cross-sectional study used the International Classification of Primary Care, second edition, and was conducted in Japan from 1 October 2016 to 31 March 2017. Participants were patients who received home visits from 10 enrolled GPs working in urban and rural areas across Japan. The main outcome measures were reasons for encounter, health problems and multimorbidity. RESULTS Of 253 potential patient participants, 250 were included in this analysis; 92.4% were aged 65 years and older. We registered 1,278 regular home visits and 110 emergency home visits. The top three reasons for encounters home visits were associated with cardiovascular and gastrointestinal disorders: prescriptions for cardiovascular diseases (n = 796), medical examination/health evaluation for cardiovascular diseases (n = 758) and prescriptions for gastrointestinal problems (n = 554). About 50% of patients had multimorbidity. Cardiovascular, endocrine and neuropsychological diseases were the most frequent problems in patients with multimorbidity. CONCLUSIONS The main reasons for encounter were prescriptions for chronic conditions. Emergency visits accounted for 8% of all visits. Around half of the patients had multimorbidity. This information may help GPs and policy makers to better assess home visit patients' needs.
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Affiliation(s)
- Makoto Kaneko
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Nishishimbashi, Minato-ku, Tokyo, Japan.,Department of Family and Community Medicine, Hamamatsu University School of Medicine, Handayama, Higashi-ku, Hamamatsu, Japan
| | - Kees Van Boven
- Department of Primary and Community Care, Radboud University, Geert Grooteplein, EZ Nijmegen, The Netherlands
| | - Hiroshi Takayanagi
- The Community Medical Support Center of the Kumamoto University Hospital, Honjo, Kumamoto Chuo-ku, Kumamoto, Japan
| | - Tesshu Kusaba
- The Hokkaido Centre for Family Medicine, Higashi, Higashikukita, Sapporo-shi, Hokkaido, Japan
| | | | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Nishishimbashi, Minato-ku, Tokyo, Japan
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Rogero-Blanco E, Lopez-Rodriguez JA, Sanz-Cuesta T, Aza-Pascual-Salcedo M, Bujalance-Zafra MJ, Cura-Gonzalez I. Use of an Electronic Clinical Decision Support System in Primary Care to Assess Inappropriate Polypharmacy in Young Seniors With Multimorbidity: Observational, Descriptive, Cross-Sectional Study. JMIR Med Inform 2020; 8:e14130. [PMID: 32149715 PMCID: PMC7078622 DOI: 10.2196/14130] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 10/22/2019] [Accepted: 12/17/2019] [Indexed: 01/25/2023] Open
Abstract
Background Multimorbidity is a global health problem that is usually associated with polypharmacy, which increases the risk of potentially inappropriate prescribing (PIP). PIP entails higher hospitalization rates and mortality and increased usage of services provided by the health system. Tools exist to improve prescription practices and decrease PIP, including screening tools and explicit criteria that can be applied in an automated manner. Objective This study aimed to describe the prevalence of PIP in primary care consultations among patients aged 65-75 years with multimorbidity and polypharmacy, detected by an electronic clinical decision support system (ECDSS) following the 2015 American Geriatrics Society Beers Criteria, the European Screening Tool of Older Person’s Prescription (STOPP), and the Screening Tool to Alert doctors to Right Treatment (START). Methods This was an observational, descriptive, cross-sectional study. The sample included 593 community-dwelling adults aged 65-75 years (henceforth called young seniors), with multimorbidity (≥3 diseases) and polypharmacy (≥5 medications), who had visited their primary care doctor at least once over the last year at 1 of the 38 health care centers participating in the Multimorbidity and Polypharmacy in Primary Care (Multi-PAP) trial. Sociodemographic data, clinical and pharmacological treatment variables, and PIP, as detected by 1 ECDSS, were recorded. A multivariate logistic regression model with robust estimators was built to assess the factors affecting PIP according to the STOPP criteria. Results PIP was detected in 57.0% (338/593; 95% CI 53-61) and 72.8% (432/593; 95% CI 69.3-76.4) of the patients according to the STOPP criteria and the Beers Criteria, respectively, whereas 42.8% (254/593; 95% CI 38.9-46.8) of the patients partially met the START criteria. The most frequently detected PIPs were benzodiazepines (BZD) intake for more than 4 weeks (217/593, 36.6%) using the STOPP version 2 and the prolonged use of proton pump inhibitors (269/593, 45.4%) using the 2015 Beers Criteria. Being a woman (odds ratio [OR] 1.43, 95% CI 1.01-2.01; P=.04), taking a greater number of medicines (OR 1.25, 95% CI 1.14-1.37; P<.04), working in the primary sector (OR 1.91, 95% CI 1.25-2.93; P=.003), and being prescribed drugs for the central nervous system (OR 3.75, 95% CI 2.45-5.76; P<.001) were related to a higher frequency of PIP. Conclusions There is a high prevalence of PIP in primary care as detected by an ECDSS in community-dwelling young seniors with comorbidity and polypharmacy. The specific PIP criteria defined by this study are consistent with the current literature. This ECDSS can be useful for supervising prescriptions in primary health care consultations.
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Affiliation(s)
- Eloisa Rogero-Blanco
- General Ricardos Primary Health Care Centre, Madrid, Spain.,Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Madrid, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain
| | - Juan A Lopez-Rodriguez
- General Ricardos Primary Health Care Centre, Madrid, Spain.,Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Madrid, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Research Support Unit, Primary Care Management, Madrid, Spain
| | - Teresa Sanz-Cuesta
- Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Research Support Unit, Primary Care Management, Madrid, Spain
| | | | - M Jose Bujalance-Zafra
- Dirección Unidad Gestión Clínica Victoria en Málaga, Servicio Andaluz de Salud, Málaga, Spain
| | - Isabel Cura-Gonzalez
- Medical Specialties and Public Health, School of Health Sciences, University Rey Juan Carlos, Alcorcón, Madrid, Spain.,Health Services Research on Chronic Patients Network (REDISSEC), Madrid, Spain.,Research Support Unit, Primary Care Management, Madrid, Spain
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Aguado A, Moratalla-Navarro F, López-Simarro F, Moreno V. MorbiNet: multimorbidity networks in adult general population. Analysis of type 2 diabetes mellitus comorbidity. Sci Rep 2020; 10:2416. [PMID: 32051506 PMCID: PMC7016191 DOI: 10.1038/s41598-020-59336-1] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Accepted: 01/10/2020] [Indexed: 01/08/2023] Open
Abstract
Multimorbidity has great impact on health care. We constructed multimorbidity networks in the general population, extracted subnets focused on common chronic conditions and analysed type 2 diabetes mellitus (T2DM) comorbidity network. We used electronic records from 3,135,948 adult people in Catalonia, Spain (539,909 with T2DM), with at least 2 coexistent chronic conditions within the study period (2006-2017). We constructed networks from odds-ratio estimates adjusted by age and sex and considered connections with OR > 1.2 and p-value < 1e-5. Directed networks and trajectories were derived from temporal associations. Interactive networks are freely available in a website with the option to customize characteristics and subnets. The more connected conditions in T2DM undirected network were: complicated hypertension and atherosclerosis/peripheral vascular disease (degree: 32), cholecystitis/cholelithiasis, retinopathy and peripheral neuritis/neuropathy (degree: 31). T2DM has moderate number of connections and centrality but is associated with conditions with high scores in the multimorbidity network (neuropathy, anaemia and digestive diseases), and severe conditions with poor prognosis. The strongest associations from T2DM directed networks were to retinopathy (OR: 23.8), glomerulonephritis/nephrosis (OR: 3.4), peripheral neuritis/neuropathy (OR: 2.7) and pancreas cancer (OR: 2.4). Temporal associations showed the relevance of retinopathy in the progression to complicated hypertension, cerebrovascular disease, ischemic heart disease and organ failure.
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Affiliation(s)
- Alba Aguado
- CAP Sagrada Familia. Consorci Sanitari Integral, Barcelona, Spain.
| | - Ferran Moratalla-Navarro
- Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain
- ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain
| | - Flora López-Simarro
- ABS Urban Martorell, Catalan Institute of Health, Martorell, Barcelona, Spain
| | - Victor Moreno
- Oncology Data Analytics Program, Catalan Institute of Oncology (ICO), L'Hospitalet de Llobregat, Barcelona, Spain.
- ONCOBELL Program, Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
- Department of Clinical Sciences, Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain.
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Smeets RGM, Elissen AMJ, Kroese MEAL, Hameleers N, Ruwaard D. Identifying subgroups of high-need, high-cost, chronically ill patients in primary care: A latent class analysis. PLoS One 2020; 15:e0228103. [PMID: 31995630 PMCID: PMC6988945 DOI: 10.1371/journal.pone.0228103] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Accepted: 01/07/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction Segmentation of the high-need, high-cost (HNHC) population is required for reorganizing care to accommodate person-centered, integrated care delivery. Therefore, we aimed to identify and characterize relevant subgroups of the HNHC population in primary care by using demographic, biomedical, and socioeconomic patient characteristics. Methods This was a retrospective cohort study within a Dutch primary care group, with a follow-up period from September 1, 2014 to August 31, 2017. Chronically ill patients were included in the HNHC population if they belonged to the top 10% of care utilizers and/or suffered from multimorbidity and had an above-average care utilization. In a latent class analysis, forty-one patient characteristics were initially used as potential indicators of heterogeneity in HNHC patients’ needs. Results Patient data from 12 602 HNHC patients was used. A 4-class model was considered statistically and clinically superior. The classes were named according to the characteristics that were most dominantly present and distinctive between the classes (i.e. mainly age, household position, and source of income). Class 1 (‘older adults living with partner’) included 39.3% of patients, class 2 (‘older adults living alone’) included 25.5% of patients, class 3 (‘middle-aged, employed adults with family’) included 23.3% of patients, and class 4 (‘middle-aged adults with social welfare dependency’) included 11.9% of patients. Diabetes was the most common condition in all classes; the second most prevalent condition differed between osteoarthritis in class 1 (21.7%) and 2 (23.8%), asthma in class 3 (25.3%), and mood disorders in class 4 (23.1%). Furthermore, while general practitioner (GP) care utilization increased during the follow-up period in the classes of older adults, it remained relatively stable in the middle-aged classes. Conclusions Although the HNHC population is heterogeneous, distinct subgroups with relatively homogeneous patterns of mainly demographic and socioeconomic characteristics can be identified. This calls for tailoring care and increased attention for social determinants of health.
