51
|
Gesell SB, Bushnell CD, Jones SB, Coleman SW, Levy SM, Xenakis JG, Lutz BJ, Bettger JP, Freburger J, Halladay JR, Johnson AM, Kucharska-Newton AM, Mettam LH, Pastva AM, Psioda MA, Radman MD, Rosamond WD, Sissine ME, Halls J, Duncan PW. Implementation of a billable transitional care model for stroke patients: the COMPASS study. BMC Health Serv Res 2019; 19:978. [PMID: 31856808 PMCID: PMC6923985 DOI: 10.1186/s12913-019-4771-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 11/22/2019] [Indexed: 11/16/2022] Open
Abstract
Background The COMprehensive Post-Acute Stroke Services (COMPASS) pragmatic trial compared the effectiveness of comprehensive transitional care (COMPASS-TC) versus usual care among stroke and transient ischemic attack (TIA) patients discharged home from North Carolina hospitals. We evaluated implementation of COMPASS-TC in 20 hospitals randomized to the intervention using the RE-AIM framework. Methods We evaluated hospital-level Adoption of COMPASS-TC; patient Reach (meeting transitional care management requirements of timely telephone and face-to-face follow-up); Implementation using hospital quality measures (concurrent enrollment, two-day telephone follow-up, 14-day clinic visit scheduling); and hospital-level sustainability (Maintenance). Effectiveness compared 90-day physical function (Stroke Impact Scale-16), between patients receiving COMPASS-TC versus not. Associations between hospital and patient characteristics with Implementation and Reach measures were estimated with mixed logistic regression models. Results Adoption: Of 95 eligible hospitals, 41 (43%) participated in the trial. Of the 20 hospitals randomized to the intervention, 19 (95%) initiated COMPASS-TC. Reach: A total of 24% (656/2751) of patients enrolled received a billable TC intervention, ranging from 6 to 66% across hospitals. Implementation: Of eligible patients enrolled, 75.9% received two-day calls (or two attempts) and 77.5% were scheduled/offered clinic visits. Most completed visits (78% of 975) occurred within 14 days. Effectiveness: Physical function was better among patients who attended a 14-day visit versus those who did not (adjusted mean difference: 3.84, 95% CI 1.42–6.27, p = 0.002). Maintenance: Of the 19 adopting hospitals, 14 (74%) sustained COMPASS-TC. Conclusions COMPASS-TC implementation varied widely. The greatest challenge was reaching patients because of system difficulties maintaining consistent delivery of follow-up visits and patient preferences to pursue alternate post-acute care. Receiving COMPASS-TC was associated with better functional status. Trial registration ClinicalTrials.gov number: NCT02588664. Registered 28 October 2015.
Collapse
Affiliation(s)
- Sabina B Gesell
- Department of Social Sciences and Health Policy, Department of Implementation Science, Wake Forest School of Medicine, One Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Cheryl D Bushnell
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Sara B Jones
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Sylvia W Coleman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Samantha M Levy
- Department of Biostatistics, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - James G Xenakis
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Barbara J Lutz
- University of North Carolina at Wilmington, School of Nursing, Wilmington, NC, USA
| | | | - Janet Freburger
- University of Pittsburgh, School of Health and Rehabilitation Sciences, Pittsburgh, PA, USA
| | - Jacqueline R Halladay
- Department of Family Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Anna M Johnson
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Anna M Kucharska-Newton
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA.,Department of Epidemiology, University of Kentucky, College of Public Health, Lexington, KY, USA
| | - Laurie H Mettam
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Amy M Pastva
- Duke University, School of Medicine, Durham, NC, USA
| | - Matthew A Psioda
- Department of Biostatistics, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Meghan D Radman
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Wayne D Rosamond
- Department of Epidemiology, University of North Carolina at Chapel Hill, Gillings School of Global Public Health, Chapel Hill, NC, USA
| | - Mysha E Sissine
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Joanne Halls
- Department of Earth and Ocean Sciences, University of North Carolina at Wilmington, Wilmington, NC, USA
| | - Pamela W Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, NC, USA
| |
Collapse
|
52
|
Finch E, Foster M, Cruwys T, Fleming J, Aitken P, Jaques K, Williams I, Shah D. Meeting unmet needs following minor stroke: the SUN randomised controlled trial protocol. BMC Health Serv Res 2019; 19:894. [PMID: 31771639 PMCID: PMC6880549 DOI: 10.1186/s12913-019-4746-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 11/14/2019] [Indexed: 11/12/2022] Open
Abstract
Background Whilst there are comprehensive guidelines for the rehabilitation of people with severe impairments from stroke, there has been less attention on the health and rehabilitation needs of people with minor stroke. Our study will assess whether a new multi-component service pathway using an integrated model based around primary care will reduce unmet need following minor stroke compared with usual care 1 and 3 months post-hospital discharge. Methods One hundred ten patients with minor stroke will be recruited within a parallel, randomised controlled trial design comparing a new service pathway and usual care. The new service pathway will comprise a self-management kit, customised General Practitioner checklist, and a series of minor stroke educational topics. Participants will complete assessments pre-hospital discharge and 1 and 3 months later. The primary outcome measure will be the Survey of Unmet Needs and Service Usage. Secondary outcome measures will include assessments of ability, adjustment and participation; social group connectedness; return to work; health-related quality of life; and perceptions of the new service pathway (intervention group only). Mixed model repeated measures will be used to analyse within and between group differences at each time point. Return to work will be analysed using Chi square tests. Perceptions of the new service pathway will be analysed qualitatively. Dissemination of results The project will produce an evidence-based, multicomponent service pathway for minor stroke patients, applicable to other health services nationally and internationally. Dissemination will include publications and presentations. Trial registration Prospectively registered - Australian New Zealand Clinical Trials Registry (ACTRN12619000133134p) 30 January 2019.