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Affiliation(s)
- Rowan G. M. Smeets
- Department of Health Services Research, Maastricht University, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
- * E-mail:
| | - Arianne M. J. Elissen
- Department of Health Services Research, Maastricht University, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Mariëlle E. A. L. Kroese
- Department of Health Services Research, Maastricht University, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Niels Hameleers
- Department of Health Services Research, Maastricht University, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
| | - Dirk Ruwaard
- Department of Health Services Research, Maastricht University, Faculty of Health, Medicine and Life Sciences, Care and Public Health Research Institute (CAPHRI), Maastricht, The Netherlands
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Finlay-Jones A, Boyes M, Perry Y, Sirois F, Lee R, Rees C. Online self-compassion training to improve the wellbeing of youth with chronic medical conditions: protocol for a randomised control trial. BMC Public Health 2020; 20:106. [PMID: 31992269 PMCID: PMC6986046 DOI: 10.1186/s12889-020-8226-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 01/15/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Chronic medical conditions (CMCs) affect up to 35% of children and adolescents. Youth with chronic medical conditions are at an increased risk of psychological distress and reduced health-related quality of life, and report rates of mental illness up to double that of their physically healthy peers. Accessible, evidence-based interventions for young people with chronic illness are urgently required to improve their mental health and daily functioning. Self-compassion involves taking a mindful, accepting approach to difficult experiences, being aware that one is not alone in one's suffering, and being kind and understanding with oneself during challenging times. Self-compassion shares strong associations with mental health outcomes among young people and preliminary work indicates that interventions that build self-compassion have the potential to substantially improve youth mental health. Self-compassion is also associated with better physical and mental health outcomes among individuals living with CMCs. While face-to-face self-compassion training is available, there are several barriers to access for youth with CMCs. Online self-compassion training potentially offers an accessible alternative for this high-risk group. METHODS Self-Compassion Online (SCO) is a self-compassion program that has been tested with a non-clinical adult group. For the proposed trial, a reference group of youth (16-25 years) with chronic illness reviewed the program and proposed adaptations to improve its suitability for youth with chronic illness. In alignment with the SPIRIT Checklist, this paper outlines the protocol for a CONSORT-compliant, single-blind randomised controlled trial to test the efficacy of the adapted program, relative to a waitlist control, for improving self-compassion, wellbeing, distress, emotion regulation, coping and quality of life among young Australians with CMCs. Mechanisms of action and feasibility of SCO will be analysed using quantitative data and participant interviews, respectively. Finally, cost-utility will be analysed using health-related quality of life data. DISCUSSION The SCO program could provide a scalable solution for improving psychological outcomes and quality of life among youth with chronic illness. The proposed trial will be the first to determine its efficacy for improving these outcomes, relative to waitlist control. TRIAL REGISTRATION The trial was registered on the Australian New Zealand Clinical Trials Registry on the 11th April 2019, ACTRN12619000572167. Protocol version: Version 2, 21 December 2019.
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Affiliation(s)
- Amy Finlay-Jones
- Telethon Kids Institute, PO Box 855, West Perth, Western Australia, 6872, Australia. .,School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia. .,University of Western Australia, 35 Stirling Hwy, Crawley, WA, 6009, Australia.
| | - Mark Boyes
- School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Yael Perry
- Telethon Kids Institute, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Fuschia Sirois
- Department of Psychology, University of Sheffield, Cathedral Court, 1 Vicar Lane, Sheffield, S1 2LT, UK
| | - Rachael Lee
- School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
| | - Clare Rees
- School of Psychology, Curtin University, GPO Box U1987, Perth, Western Australia, 6845, Australia
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Naunton J, Harrison C, Britt H, Haines T, Malliaras P. General practice management of rotator cuff related shoulder pain: A reliance on ultrasound and injection guided care. PLoS One 2020; 15:e0227688. [PMID: 31929588 PMCID: PMC6957186 DOI: 10.1371/journal.pone.0227688] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Accepted: 12/26/2019] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVE To describe general practitioner's (GP's) current management of rotator cuff related shoulder pain (RCRP) in Australia and identify if this is consistent with recommended care and best available evidence. The secondary aim was to determine if GP management of RCRP changed over time. METHODS Data about management of RCRP by Australian GPs was extracted from the Bettering the Evaluation of Care of Health program database over its final five years (April 2011-March 2016). Patient and GP characteristics and encounter management data were extracted. Results are reported using descriptive statistics with point estimates and 95% confidence intervals. A secondary analysis over a 16 year period (2000-2016) examined management data for RCRP in four year periods. RESULTS RCRP was the most common shoulder condition managed by GPs at 5.12 per 1,000 encounters; and at an estimated 732,000 times nationally in 2015-2016. Management rate was higher among male patients (5.5 per 1000 encounters c.f. 4.8 for female patients) and was highest in the 45-64 year old age group (8.6 per 1000). RCRP was most frequently managed with medications (54.7%), steroid injection (19.5%) followed by non-steroidal anti-inflammatory drugs (NSAIDs) (19.1%). Imaging was ordered for 43.4% (ultrasound 41.2% and x-ray 11.6%) of all RCRP presentations (new and returning). Over half (53.0%) of new RCRP presentations were referred for ultrasound imaging. In the 16 year period 2000-16 ultrasound imaging more than doubled from 19.1% to 41.9% of management occasions. In parallel, prescribed steroid injection increased from 9.8% to 19.7%. CONCLUSION The usual care provided by GPs for RCRP relies on the use of ultrasound and steroid injection. This is not consistent with recommended care and clinical guidelines that recommend these are delayed until after 6-12 weeks of NSAID medication, exercise and activity modification. There has been a significant increase in the rate of steroid injection and ultrasound imaging, which may be due in part to policy change.
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Affiliation(s)
- Josh Naunton
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Christopher Harrison
- Menzies Centre for Health Policy, Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Helena Britt
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Terrence Haines
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Victoria, Australia
| | - Peter Malliaras
- Physiotherapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Victoria, Australia
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Bernard L, Ecochard R, Gueyffier F, Letrilliart L. Drug prescription goals in primary care: a cross-sectional study. BMC Health Serv Res 2020; 20:6. [PMID: 31898496 PMCID: PMC6941394 DOI: 10.1186/s12913-019-4870-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 12/24/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Care goals are often implicit, although their identification is a key element of any prescription process. This study aimed to describe the clinical goals of drug prescriptions in general practice, their determinants and the agreement between physicians and patients. METHODS This was a cross-sectional study conducted by 11 resident trainees acting as observers in 23 general practices. The residents recorded the indication and main physician's goal for all drugs prescribed during five consultation days in each practice in December 2015, and the main patient's goal for a sub-sample of consultations. We used an eight-category generic classification of prescription goals, including three specific (mortality, morbidity and cure), three non-specific (symptoms, quality of life, functioning) and two non-specified (other goal, no goal) categories. Analyses were based on a multivariable, multilevel model and on the kappa statistic applied to the sub-sample of consultations. RESULTS The sample encompassed 2141 consultations and 5036 drugs. The main physicians' goal of drug prescriptions was to relieve symptoms (43.3%). The other goals were to decrease the risk of morbidity (22.4%), to cure disease (11.7%), to improve quality of life (10.6%), to decrease the risk of mortality (8.5%) and to improve functioning (1.8%). The choice of a specific goal was more frequent in patients with the following characteristics: over 50 (OR [1.09;1.15]), of male gender (OR [1.09;1.39]), with full financial coverage for a long-term condition (OR [1.47;1.97]), known by the physician (OR [1.19;2.23]), or with a somatic health problem (OR [2.56;4.17]). Cohen's kappa for drug prescription goals between the patients and the physicians was 0.26 (0.23-0.30). CONCLUSIONS Physicians' goals are poorly shared with patients. It remains to be assessed whether it is possible to collect and discuss information on prescription goals on a daily basis.
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Affiliation(s)
- Louis Bernard
- Univ. Lyon, Université Claude Bernard Lyon 1, Collège universitaire de médecine générale, F-69008 Lyon, France
| | - René Ecochard
- Hospices Civils de Lyon, Service de Biostatistique-Bioinformatique, Lyon, France
- Université Lyon 1, Villeurbanne, France
- Laboratoire de Biométrie et Biologie Évolutive, Équipe Biostatistique-Santé, CNRS, Villeurbanne, France
| | - François Gueyffier
- UMR5558, service de pharmacologie et toxicologie, faculté Laennec, Lyon, France
| | - Laurent Letrilliart
- Univ. Lyon, Université Claude Bernard Lyon 1, Collège universitaire de médecine générale, F-69008 Lyon, France
- Univ. Lyon, Université Claude Bernard Lyon 1, HESPER EA 7425, F-69008 Lyon, France
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Aguado A, García del Álamo M. Comorbilidad y síntomas digestivos asociados a depresión en pacientes mayores de 60 años. Semergen 2020; 46:27-32. [DOI: 10.1016/j.semerg.2019.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/11/2019] [Accepted: 03/18/2019] [Indexed: 02/07/2023]
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Catzikiris N, Tapley A, Morgan S, van Driel M, Spike N, Holliday EG, Ball J, Henderson K, McArthur L, Magin P. Emergency department referral patterns of Australian general practitioner registrars: a cross-sectional analysis of prevalence, nature and associations. AUST HEALTH REV 2019; 43:21-28. [PMID: 29117892 DOI: 10.1071/ah17005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Accepted: 09/28/2017] [Indexed: 11/23/2022]
Abstract
Objective Limited international evidence suggests general practice registrars' emergency department (ED) referral rates exceed those of established general practitioners (GPs). The aim of the present study was to fill an evidence gap by establishing the prevalence, nature and associations of Australian GP registrar ED referrals. Methods A cross-sectional analysis was performed of the Registrar Clinical Encounters in Training (ReCEnT) cohort study of GP registrars' consultation experiences, between 2010 and 2015. The outcome factor in logistic regression analysis was referral to an ED. Independent variables included patient-level, registrar-level, practice-level and consultation-level factors. Results In all, 1161 GP registrars (response rate 95.5%) contributed data from 166966 consultations, comprising 258381 individual problems. Based on responses, 0.5% of problems resulted in ED referral, of which nearly 25% comprised chest pain, abdominal pain and fractures. Significant (P < 0.05) associations of ED referral included patient age <15 and >34 years, the patient being new to the registrar, one particular regional training provider (RTP), in-consultation information or assistance being sought and learning goals being generated. Outer regional-, remote- or very remote-based registrars made significantly fewer ED referrals than more urban registrars. Of the problems referred to the ED, 45.5% involved the seeking of in-consultation information or assistance, predominantly from supervisors. Conclusions Registrars' ED referral rates are nearly twice those of established GPs. The findings of the present study suggest acute illnesses or injuries present registrars with clinical challenges and real learning opportunities, and highlight the importance of continuity of care, even for acute presentations. What is known about the topic? A GP's decision concerning continued community- versus hospital-based management of acute presentations demands careful consideration of a suite of factors, including implications for patient care and resource expenditure. General practice vocational training is a critical period for the development of GP registrars' long-term patterns of practice. Although limited international evidence suggests GP registrars and early career GPs refer patients to the ED at a higher rate than their more experienced peers, these studies involved small subject numbers and did not investigate associations of registrars making an ED referral. Relevant Australian studies focusing on GP registrars' ED referral patterns are lacking. What does this paper add? The present ongoing cohort study is the first to establish the patterns of ED referrals made by Australian GP registrars, encompassing five general practice RTPs across five states, with participating registrars practising in urban, rural, remote and very remote practices. Several significant associations were found with GP registrars making ED referrals, including patient age, continuity of care, the registrar's RTP, assistance sought by the registrar and rurality of the registrar's practice. What are the implications for practitioners? The higher likelihood of GP registrars seeing acute presentations than their more established practice colleagues, coupled with a demonstrated association of registrars seeking in-consultation assistance for such presentations, highlights the importance of GP supervisor accessibility in facilitating ED referral appropriateness and in the development of registrars' safe clinical practice.
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Affiliation(s)
- Nigel Catzikiris
- GP Synergy, NSW and ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia. ;
| | - Amanda Tapley
- GP Synergy, NSW and ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia. ;
| | - Simon Morgan
- GP Synergy, NSW and ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia. ;
| | - Mieke van Driel
- Discipline of General Practice, School of Medicine, University of Queensland, Level 8 Health Sciences Building, Royal Brisbane and Women's Hospital, Brisbane, Qld 4029, Australia
| | - Neil Spike
- Eastern Victoria GP Training, 15 Cato Street, Hawthorn, Vic. 3122, Australia. Email
| | - Elizabeth G Holliday
- School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia
| | - Jean Ball
- Public Health Research Program, Hunter Medical Research Institute, Locked Bag 1000, New Lambton, NSW 2305, Australia.
| | - Kim Henderson
- GP Synergy, NSW and ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia. ;
| | - Lawrie McArthur
- Discipline of General Practice, University of Adelaide, 183 Melbourne Street, North Adelaide, SA 5006, Australia. Email
| | - Parker Magin
- GP Synergy, NSW and ACT Research and Evaluation Unit, 20 McIntosh Drive, Mayfield West, NSW 2304, Australia. ;
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Rasul FB, Kalmus O, Sarker M, Adib HI, Hossain MS, Hasan MZ, Brenner S, Nazneen S, Islam MN, De Allegri M. Determinants of health seeking behavior for chronic non-communicable diseases and related out-of-pocket expenditure: results from a cross-sectional survey in northern Bangladesh. JOURNAL OF HEALTH, POPULATION, AND NUTRITION 2019; 38:48. [PMID: 31870436 PMCID: PMC6929492 DOI: 10.1186/s41043-019-0195-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Accepted: 10/17/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND In spite of high prevalence rates, little is known about health seeking and related expenditure for chronic non-communicable diseases in low-income countries. We assessed relevant patterns of health seeking and related out-of-pocket expenditure in Bangladesh. METHODS We used data from a household survey of 2500 households conducted in 2013 in Rangpur district. We employed multinomial logistic regression to assess factors associated with health seeking choices (no care or self-care, semi-qualified professional care, and qualified professional care). We used descriptive statistics (5% trimmed mean and range, median) to assess related patterns of out-of-pocket expenditure (including only direct costs). RESULTS Eight hundred sixty-six (12.5%) out of 6958 individuals reported at least one chronic non-communicable disease. Of these 866 individuals, 139 (16%) sought no care or self-care, 364 (42%) sought semi-qualified care, and 363 (42%) sought qualified care. Multivariate analysis confirmed that the following factors increased the likelihood of seeking qualified care: a higher education, a major chronic non-communicable disease, a higher socio-economic status, a lower proportion of chronic household patients, and a shorter distance between a household and a sub-district public referral health facility. Seven hundred fifty-four (87 %) individuals reported out-of-pocket expenditure, with drugs absorbing the largest portion (85%) of total expenditure. On average, qualified care seekers encountered the highest out-of-pocket expenditure, followed by those who sought semi-qualified care and no care, or self-care. CONCLUSION Our study reveals insufficiencies in health provision for chronic conditions, with more than half of all affected people still not seeking qualified care, and the majority still encountering considerable out-of-pocket expenditure. This calls for urgent measures to secure better access to care and financial protection.
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Affiliation(s)
- Fatema Binte Rasul
- BRAC JPG School of Public Health, BRAC University, 68, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Olivier Kalmus
- Working group for Translational Health Economics, Department for Conservative Dentistry, University Hospital Heidelberg, Heidelberg, 69120 Germany
| | - Malabika Sarker
- BRAC JPG School of Public Health, BRAC University, 68, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Hossain Ishrath Adib
- East West University, Dhaka, Bangladesh
- Practical Action, Bangladesh Country Programme, Dhaka, Bangladesh
| | | | - Md Zabir Hasan
- Department of International Health, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD 21205 USA
| | - Stephan Brenner
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
| | - Shaila Nazneen
- BRAC JPG School of Public Health, BRAC University, 68, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Muhammed Nazmul Islam
- BRAC JPG School of Public Health, BRAC University, 68, Shahid Tajuddin Ahmed Sharani, Mohakhali, Dhaka, 1212 Bangladesh
| | - Manuela De Allegri
- Heidelberg Institute of Global Health, Medical Faculty and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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From protocolized to person-centered chronic care in general practice: study protocol of an action-based research project (COPILOT). Prim Health Care Res Dev 2019; 20:e134. [PMID: 31547898 PMCID: PMC6764186 DOI: 10.1017/s1463423619000550] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
AIM To develop a proactive person-centered care approach for persons with (multiple) chronic diseases in general practice, and to explore the impact on 'Quadruple aims': experiences of patients and professionals, patient outcomes and costs of resources use. BACKGROUND The management of people with multiple chronic diseases challenges health care systems designed around single disease. Patients with multimorbidity often receive highly fragmented care that may lead to inefficient, ineffective and potentially harmful treatments and neglect of essential health needs. A more comprehensive, person-centered approach is advocated for persons with multiple morbidities. However, examples on how to provide more person-centered care and evidence of its impact are scarce. A group of Dutch general practitioners (GPs) took the initiative to develop such a care approach. METHODS/DESIGN Mixed methods with a development and pilot-testing phase. The proactive person-centered approach will be developed using an action-based research design consisting of multiple plan-act-observe-reflect-adjust cycles. In each cycle, experiences of patients and primary care professionals from 13 practices will be collected via interviews, observations and focus groups. Starting point for the first cycle is a 'person-centered consultation' of up to 1 h in which the GP discusses the health status and health care needs of the patient. Furthermore, shared decisions between GP and patient are made on treatment goals and follow-up. In the pilot-test phase, a nested case cohort study allows to explore the impact of the new approach on 'Quadruple aim' outcomes comparing persons with and without exposure to the new care approach. DISCUSSION This study will provide a proactive person-centered approach for persons with multimorbidity in primary care and estimate its potential impact on quadruple outcomes.
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van Erp NF, Helsper CW, Olyhoek SM, Janssen RRT, Winsveen A, Peeters PHM, de Wit NJ. Potential for Reducing Time to Referral for Colorectal Cancer Patients in Primary Care. Ann Fam Med 2019; 17:419-427. [PMID: 31501203 PMCID: PMC7032917 DOI: 10.1370/afm.2446] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 03/29/2019] [Accepted: 04/11/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE An optimal diagnostic process in primary care is pivotal for reducing cancer-related disease burden. This study aims to explore reasons for long times to referral for Dutch colorectal cancer (CRC) patients in primary care. METHODS A retrospective cohort study of anonymized free-text primary care records from the Julius General Practitioners' Network database, linked to the Netherlands Cancer Registry. Patients with a confirmed CRC diagnosis from 2007 through 2011 that symptomatically presented in primary care were included. Median time and interquartile ranges from presentation in primary care to referral were calculated for multiple patient and presentation characteristics. Associations of these characteristics with long time to referral (75th percentile was ≥59 days) were examined with log-binomial regression analyses. Routes to referral of patients with the longest times to referral were explored using thematic free-text analyses (90th percentile at ≥219 days). RESULTS Among the 309 people with CRC, patients who were female, did not have a registered family history, had a history of malignancy, lacked alarm symptoms at presentation, or had hemorrhoids at physical examination were at risk for longer time to referral in univariable analyses (longer median durations and/or univariable association with the 75th percentile). Only presentation without alarm symptoms showed a statistically significant association with long duration (75th percentile) in multivariable analysis (relative risk = 1.7; 95% CI, 1.1-2.6). Thematic exploration of the diagnostic routes to referral of patients with the longest durations (90th percentile) showed 2 dominating themes: "alternative working diagnosis" and "suboptimal diagnostic strategies," and included the sub-themes "omitting to reconsider an initial diagnosis" and "lacking follow-up." CONCLUSIONS Long time to referral for CRC in primary care is mainly related to low cancer suspicion. There is potential for reducing the longest times to referral for patients with CRC in primary care, with earlier reconsideration of the initial hypothesis and implementation of strict follow-up consultations.
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Affiliation(s)
- Nicole F van Erp
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Charles W Helsper
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Saskia M Olyhoek
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Ramon R T Janssen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Amber Winsveen
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Petra H M Peeters
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Niek J de Wit
- Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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80
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Sidorkiewicz S, Malmartel A, Prevost L, Partouche H, Pinot J, Grangé-Cabane A, du Vaure CB, Gilberg S. Patient-Physician Agreement in Reporting and Prioritizing Existing Chronic Conditions. Ann Fam Med 2019; 17:396-402. [PMID: 31501200 PMCID: PMC7032904 DOI: 10.1370/afm.2444] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 02/15/2019] [Accepted: 03/28/2019] [Indexed: 12/21/2022] Open
Abstract
PURPOSE In this study, we aimed to assess (1) the agreement between patient self-reports and general practitioner (GP) reports of the chronic conditions affecting the patients and (2) the agreement between patients and GPs on health priorities in a primary care setting. METHOD Patients were recruited in the Parisian area of France by a convenience sample of GPs; eligibility criteria required that the GP was the patient's listed primary care provider for at least 12 months. Participants were asked to report all the patient's current chronic conditions by using a previously developed list of 124 chronic conditions and write a list of up to 3 priority conditions. RESULTS From April to May 2017, 233 patients were recruited from 16 GP practices. Agreement between the number of conditions reported by patients and by GPs was moderate (intraclass correlation coefficient 0.59, 95% CI, 0.50 to 0.69). Agreement between patient self-reports and GP reports of each chronic condition ranged from very good (eg, κ = 0.85 for hypothyroidism) to poor (eg, κ = 0.12 for chronic anxiety disorder). Among the 153 patient-GP pairs for which both the patient and GP wrote a priority list, 45 (29.4%) of patients' first priorities did not appear anywhere on the corresponding GPs' lists, and 19 (12.4%) pairs had no matching priority condition. CONCLUSIONS Agreement between patients and their GPs varied widely depending on the diseases reported. Low agreement on health priorities suggests a need for improvement to ensure better alignment between patient and physician perspectives.