Collapse
Affiliation(s)
- Emma Finch
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia. .,Speech Pathology Department, Princess Alexandra Hospital, Brisbane, Australia. .,Centre for Functioning and Health Research, Metro South Health, Brisbane, Australia.
| | - Michele Foster
- Hopkins Centre, Division of Rehabilitation, Metro South Health, Brisbane, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Australia
| | - Tegan Cruwys
- Research School of Psychology, The Australian National University, Canberra, Australia
| | - Jennifer Fleming
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, QLD, 4072, Australia
| | - Philip Aitken
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| | | | | | - Darshan Shah
- Princess Alexandra Hospital, Brisbane, QLD, Australia.,School of Medicine, The University of Queensland, Brisbane, Australia
| |
Collapse
|
53
|
Hartford W, Lear S, Nimmon L. Stroke survivors' experiences of team support along their recovery continuum. BMC Health Serv Res 2019; 19:723. [PMID: 31638959 PMCID: PMC6805495 DOI: 10.1186/s12913-019-4533-z] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 09/13/2019] [Indexed: 11/21/2022] Open
Abstract
Background A coordinated stroke rehabilitation care team is considered optimal for supporting stroke survivors from diagnosis to recovery. Despite this recognition, many stroke survivors cannot access essential rehabilitation services. Furthermore, there is a lack of understanding of stroke patients’ and their caregivers’ rehabilitation needs and wishes. We sought to gain insight into healthcare and social structures from the perspective of patients and caregivers that can better support long-term stroke recovery. Methods We conducted individual interviews with 24 participants comprised of stroke survivors, spousal caregivers, stroke support group coordinators, and speech pathologist. Participants were recruited through three stroke survivor support groups. An empowerment lens was integrated into data analysis and data interpretation. Results Two dominant themes captured participants’ experiences through stroke survivors’ trajectory of care. 1) Experiences of managing stroke. This theme identified stroke survivors and spousal caregivers’ experiences with stroke recovery, rehabilitation, and fulfilling unmet needs. 2) Resources of support. This theme described the social and financial support structures drawn upon to assist with stroke rehabilitation. Conclusions The study highlighted a lack of teamwork between stroke survivors, spousal caregivers, and health professionals. This fragmented care was compounded by inequities in rehabilitation programs and health services resulting in what appeared to be a disempowering rehabilitation process. Although stroke recovery groups were a significant source of support for stroke survivors and spousal caregivers, participants perceived they were overlooked, by stroke recovery healthcare providers, as a site for stroke recovery healthcare services. An empowerment approach to stroke rehabilitation involves collaboration between stroke survivors, caregivers, healthcare providers, health services, and existing community stroke support structures. Framing stroke based care through an empowerment lens may serve to address stroke rehabilitation inadequacies and inequities.