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Affiliation(s)
- Stéphanie Sidorkiewicz
- Department of General Medicine, Paris Descartes University, Paris, France .,METHODS Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, UMR 1153, Paris, France
| | - Alexandre Malmartel
- Department of General Medicine, Paris Descartes University, Paris, France.,METHODS Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, UMR 1153, Paris, France
| | - Lea Prevost
- Department of General Medicine, Paris Descartes University, Paris, France
| | - Henri Partouche
- Department of General Medicine, Paris Descartes University, Paris, France
| | - Juliette Pinot
- Department of General Medicine, Paris Descartes University, Paris, France
| | | | - Céline Buffel du Vaure
- Department of General Medicine, Paris Descartes University, Paris, France.,METHODS Team, Centre of Research in Epidemiology and Statistics Sorbonne Paris Cité (CRESS), INSERM, UMR 1153, Paris, France
| | - Serge Gilberg
- Department of General Medicine, Paris Descartes University, Paris, France
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81
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Nielen MMJ, Spronk I, Davids R, Korevaar JC, Poos R, Hoeymans N, Opstelten W, van der Sande MAB, Biermans MCJ, Schellevis FG, Verheij RA. Estimating Morbidity Rates Based on Routine Electronic Health Records in Primary Care: Observational Study. JMIR Med Inform 2019; 7:e11929. [PMID: 31350839 PMCID: PMC6688441 DOI: 10.2196/11929] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 04/30/2019] [Accepted: 06/17/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Routinely recorded electronic health records (EHRs) from general practitioners (GPs) are increasingly available and provide valuable data for estimating incidence and prevalence rates of diseases in the population. This paper describes how we developed an algorithm to construct episodes of illness based on EHR data to calculate morbidity rates. OBJECTIVE The goal of the research was to develop a simple and uniform algorithm to construct episodes of illness based on electronic health record data and develop a method to calculate morbidity rates based on these episodes of illness. METHODS The algorithm was developed in discussion rounds with two expert groups and tested with data from the Netherlands Institute for Health Services Research Primary Care Database, which consisted of a representative sample of 219 general practices covering a total population of 867,140 listed patients in 2012. RESULTS All 685 symptoms and diseases in the International Classification of Primary Care version 1 were categorized as acute symptoms and diseases, long-lasting reversible diseases, or chronic diseases. For the nonchronic diseases, a contact-free interval (the period in which it is likely that a patient will visit the GP again if a medical complaint persists) was defined. The constructed episode of illness starts with the date of diagnosis and ends at the time of the last encounter plus half of the duration of the contact-free interval. Chronic diseases were considered irreversible and for these diseases no contact-free interval was needed. CONCLUSIONS An algorithm was developed to construct episodes of illness based on routinely recorded EHR data to estimate morbidity rates. The algorithm constitutes a simple and uniform way of using EHR data and can easily be applied in other registries.
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Affiliation(s)
- Mark M J Nielen
- Netherlands Institute for Health Services Research, Utrecht, Netherlands.,Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Inge Spronk
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Rodrigo Davids
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Joke C Korevaar
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - René Poos
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Nancy Hoeymans
- Centre for Health and Society, National Institute for Public Health and the Environment, Bilthoven, Netherlands
| | - Wim Opstelten
- Dutch College of General Practitioners, Utrecht, Netherlands
| | - Marianne A B van der Sande
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Bilthoven, Netherlands.,Julius Center for Health Sciences and Primary Care, Julius Global Health, Utrecht, Netherlands
| | - Marion C J Biermans
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Robert A Verheij
- Netherlands Institute for Health Services Research, Utrecht, Netherlands
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Zechmann S, Di Gangi S, Kaplan V, Meier R, Rosemann T, Valeri F, Senn O. Time trends in prostate cancer screening in Swiss primary care (2010 to 2017) - A retrospective study. PLoS One 2019; 14:e0217879. [PMID: 31194773 PMCID: PMC6565361 DOI: 10.1371/journal.pone.0217879] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 05/20/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Following years of controversy regarding screening for prostate cancer using prostate-specific antigen, evidence evolves towards a more restrained and preference-based use. This study reports the impact of landmark trials and updated recommendations on the incidence rate of prostate cancer screening by Swiss general practitioners. Methods We performed a retrospective analysis of primary care data, separated in 3 time periods based on dates of publications of important prostate-specific antigen screening recommendations. 1: 2010-mid 2012 including 2 updates; 2: mid 2012-mid 2014 including a Smarter Medicine recommendation; 3: mid-2014—mid-2017 maintenance period. Period 2 including the Smarter Medicine recommendation was defined as reference period. We further assessed the influence of patient’s age and the number of prostate-specific-antigen (PSA) tests, by the patient and within each time period, on the mean PSA concentration. Uni- and multivariable analyses were used as needed. Results 36,800 men aged 55 to 75 years were included. 14.6% had ≥ 2 chronic conditions, 11.7% had ≥ 1 prostate-specific antigen test, (mean 2.60 ng/ml [SD 12.3]). 113,921 patient-years were covered. Data derived from 221 general practitioners, 33.5% of GP were women, mean age was 49.4 years (SD 10.0), 67.9% used prostate-specific antigen testing. Adjusted incidence rate-ratio (95%-CI) dropped significantly over time periods: Reference Period 2: incidence rate-ratio 1.00; Period 1: incidence rate-ratio 1.74 (1.59–1.90); Period 3: incidence rate-ratio 0.61 (0.56–0.67). A higher number of chronic conditions and a patient age between 60–69 years were significantly associated with higher screening rate. Increasing numbers of PSA testing per patient, as well as increasing age, were independently and significantly associated with an increase in the PSA value. Conclusion Swiss general practitioners adapted screening behavior as early as evidence of a limited health benefit evolved, while using a risk-adapted approach whenever performing multiple testing. Updated recommendations might have helped to maintain this decrease. Further recommendations and campaigns should aimed at older patients with multimorbidity, to sustain a further decline in prostate-specific antigen screening practices.
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Affiliation(s)
- Stefan Zechmann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
- * E-mail:
| | - Stefania Di Gangi
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Vladimir Kaplan
- Department of Internal Medicine, Hospital Muri, Muri, Switzerland
| | - Rahel Meier
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Fabio Valeri
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, University Hospital Zurich, Zurich, Switzerland
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Guisado-Clavero M, Violán C, López-Jimenez T, Roso-Llorach A, Pons-Vigués M, Muñoz MA, Foguet-Boreu Q. Medication patterns in older adults with multimorbidity: a cluster analysis of primary care patients. BMC FAMILY PRACTICE 2019; 20:82. [PMID: 31195985 PMCID: PMC6567459 DOI: 10.1186/s12875-019-0969-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 05/23/2019] [Indexed: 12/12/2022]
Abstract
BACKGROUND Older adults suffer from various chronic conditions which make them particularly vulnerable. The proper management of multiple drug use is therefore crucial. The aim of our study was to describe drug prescription and medication patterns in this population. METHODS A cross-sectional study in Barcelona (Spain) using electronic health records from 50 primary healthcare centres. Participants were aged 65 to 94 years, presenting multimorbidity (≥2 chronic diseases), and had been prescribed at least 1 drug for 6 months or longer during 2009. We calculated the prevalence of prescribed drugs and identified medication patterns using multiple correspondence analysis and k-means clustering. Analyses were stratified by sex and age (65-79, 80-94 years). RESULTS We studied 164,513 patients (66.8% women) prescribed a median of 4 drugs (interquartile range [IQR] = 3-7) in the 65-79 age-group and 6 drugs (IQR = 4-8) in the 80-94 age-group. A minimum of 45.9% of patients aged 65-79 years, and 61.8% of those aged 80-94 years, were prescribed 5 or more drugs. We identified 6 medication patterns, a non-specific one and 5 encompassing 8 anatomical groups (alimentary tract and metabolism, blood, cardiovascular, dermatological, musculo-skeletal, neurological, respiratory, and sensory organ). CONCLUSIONS Drug prescription is widespread among the elderly. Six medication patterns were identified, 5 of which were related to one or more anatomical group, with associations among drugs from different systems. Overall, guidelines do not accurately reflect the situation of the elderly multimorbid, new strategies for managing multiple drug uses are needed to optimize prescribing in these patients.
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Affiliation(s)
- Marina Guisado-Clavero
- Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Carrer Balmes 22, Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - Concepción Violán
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - Tomàs López-Jimenez
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - Albert Roso-Llorach
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
| | - Mariona Pons-Vigués
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
- Facultat d’infermeria, Universitat de Girona, Emili Grahit, 77, 17071 Girona, Spain
| | - Miguel Angel Muñoz
- Gerència d’Àmbit d’Atenció Primària Barcelona Ciutat, Institut Català de la Salut, Carrer Balmes 22, Barcelona, Spain
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
- Unitat de Suport a la Recerca de Barcelona, Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Carrer Sardenya, 375, 08025 Barcelona, Spain
| | - Quintí Foguet-Boreu
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra, Barcelona, Spain
- Departament de psiquiatria, Hospital Universitari de Vic, Francesc Pla el Vigatà, 1, 08500 Vic, Barcelona, Spain
- Facultat de Ciències de la Salut i Benestar, Universitat de Vic – Universitat Central de Catalunya, Sagrada Família, 7, 08500 Vic, Spain
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Griffith LE, Gruneir A, Fisher K, Panjwani D, Gafni A, Patterson C, Markle-Reid M, Ploeg J. Insights on multimorbidity and associated health service use and costs from three population-based studies of older adults in Ontario with diabetes, dementia and stroke. BMC Health Serv Res 2019; 19:313. [PMID: 31096989 PMCID: PMC6524233 DOI: 10.1186/s12913-019-4149-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Accepted: 05/08/2019] [Indexed: 01/03/2023] Open
Abstract
Background Most studies that examine comorbidity and its impact on health service utilization focus on a single index-condition and are published in disease-specific journals, which limit opportunities to identify patterns across conditions/disciplines. These comparisons are further complicated by the impact of using different study designs, multimorbidity definitions and data sources. The aim of this paper is to share insights on multimorbidity and associated health services use and costs by reflecting on the common patterns across 3 parallel studies in distinct disease cohorts (diabetes, dementia, and stroke) that used the same study design and were conducted in the same health jurisdiction over the same time period. Methods We present findings that lend to broader Insights regarding multimorbidity based on the relationship between comorbidity and health service use and costs seen across three distinct disease cohorts. These cohorts were originally created using multiple linked administrative databases to identify community-dwelling residents of Ontario, Canada with one of diabetes, dementia, or stroke in 2008 and each was followed for health service use and associated costs. Results We identified 376,434 indviduals wtih diabetes, 95,399 wtih dementia, and 29,671 with stroke. Four broad insights were identified from considering the similarity in comorbidity, utilization and cost patterns across the three cohorts: 1) the most prevalent comorbidity types were hypertension and arthritis, which accounted for over 75% of comorbidity in each cohort; 2) overall utilization increased consistently with the number of comorbidities, with the vast majority of services attributed to comorbidity rather than the index conditions; 3) the biggest driver of costs for those with lower levels of comorbidity was community-based care, e.g., home care, GP visits, but at higher levels of comorbidity the driver was acute care services; 4) service-specific comorbidity and age patterns were consistent across the three cohorts. Conclusions Despite the differences in population demographics and prevalence of the three index conditions, there are common patterns with respect to comorbidity, utilization, and costs. These common patterns may illustrate underlying needs of people with multimorbidity that are often obscured in literature that is still single disease-focused. Electronic supplementary material The online version of this article (10.1186/s12913-019-4149-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lauren E Griffith
- Department of Health Research Methods, Evidence, and Impact, McMaster University, McMaster Innovation Park, 175 Longwood Road South, Hamilton, ON, L8P 0A1, Canada.
| | - Andrea Gruneir
- Department of Family Medicine, University of Alberta, 6-10 University Terrace, Edmonton, AB, T6G 2T4, Canada
| | - Kathryn Fisher
- School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre, Room 3N25G, Hamilton, Ontario, L8S 4K1, Canada
| | - Dilzayn Panjwani
- Women's College Research Institute, Women's College Hospital, 790 Bay St., 7th floor, Toronto, ON, M5G 1N8, Canada
| | - Amiram Gafni
- Centre for Health Economics and Policy Analysis; Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Room CRL-208, Hamilton, Ontario, L8S 4K1, Canada
| | - Christopher Patterson
- Department of Medicine, McMaster University, St. Peter's Hospital, 88 Maplewood, Hamilton, Ontario, L8M 1W9, Canada
| | - Maureen Markle-Reid
- School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre, Room 3N25B, Hamilton, Ontario, L8S 4K1, Canada
| | - Jenny Ploeg
- School of Nursing, McMaster University, 1280 Main Street West, Health Sciences Centre, Room 3N25C, Hamilton, Ontario, L8S 4K1, Canada
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Comorbidity in patients with cardiovascular disease in primary care: a cohort study with routine healthcare data. Br J Gen Pract 2019; 69:e398-e406. [PMID: 31064742 DOI: 10.3399/bjgp19x702725] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 06/15/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Comorbidity is a major public health issue, which challenges health care configured around single diseases. AIM To provide an overview of frequent disease combinations of one and two additional chronic diseases and groups among patients with cardiovascular disease (CVD) in general practice. DESIGN AND SETTING Medical record data from the Julius General Practitioners' Network of 226 670 patients registered in 2015-2016 in Utrecht, the Netherlands, were collected and examined. METHOD Prevalences and combinations of one and two comorbid conditions were determined, by age and sex, in four populations of patients with CVD: heart failure, peripheral arterial disease (PAD), coronary heart disease (CHD), or stroke. Using logistic regression analyses, the authors examined whether comorbid conditions were significantly more prevalent in patients with a specific cardiovascular condition compared with those without. RESULTS Low vision, diabetes mellitus, back/neck problems, osteoarthritis, chronic obstructive pulmonary disease (COPD), and cancer were the most prevalent non-cardiovascular conditions and ranked in the top five of non-cardiovascular comorbid conditions in the different CVDs studied, irrespective of patient age and sex. Of these, diabetes, COPD, and low vision were statistically significantly more prevalent in all four cardiovascular conditions when compared with patients without the respective disease. Over the life span, the majority of the comorbid conditions were most prevalent in patients with heart failure, directly followed by those with PAD; they were less prevalent in patients with CHD and stroke. CONCLUSION Comorbid conditions are very common in patients with CVD, even in younger age groups. To ensure efficient and effective treatment, organisational adaptations may be required in the healthcare system to accommodate comorbid conditions in patients with CVD.
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Veenendaal M, Westerik JAM, van den Bemt L, Kocks JWH, Bischoff EW, Schermer TR. Age- and sex-specific prevalence of chronic comorbidity in adult patients with asthma: A real-life study. NPJ Prim Care Respir Med 2019; 29:14. [PMID: 31036820 PMCID: PMC6488608 DOI: 10.1038/s41533-019-0127-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Accepted: 03/29/2019] [Indexed: 11/10/2022] Open
Abstract
The presence of comorbidity can be associated with poorer asthma outcomes. Previous prevalence studies focused on a limited selection of comorbid conditions in asthma only. We aimed to determine age- and sex-specific prevalence estimates for the full range of chronic comorbid conditions in adult asthma patients by performing a retrospective cohort study based on 32,787 medical records of patients aged ≥16 years with asthma from 179 general practices in the Netherlands. Age- and sex-specific prevalence estimates of 76 chronic comorbidities and 14 disease categories based on International Classification of Primary Care codes were determined. Chronic comorbidity was present in 65.3% of male asthma patients and 72.8% of female asthma patients, with female patients having a higher mean (SD) of 2.0 (2.1) comorbidities compared to male patients (1.7 (2.0)). This mean increased to 5.0 (2.7) conditions in the 75+ age group. Most prevalent comorbidities were hypertension (20.1%), osteoarthritis (11.5%), eczema (11.5%) and dyspepsia (10.7%). Compared to male asthma patients, female asthma patients showed higher odds for the presence of other chronic conditions in eight disease categories. Neurological (odds ratio [OR]; 95% confidence interval 2.01; 1.76-2.29), blood forming/lymphatics (OR 1.83; 1.38-2.42) and musculoskeletal diseases (OR 1.82; 1.69-1.95) showed the highest association with female sex. In conclusion, the presence of chronic comorbidity is the norm in adults with asthma and it is more prevalent in female than in male asthma patients. The odds of having a specific comorbid condition may differ between the sexes. Attention in guidelines on how to handle comorbidities may lead to a more targeted treatment for comorbidities and more patient-centred asthma management.
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Affiliation(s)
- Mathijs Veenendaal
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janine A M Westerik
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Lisette van den Bemt
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Janwillem W H Kocks
- Department of Inhalation Medicine, Observational Pragmatic Research Institute, Singapore, Singapore
| | - Erik W Bischoff
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Tjard R Schermer
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.
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87
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Cramm JM, Nieboer AP. The importance of health behaviours and especially broader self-management abilities for older Turkish immigrants. Eur J Public Health 2018; 28:1087-1092. [PMID: 30184063 PMCID: PMC6241207 DOI: 10.1093/eurpub/cky174] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background This study aims to identify the relationships between health behaviours, self-management abilities, physical health, depressive symptoms and well-being among Turkish older immigrants. Methods A total of 2350 older Turkish migrants aged > 65 years residing in Rotterdam, the Netherlands were identified using the municipal register of which 680 respondents completed the questionnaires (response rate of 32%). Results Average age of the respondents was 72.90 (standard deviation 5.02) (range 66–95) years and about half of them were women (47.6%). The majority of respondents reported having a low education (80.3%), low income level (83.4%), is chronically ill (90.6%), overweight (86.5%) and about half obese (46.0%). More than half of the respondents eat enough fruit (58.2%) and vegetables per week (55.3%). About a third of the respondents smoke (33.5%) and 43.0% can be considered to be physically active. Looking at the health behaviours a weak positive relationship was found between eating enough vegetables and well-being (β = 0.14; P = 0.017). In addition, weak relationships were found between physical activity and depressive symptoms (β = −0.16; P = 0.007), smoking and depressive symptoms (β = 0.16; P = 0.009) and self-management abilities and physical health (β = 0.17; P = 0.015). Strongest relationships were found between self-management abilities and depressive symptoms (β = −0.39; P < 0.001) and self-management abilities with overall well-being (β = 0.49; P < 0.001). Conclusions From this study, we can conclude that next to health behaviours broader self-management abilities to maintain overall well-being are important for Turkish older people. Interventions to improve self-management abilities may help Turkish older people better deal with function losses and chronic diseases as they age further.
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Affiliation(s)
- Jane M Cramm
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anna P Nieboer
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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Amell A, Roso-Llorach A, Palomero L, Cuadras D, Galván-Femenía I, Serra-Musach J, Comellas F, de Cid R, Pujana MA, Violán C. Disease networks identify specific conditions and pleiotropy influencing multimorbidity in the general population. Sci Rep 2018; 8:15970. [PMID: 30374096 PMCID: PMC6206057 DOI: 10.1038/s41598-018-34361-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 10/15/2018] [Indexed: 01/16/2023] Open
Abstract
Multimorbidity is an emerging topic in public health policy because of its increasing prevalence and socio-economic impact. However, the age- and gender-dependent trends of disease associations at fine resolution, and the underlying genetic factors, remain incompletely understood. Here, by analyzing disease networks from electronic medical records of primary health care, we identify key conditions and shared genetic factors influencing multimorbidity. Three types of diseases are outlined: "central", which include chronic and non-chronic conditions, have higher cumulative risks of disease associations; "community roots" have lower cumulative risks, but inform on continuing clustered disease associations with age; and "seeds of bursts", which most are chronic, reveal outbreaks of disease associations leading to multimorbidity. The diseases with a major impact on multimorbidity are caused by genes that occupy central positions in the network of human disease genes. Alteration of lipid metabolism connects breast cancer, diabetic neuropathy and nutritional anemia. Evaluation of key disease associations by a genome-wide association study identifies shared genetic factors and further supports causal commonalities between nervous system diseases and nutritional anemias. This study also reveals many shared genetic signals with other diseases. Collectively, our results depict novel population-based multimorbidity patterns, identify key diseases within them, and highlight pleiotropy influencing multimorbidity.
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Affiliation(s)
- A Amell
- Department of Mathematics, Technical University of Catalonia, Castelldefels, Barcelona, 08860, Catalonia, Spain
| | - A Roso-Llorach
- Jordi Gol University Institute for Research Primary Healthcare (IDIAP Jordi Gol), Barcelona, 08007, Catalonia, Spain
- Autonomous University of Barcelona, Bellaterra, 08193, Catalonia, Spain
| | - L Palomero
- ProCURE, Catalan Institute of Oncology (ICO), Oncobell, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, 08908, Catalonia, Spain
| | - D Cuadras
- Statistics Department, Foundation Sant Joan de Déu, Esplugues, 08950, Catalonia, Spain
| | - I Galván-Femenía
- GCAT-Genomes for Life, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Program for Predictive and Personalized Medicine of Cancer (IMPPC), Badalona, 08916, Catalonia, Spain
| | - J Serra-Musach
- ProCURE, Catalan Institute of Oncology (ICO), Oncobell, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, 08908, Catalonia, Spain
| | - F Comellas
- Department of Mathematics, Technical University of Catalonia, Castelldefels, Barcelona, 08860, Catalonia, Spain
| | - R de Cid
- GCAT-Genomes for Life, Germans Trias i Pujol Health Sciences Research Institute (IGTP), Program for Predictive and Personalized Medicine of Cancer (IMPPC), Badalona, 08916, Catalonia, Spain.
| | - M A Pujana
- ProCURE, Catalan Institute of Oncology (ICO), Oncobell, Bellvitge Institute for Biomedical Research (IDIBELL), L'Hospitalet del Llobregat, Barcelona, 08908, Catalonia, Spain.
| | - C Violán
- Jordi Gol University Institute for Research Primary Healthcare (IDIAP Jordi Gol), Barcelona, 08007, Catalonia, Spain.
- Autonomous University of Barcelona, Bellaterra, 08193, Catalonia, Spain.
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89
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Magin P, Tapley A, Dunlop AJ, Davey A, van Driel M, Holliday E, Morgan S, Henderson K, Ball J, Catzikiris N, Mulquiney K, Spike N, Kerr R, Holliday S. Changes in Australian Early-Career General Practitioners' Benzodiazepine Prescribing: a Longitudinal Analysis. J Gen Intern Med 2018; 33:1676-1684. [PMID: 30039495 PMCID: PMC6153232 DOI: 10.1007/s11606-018-4577-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Revised: 05/18/2018] [Accepted: 07/02/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Australian and international guidelines recommend benzodiazepines and related drugs (hereafter "benzodiazepines") as second-line, short-term medications only. Most benzodiazepines are prescribed by general practitioners (GPs; family physicians). Australian GP registrars ("trainees" or "residents" participating in a post-hospital training, apprenticeship-like, practice-based vocational training program), like senior GPs, prescribe benzodiazepines at high rates. Education within a training program, and experience in general practice, would be expected to reduce benzodiazepine prescribing. OBJECTIVE To establish if registrars' prescribing of benzodiazepines decreases with time within a GP training program DESIGN: Longitudinal analysis from the Registrar Clinical Encounters in Training multi-site cohort study PARTICIPANTS: Registrars of five of Australia's 17 Regional Training Providers. Analyses were restricted to patients ≥ 16 years. MAIN MEASURES The main outcome factor was prescription of a benzodiazepine. Conditional logistic regression was used, with registrar included as a fixed effect, to assess within-registrar changes in benzodiazepine-prescribing rates. The "time" predictor variable was "training term" (6-month duration Terms 1-4). To contextualize these "within-registrar" changes, a mixed effects logistic regression model was used, including a random effect for registrar, to assess within-program changes in benzodiazepine-prescribing rates over time. The "time" predictor variable was "year" (2010-2015). KEY RESULTS Over 12 terms of data collection, 2010-2015, 1161 registrars (response rate 96%) provided data on 136,809 face-to-face office-based consultations. Two thousand six hundred thirty-two benzodiazepines were prescribed (for 1.2% of all problems managed). In the multivariable model, there was a significant reduction in within-program benzodiazepine prescribing over time (year) (p = < 0.001, OR = 0.94, CI = 0.90, 0.97). However, there was no significant change in 'within-registrar' prescribing over time (registrar Term) (p = 0.92, OR = 1.00 [95% CI = 0.94-1.06]). CONCLUSIONS Despite a welcome temporal trend for reductions in overall benzodiazepine prescribing from 2010 to 2015, there is still room for improvement and our findings suggest a lack of effect of specific GP vocational training program education and, thus, an opportunity for targeted education.
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Affiliation(s)
- Parker Magin
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia. .,GP Synergy General Practice Regional Training Organisation, Newcastle, Australia.
| | - Amanda Tapley
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,GP Synergy General Practice Regional Training Organisation, Newcastle, Australia
| | - Adrian J Dunlop
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Drug and Alcohol Clinical Services, Hunter New England Health, Newcastle, Australia
| | - Andrew Davey
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,GP Synergy General Practice Regional Training Organisation, Newcastle, Australia
| | - Mieke van Driel
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Elizabeth Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Hunter Medical Research Institute, Newcastle, Australia
| | - Simon Morgan
- GP Synergy General Practice Regional Training Organisation, Newcastle, Australia
| | - Kim Henderson
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,GP Synergy General Practice Regional Training Organisation, Newcastle, Australia
| | - Jean Ball
- Hunter Medical Research Institute, Newcastle, Australia
| | - Nigel Catzikiris
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,GP Synergy General Practice Regional Training Organisation, Newcastle, Australia
| | - Katie Mulquiney
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,GP Synergy General Practice Regional Training Organisation, Newcastle, Australia
| | - Neil Spike
- Eastern Victoria GP Training, Melbourne, Australia.,University of Melbourne, Melbourne, Australia
| | - Rohan Kerr
- General Practice Training Tasmania, Hobart, Australia
| | - Simon Holliday
- School of Medicine and Public Health, University of Newcastle, Callaghan, Australia.,Drug and Alcohol Clinical Services, Hunter New England Health, Newcastle, Australia
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Aging perceptions matter for the well-being of elderly Turkish migrants, especially among the chronically ill. BMC Geriatr 2018; 18:229. [PMID: 30257652 PMCID: PMC6158894 DOI: 10.1186/s12877-018-0902-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 08/28/2018] [Indexed: 11/29/2022] Open
Abstract
Background Research on cultural ideology with respect to aging perceptions leading to poorer health and well-being is necessary to improve the quality and effectiveness of (preventive) healthcare delivery in reaching immigrant elderly people and delivering care tailored to their needs. Despite the potential benefits of positive aging perceptions on well-being, there is a lack of empirical quantitative research on aging perceptions among elderly Turkish migrants. Therefore, the current study aimed to identify the importance of aging perceptions for the well-being of Turkish elderly in Rotterdam. Methods The current research is a large-scale quantitative study aimed at investigating the contribution of aging perceptions to well-being among elderly Turkish migrants in Rotterdam. All Turkish people aged > 65 years were identified using the Rotterdam municipal register and invited to participate in the study. In total, 680 Turkish respondents returned completed questionnaires (32% response rate). Results The average respondent age was 72.90 (SD, 5.02) (range, 66–95) years and approximately half of the respondents (47.6%) were women. The majority of the respondents was of a low education (80.3%) and reported a low income level (83.4%). The mean number of chronic diseases among study participants was 2.68 (SD, 1.87) (range, 0–10). Being female (p ≤ 0.01), being single (p ≤ 0.01), having a low education level (p ≤ 0.01) and number of chronic diseases (p ≤ 0.001) were negatively associated with well-being. In addition, negative perceptions on aging were negatively associated with well-being while positive perceptions on aging were positively associated with well-being. Stepwise regression analyses showed a mediating effect of perceptions of aging on the relationship between the number of chronic diseases and the well-being of study participants. Conclusions Aging perceptions, especially perceived consequences of aging (both positive and negative), feelings of control (both positive and negative), and emotional representations are important to the well-being of Turkish elderly residing in the Netherlands. These results indicate the importance of the development of interventions in the perceptions on aging in the elderly Turkish population in Western Europe.
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91
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Abstract
BACKGROUND The presence of multimorbidity in the family practice setting is as evident as it is hard to measure. OBJECTIVE The objective of this study was to describe the differences in the prevalence of multimorbidity in a single primary care population, through the use of the only two available lists of chronic conditions based on the International Classification for Primary Care coding system. METHODS This is a cross-sectional, analytical study. Secondary analysis of existing chronic conditions data involved 1279 women and 714 men attending primary care centres in mainland Portugal. Multimorbidity was measured by the presence in each patient of both ≥2 and ≥3 chronic conditions, from both a list of 147 conditions and another list of 75 conditions. Logistic regression analyses were conducted to study the association of multimorbidity with sex, age, education and income by the type of list of chronic conditions. RESULTS Multimorbidity prevalence estimates are modified by (i) the number of chronic conditions included in the lists used and (ii) the number of conditions necessary to define the cut-off for multimorbidity. The use of different lists of conditions modifies not only the multimorbidity prevalence estimates but also the evaluation of the determinants of multimorbidity. CONCLUSIONS The use of different lists of chronic conditions produces different research results. Even the use of lists designed to be more general practice-oriented may underestimate the frequency of multimorbidity by limiting the number of conditions considered. Further research is still needed to grasp the full implications of using different lists of chronic conditions in multimorbidity research.
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Affiliation(s)
- Filipe Prazeres
- Faculdade de Ciências da Saúde, Universidade da Beira Interior, Covilhã, Portugal.,USF Beira Ria, Gafanha da Nazaré, Portugal
| | - Luiz Santiago
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Holvast F, Wouters H, Hek K, Schellevis F, Oude Voshaar R, van Dijk L, Burger H, Verhaak P. Non-adherence to cardiovascular drugs in older patients with depression: A population-based cohort study. Int J Cardiol 2018; 274:366-371. [PMID: 30249352 DOI: 10.1016/j.ijcard.2018.08.100] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Revised: 07/20/2018] [Accepted: 08/31/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Depression is common among patients with cardiovascular disease and has been associated with both drug non-adherence and increased mortality. Non-adherence can occur because of non-initiation, suboptimal implementation, or non-persistence. We aimed to determine if depression increased the risk of any of these components of non-adherence among older patients prescribed cardiovascular drugs in primary care. METHODS A longitudinal analysis of routine primary care data from the Nivel Primary Care Database was performed using data for 2011-2013. A total of 1512 patients aged ≥60 years diagnosed with depression in 2012 were compared with age- and sex-matched groups with either other psychological diagnoses (N = 1457) or mentally healthy controls (N = 1508), resulting in the inclusion of 4477 patients. Non-adherence was classified as non-initiation, suboptimal implementation, or non-persistence. Regression analyses were performed to determine the association between mental health status and non-initiation, suboptimal implementation, and non-persistence. RESULTS Mixed-effects logistic regression analyses showed increased odds for suboptimal implementation of beta-blockers among depressed patients (2.18; 95% CI 1.29-3.69). For non-persistence, a clustered Cox regression analysis demonstrated that, compared with controls, there was an increased hazard ratio for depressed patients to discontinue beta-blockers (2.31; 95% CI 1.58-3.37) and calcium antagonists (1.74; 95% CI 1.23-2.46). CONCLUSIONS It is likely that older patients in primary care diagnosed with depression are at increased risk of non-persistence with cardiovascular drug therapy. Because non-adherence is associated with increased cardiovascular mortality, it is important that physicians ensure that older depressed patients persevere with therapy.
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Affiliation(s)
- Floor Holvast
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands.
| | - Hans Wouters
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Karin Hek
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - François Schellevis
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; Department of General Practice and Elderly care medicine/Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, the Netherlands
| | - Richard Oude Voshaar
- University of Groningen, University Medical Center Groningen, University Center of Psychiatry, Groningen, the Netherlands
| | - Liset van Dijk
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
| | - Huibert Burger
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands
| | - Peter Verhaak
- University of Groningen, University Medical Center Groningen, Department of General Practice, Groningen, the Netherlands; NIVEL, Netherlands Institute for Health Services Research, Utrecht, the Netherlands
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93
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Maneze D, Ramjan L, DiGiacomo M, Everett B, Davidson PM, Salamonson Y. Negotiating health and chronic illness in Filipino-Australians: a qualitative study with implications for health promotion. ETHNICITY & HEALTH 2018; 23:611-628. [PMID: 28271720 DOI: 10.1080/13557858.2017.1294656] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE In spite of the healthy immigrant effect, the prevalence of lifestyle-related chronic diseases among migrants is reported to approximate that of the host country with longer duration of stay. For example, higher rates of chronic diseases such as Type 2 diabetes and hypertension have been observed among Filipino migrants and these have been linked to acculturation. The aim of this study was to explore the experiences of Filipino-Australian migrants in managing their chronic health conditions in a Western host country. DESIGN This paper reports on qualitative findings of a mixed methods study that used an explanatory sequential design. Nine focus group discussions were undertaken with 58 Filipino-Australian migrants with chronic disease. Thematic analysis was undertaken using a five-stage general purpose thematic framework ensuring that themes closely identified key participants' experiences . RESULTS Findings revealed that health benefits provided by the health system in Australia were considered advantageous. However, a lack of social and instrumental support compounded isolation and disempowerment, limiting self-management strategies for chronic illnesses. Cultural beliefs and practices influenced their knowledge, attitude to and management of chronic disease, which health service providers overlooked because of perceived acculturation and English language skills. Overall this study has clearly identified recognition of cultural beliefs, language needs and support as three core needs of Filipino-Australian migrants with the elderly the most vulnerable. CONCLUSION This paper highlights that self-management of chronic disease among elderly Filipino immigrants may be adversely affected by host language difficulties, a lack of social support and cultural issues, impacting on access to services, health-seeking behaviours and participation in health promotion initiatives. Language, culture-specific health interventions and resources and enhancing social support are likely important strategies in promoting chronic disease self-management among the elderly. These interventions have the potential to empower and encourage individuals to take control and better manage their chronic disease.
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Affiliation(s)
- Della Maneze
- a South Western Sydney Local Health District (SWSLHD) , Ingleburn , Australia
- b Centre for Applied Nursing Research (CANR) , Ingham Institute for Applied Medical Research , Liverpool , Australia
- c School of Nursing and Midwifery , Western Sydney University , Penrith , Australia
| | - Lucie Ramjan
- b Centre for Applied Nursing Research (CANR) , Ingham Institute for Applied Medical Research , Liverpool , Australia
- c School of Nursing and Midwifery , Western Sydney University , Penrith , Australia
| | - Michelle DiGiacomo
- d Centre for Cardiovascular and Chronic Care, Faculty of Health , University of Technology Sydney , Ultimo , Australia
| | - Bronwyn Everett
- b Centre for Applied Nursing Research (CANR) , Ingham Institute for Applied Medical Research , Liverpool , Australia
- c School of Nursing and Midwifery , Western Sydney University , Penrith , Australia
- e South Western Sydney Local Health District (SWSLHD) , Liverpool , Australia
| | - Patricia Mary Davidson
- d Centre for Cardiovascular and Chronic Care, Faculty of Health , University of Technology Sydney , Ultimo , Australia
- f School of Nursing , Johns Hopkins University , Baltimore , USA
| | - Yenna Salamonson
- b Centre for Applied Nursing Research (CANR) , Ingham Institute for Applied Medical Research , Liverpool , Australia
- c School of Nursing and Midwifery , Western Sydney University , Penrith , Australia
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Violán C, Roso-Llorach A, Foguet-Boreu Q, Guisado-Clavero M, Pons-Vigués M, Pujol-Ribera E, Valderas JM. Multimorbidity patterns with K-means nonhierarchical cluster analysis. BMC FAMILY PRACTICE 2018; 19:108. [PMID: 29969997 PMCID: PMC6031109 DOI: 10.1186/s12875-018-0790-x] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 06/08/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND The purpose of this study was to ascertain multimorbidity patterns using a non-hierarchical cluster analysis in adult primary patients with multimorbidity attended in primary care centers in Catalonia. METHODS Cross-sectional study using electronic health records from 523,656 patients, aged 45-64 years in 274 primary health care teams in 2010 in Catalonia, Spain. Data were provided by the Information System for the Development of Research in Primary Care (SIDIAP), a population database. Diagnoses were extracted using 241 blocks of diseases (International Classification of Diseases, version 10). Multimorbidity patterns were identified using two steps: 1) multiple correspondence analysis and 2) k-means clustering. Analysis was stratified by sex. RESULTS The 408,994 patients who met multimorbidity criteria were included in the analysis (mean age, 54.2 years [Standard deviation, SD: 5.8], 53.3% women). Six multimorbidity patterns were obtained for each sex; the three most prevalent included 68% of the women and 66% of the men, respectively. The top cluster included coincident diseases in both men and women: Metabolic disorders, Hypertensive diseases, Mental and behavioural disorders due to psychoactive substance use, Other dorsopathies, and Other soft tissue disorders. CONCLUSION Non-hierarchical cluster analysis identified multimorbidity patterns consistent with clinical practice, identifying phenotypic subgroups of patients.
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Affiliation(s)
- Concepción Violán
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Albert Roso-Llorach
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Quintí Foguet-Boreu
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Department of Psychiatry, Vic University Hospital, Francesc Pla el Vigatà, 1, 08500 Vic, Barcelona Spain
| | - Marina Guisado-Clavero
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
| | - Mariona Pons-Vigués
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Faculty of Nursing, University of Girona, Emili Grahit, 77, 17071 Girona, Spain
| | - Enriqueta Pujol-Ribera
- Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Gran Via Corts Catalanes, 587 àtic, 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Spain
- Faculty of Nursing, University of Girona, Emili Grahit, 77, 17071 Girona, Spain
| | - Jose M. Valderas
- Health Services & Policy Research Group, Academic Collaboration for Primary Care, University of Exeter Medical School, Exeter, EX1 2LU UK
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95
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Tran G, Cowling P, Smith T, Bury J, Lucas A, Barr A, Kingsbury SR, Conaghan PG. What Imaging-Detected Pathologies Are Associated With Shoulder Symptoms and Their Persistence? A Systematic Literature Review. Arthritis Care Res (Hoboken) 2018. [PMID: 29513925 PMCID: PMC6099421 DOI: 10.1002/acr.23554] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Objective Shoulder symptoms are common, and imaging is being increasingly used to help with management. However, the relationship between imaging and symptoms remains unclear. This review aims to understand the relationship between imaging‐detected pathologies, symptoms, and their persistence. Methods A systematic review using Medline, EMBASE, Cochrane, and grey literature was conducted to April 2017. The cross‐sectional and longitudinal relationships between imaging‐detected abnormalities and symptoms were analyzed and associations qualitatively characterized by a best‐evidence synthesis based on study design, covariate adjustment, and the Grade of Recommendations Assessment, Development, and Evaluation (GRADE) methodology. Modalities included ultrasound, magnetic resonance imaging (MRI), radiographs, positron emission tomography (PET), bone scintigraphy, and computed tomography. Results A total of 6,569 abstracts was screened and 56 articles were included. In total, 50 studies did not adjust for covariates and 36 analyzed individual pathologies only. The majority of studies showed conflicting results. There was no significant association between most imaging features and symptoms among high‐quality, cross‐sectional studies. There was low‐quality evidence that enhancement of the joint capsule on MRI and increased uptake on PET were associated with symptoms in adhesive capsulitis. Based on high‐quality longitudinal studies, enlarging rotator cuff tears were associated with an increased incidence of symptoms. Conclusion There were conflicting results on the association of imaging features with shoulder symptoms and their persistence. The existing evidence was very low in quality, based on the GRADE methodology. Further high‐quality studies are required to understand the relationship between imaging and shoulder symptoms and to determine the appropriate role of imaging in care pathways.
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Affiliation(s)
| | - Paul Cowling
- Chapel Allerton Hospital, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Julie Bury
- Doncaster and Bassetlaw Teaching Hospitals NHS Foundation Trust, Doncaster, UK
| | | | | | | | - Philip G Conaghan
- University of Leeds, Leeds, and Arthritis Research UK Centre for Sport, Exercise, and Osteoarthritis, Nottingham, UK
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96
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Grimsmo A, Løhre A, Røsstad T, Gjerde I, Heiberg I, Steinsbekk A. Disease-specific clinical pathways - are they feasible in primary care? A mixed-methods study. Scand J Prim Health Care 2018; 36:152-160. [PMID: 29644927 PMCID: PMC6066276 DOI: 10.1080/02813432.2018.1459167] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
OBJECTIVE To explore the feasibility of disease-specific clinical pathways when used in primary care. DESIGN A mixed-method sequential exploratory design was used. First, merging and exploring quality interview data across two cases of collaboration between the specialist care and primary care on the introduction of clinical pathways for four selected chronic diseases. Secondly, using quantitative data covering a population of 214,700 to validate and test hypothesis derived from the qualitative findings. SETTING Primary care and specialist care collaborating to manage care coordination. RESULTS Primary-care representatives expressed that their patients often have complex health and social needs that clinical pathways guidelines seldom consider. The representatives experienced that COPD, heart failure, stroke and hip fracture, frequently seen in hospitals, appear in low numbers in primary care. The quantitative study confirmed the extensive complexity among home healthcare nursing patients and demonstrated that, for each of the four selected diagnoses, a homecare nurse on average is responsible for preparing reception of the patient at home after discharge from hospital, less often than every other year. CONCLUSIONS The feasibility of disease-specific pathways in primary care is limited, both from a clinical and organisational perspective, for patients with complex needs. The low prevalence in primary care of patients with important chronic conditions, needing coordinated care after hospital discharge, constricts transferring tasks from specialist care. Generic clinical pathways are likely to be more feasible and efficient for patients in this setting. Key points Clinical pathways in hospitals apply to single-disease guidelines, while more than 90% of the patients discharged to community health care for follow-up have multimorbidity. Primary care has to manage the health care of the patient holistically, with all his or her complex needs. Patients most frequently admitted to hospitals, i.e. patients with COPD, heart failure, stroke and hip fracture are infrequent in primary care and represent a minority among patients in need of coordinated community health care. In primary care, the low rate of receiving patients discharged from hospitals of major chronic diseases hampers maintenance of required specific skills, thus constricting the transfer of tasks to primary care. Generic clinical pathways are suggested to be more feasible than disease-specific pathways for most patients with complex needs.
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Affiliation(s)
- Anders Grimsmo
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway;
- CONTACT Anders GrimsmoDepartment of Public Health and Nursing, Norwegian University of Science and Technology, P.O. Box 8905, 7491Trondheim, Norway
| | - Audhild Løhre
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway;
| | - Tove Røsstad
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway;
| | - Ingunn Gjerde
- Faculty of Business Administration and Social Sciences, Molde University College, Specialized University in Logistics, Molde, Norway;
| | - Ina Heiberg
- Norwegian Centre for Integrated Care and Telemedicine, University Hospital of North Norway, Tromsø, Norway
| | - Aslak Steinsbekk
- Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway;
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97
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Clatici VG, Satolli F, Tatu AL, Voicu C, Draganita AMV, Lotti T. Butterfly Effect - the Concept and the Implications in Dermatology, Acne, and Rosacea. MAEDICA 2018; 13:89-94. [PMID: 30069233 PMCID: PMC6060293 DOI: 10.26574/maedica.2018.13.2.89] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Acne and Rosacea are chronic inflammatory skin diseases with an increasing frequency and an important negative impact on the quality of life, which are associated with a large number of false myths regarding causes and treatment. The butterfly effect is associated with chaos theory, and it is a concept originated in meteorology, which represents the dependence on initial conditions.
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Affiliation(s)
- Victor Gabriel Clatici
- Department of Dermatology and Regenerative Medicine, CSRMR, University of Rome Guglielmo Marconi, Rome, Italy
| | | | - Alin Laurentiu Tatu
- Faculty of Medicine and Pharmacy, "Dunarea de Jos" University of Galati, Romania
| | | | | | - Torello Lotti
- Department of Dermatology and Regenerative Medicine, CSRMR, University of Rome Guglielmo Marconi, Rome, Italy
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98
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Allen D, Scarinci N, Hickson L. The Nature of Patient- and Family-Centred Care for Young Adults Living with Chronic Disease and their Family Members: A Systematic Review. Int J Integr Care 2018; 18:14. [PMID: 30127698 PMCID: PMC6095060 DOI: 10.5334/ijic.3110] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2017] [Accepted: 05/09/2018] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND AND AIM The published literature addressing the nature of patient- and family-centred care (PFCC) among young adults (16-25 years old) living with chronic disease and their family members is diverse. The aim of this systematic review was to collect and interpretatively synthesise this literature to generate a conceptual understanding of PFCC in this age group. METHOD From an initial pool of 10,615 papers, 51 were systematically identified as relevant to the research question and appraised using the Critical Appraisal Skills Programme tools. A total of 24 papers passed the quality appraisal and proceeded to a qualitative meta-synthesis. RESULTS The qualitative meta-synthesis revealed three major elements of PFCC relevant to young adults living with chronic disease and their family members: (1) patients and practitioners felt able to engage with each other on an emotional and social level; (2) patients and families felt empowered to be part of the care process; and (3) patients and families experienced care as effective at addressing their individual needs. CONCLUSION There is agreement among young adult patients and families about what constitutes PFCC in a chronic disease setting, independent of the aetiology of the pathological process. Patients and families also have strong feelings about how practitioners can achieve PFCC in practice. These findings have implications for the delivery of health services to young adults living with chronic disease and their family members.
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Affiliation(s)
- David Allen
- The HEARing CRC, The University of Queensland, AU
- The HEARing CRC, Department of Audiology and Speech Pathology, The University of Melbourne, 550 Swanston Street, Carlton, Victoria, AU
- School of Health and Rehabilitation Sciences, The University of Queensland, AU
| | - Nerina Scarinci
- The HEARing CRC, The University of Queensland, AU
- The HEARing CRC, Department of Audiology and Speech Pathology, The University of Melbourne, 550 Swanston Street, Carlton, Victoria, AU
- School of Health and Rehabilitation Sciences, The University of Queensland, AU
| | - Louise Hickson
- The HEARing CRC, The University of Queensland, AU
- The HEARing CRC, Department of Audiology and Speech Pathology, The University of Melbourne, 550 Swanston Street, Carlton, Victoria, AU
- School of Health and Rehabilitation Sciences, The University of Queensland, AU
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99
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Roso-Llorach A, Violán C, Foguet-Boreu Q, Rodriguez-Blanco T, Pons-Vigués M, Pujol-Ribera E, Valderas JM. Comparative analysis of methods for identifying multimorbidity patterns: a study of 'real-world' data. BMJ Open 2018; 8:e018986. [PMID: 29572393 PMCID: PMC5875653 DOI: 10.1136/bmjopen-2017-018986] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE The aim was to compare multimorbidity patterns identified with the two most commonly used methods: hierarchical cluster analysis (HCA) and exploratory factor analysis (EFA) in a large primary care database. Specific objectives were: (1) to determine whether choice of method affects the composition of these patterns and (2) to consider the potential application of each method in the clinical setting. DESIGN Cross-sectional study. Diagnoses were based on the 263 corresponding blocks of the International Classification of Diseases version 10. Multimorbidity patterns were identified using HCA and EFA. Analysis was stratified by sex, and results compared for each method. SETTING AND PARTICIPANTS Electronic health records for 408 994 patients with multimorbidity aged 45-64 years in 274 primary health care teams from 2010 in Catalonia, Spain. RESULTS HCA identified 53 clusters for women, with just 12 clusters including at least 2 diagnoses, and 15 clusters for men, all of them including at least two diagnoses. EFA showed 9 factors for women and 10 factors for men. We observed differences by sex and method of analysis, although some patterns were consistent. Three combinations of diseases were observed consistently across sex groups and across both methods: hypertension and obesity, spondylopathies and deforming dorsopathies, and dermatitis eczema and mycosis. CONCLUSIONS This study showed that multimorbidity patterns vary depending on the method of analysis used (HCA vs EFA) and provided new evidence about the known limitations of attempts to compare multimorbidity patterns in real-world data studies. We found that EFA was useful in describing comorbidity relationships and HCA could be useful for in-depth study of multimorbidity. Our results suggest possible applications for each of these methods in clinical and research settings, and add information about some aspects that must be considered in standardisation of future studies: spectrum of diseases, data usage and methods of analysis.
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Affiliation(s)
- Albert Roso-Llorach
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Concepción Violán
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Quintí Foguet-Boreu
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Department of Psychiatry, Vic University Hospital, Barcelona, Spain
| | - Teresa Rodriguez-Blanco
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Mariona Pons-Vigués
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Faculty of Nursing, University of Girona, Barcelona, Spain
| | - Enriqueta Pujol-Ribera
- Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Faculty of Nursing, University of Girona, Barcelona, Spain
| | - Jose Maria Valderas
- Health Services and Policy Research Group, Academic Collaboration for Primary Care, University of Exeter Medical School, Exeter, UK
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100
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Ong SM, Lim YMF, Sivasampu S, Khoo EM. Variation of polypharmacy in older primary care attenders occurs at prescriber level. BMC Geriatr 2018; 18:59. [PMID: 29471806 PMCID: PMC5824493 DOI: 10.1186/s12877-018-0750-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 02/16/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Polypharmacy is particularly important in older persons as they are more likely to experience adverse events compared to the rest of the population. Despite the relevance, there is a lack of studies on the possible association of patient, prescriber and practice characteristics with polypharmacy. Thus, the aim of this study was to determine the rate of polypharmacy among older persons attending public and private primary care clinics, and its association with patient, prescriber and practice characteristics. METHODS We used data from The National Medical Care Survey (NMCS), a national cross-sectional survey of patients' visits to primary care clinics in Malaysia. A weighted total of 22,832 encounters of patients aged ≥65 years were analysed. Polypharmacy was defined as concomitant use of five medications and above. Multilevel logistic regression was performed to examine the association of polypharmacy with patient, prescriber and practice characteristics. RESULTS A total of 20.3% of the older primary care attenders experienced polypharmacy (26.7%% in public and 11.0% in private practice). The adjusted odds ratio (OR) of polypharmacy were 6.37 times greater in public practices. Polypharmacy was associated with patients of female gender (OR 1.49), primary education level (OR 1.61) and multimorbidity (OR 14.21). The variation in rate of polypharmacy was mainly found at prescriber level. CONCLUSION Polypharmacy is common among older persons visiting primary care practices. Given the possible adverse outcomes, interventions to reduce the burden of polypharmacy are best to be directed at individual prescribers.
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Affiliation(s)
- Su Miin Ong
- Healthcare Statistics Unit, National Clinical Research Centre, 3rd floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur, Malaysia
| | - Yvonne Mei Fong Lim
- Healthcare Statistics Unit, National Clinical Research Centre, 3rd floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur, Malaysia
| | - Sheamini Sivasampu
- Healthcare Statistics Unit, National Clinical Research Centre, 3rd floor, MMA House, 124, Jalan Pahang, 53000 Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia
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