Collapse
Affiliation(s)
- W Hartford
- Centre for Health Education Scholarship, Faculty of Medicine, P. A. Woodward Instructional Resources Centre (IRC), University of British Columbia, 429-2194 Health Sciences Mall, Vancouver, B.C, V6T 1Z3, Canada.
| | - S Lear
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, B.C, V5A 1S6, Canada
| | - L Nimmon
- Centre for Health Education Scholarship, Faculty of Medicine, P. A. Woodward Instructional Resources Centre (IRC), University of British Columbia, 429-2194 Health Sciences Mall, Vancouver, B.C, V6T 1Z3, Canada.,Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, 2211 Wesbrook Mall T325, Vancouver, B.C, V6T 2B5, Canada
| |
Collapse
|
54
|
A systematic literature review of the assessment of treatment burden experienced by patients and their caregivers. BMC Geriatr 2019; 19:262. [PMID: 31604424 PMCID: PMC6788093 DOI: 10.1186/s12877-019-1222-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Accepted: 07/22/2019] [Indexed: 11/10/2022] Open
Abstract
Background Many older adults with multiple chronic conditions, particularly those who are functionally impaired, spend considerable time juggling the competing demands of managing their conditions often assisted by caregivers. We examined methods of assessing the treatment burden experienced by this population as a first step to identifying strategies to reduce it. Methods Systematic searches were performed of the peer-reviewed and grey-literature (PubMed, Cochrane library, CINAHL, EMBASE, Web of Science, SCOPUS, New York Academy of Medicine Grey Literature Review, NLM catalog and ProQuest Digital Theses and Dissertations). After title and abstract screening, both qualitative and quantitative articles describing approaches to assessment of treatment burden were included. Results Forty-five articles from the peer reviewed and three items from the grey literature were identified. Most articles (34/48) discussed treatment burden associated with a specific condition. All but one examined the treatment burden experienced by patients and six addressed the treatment burden experienced by caregivers. Qualitative studies revealed many aspects of treatment burden including the burdens of understanding the condition, juggling, monitoring and adjusting treatments, efforts to engage with others for support as well as financial and time burdens. Many tools to assess treatment burden in different populations were identified through the qualitative data. The most commonly used instrument was the Treatment Burden Questionnaire. Conclusions Many instruments are available to assess treatment burden, but no one standardized assessment method was identified. Few articles examined approaches to measuring the treatment burden experienced by caregivers. As people live longer with more chronic conditions healthcare providers need to identify patients and caregivers burdened by treatment and engage in approaches to ameliorate treatment burden. A standard and validated assessment method to measure treatment burden in the clinical setting would help to enhance the care of people with multiple chronic conditions, allow comparison of different approaches to reducing treatment burden, and foster ongoing evaluation and monitoring of burden across conditions, patient populations, and time. Electronic supplementary material The online version of this article (10.1186/s12877-019-1222-z) contains supplementary material, which is available to authorized users.
Collapse
|
55
|
Queralt-Tomas L, Clua-Espuny JL, Fernández-Saez J, Lleixà-Fortuño MM, Albiol-Zaragoza I, Gil-Guillen V, Carratala-Munuera C. Risk of Dependency: A Challenge for Health and Social Care Planning-Observational Stroke Cohort. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2019; 22:1083-1091. [PMID: 31563250 DOI: 10.1016/j.jval.2019.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/10/2019] [Accepted: 05/27/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND After a stroke, families require the coordinated assistance of health and social care. Currently there is a lack of comprehensive evaluation and assessment tools to identify discharge needs, and there is separate management of health and social resources, and access to these services is variable between regions. OBJECTIVE The main objective of this study was to assess the factors associated with risk of dependency after stroke and propose a suitable instrument for identifying patients at higher risk. METHODS This was a 2-year prospective and community study of a stroke cohort. The primary outcome was recognized dependency. The potential predictors were considered in a multivariate regression and area under curve (AUC) to evaluate its discriminative capacity. RESULTS Overall, 233 stroke survivors were recruited, 49.8% of whom were women, and the average age was 78.1 ± 11.6 years. The total rate of dependency was 31.5 (95% confidence interval [CI] 26.1-37.7) cases/100 person-years. The independent factors associated with dependency outcome were age >80 years (hazard ratio [HR] 2.03, 95% CI 1.32-3.12, P = .001), Pfeiffer score ≥4 (HR 1.82, 95% CI 1.25-1.2.66, P = .002), Barthel score <60 (HR 1.79, 95% CI 1.21-2.66, P = .003), and Charlson score ≥3 (HR 1.49, 95% CI 1.02-2.16, P = .039). The AUC was 0.84 (95% CI 0.79-0.89; P < .001). CONCLUSIONS Stroke has serious effects on the dependency outcomes. The patient's age, cognitive or physical impairment, and comorbidities as measured on the Pfeiffer score, Barthel Index, and Charlson score identified people at high risk and may ease the integrated role of social and health services.
Collapse
Affiliation(s)
- Luisa Queralt-Tomas
- Catalonian Health Institute, Primary Care Service Terres de l'Ebre, Health Department, Generalitat de Catalunya, Primary Care Centre, Xerta, Spain.
| | - J L Clua-Espuny
- Research Institute University Primary Care (IDIAP) Jordi Gol, Catalonian Health Institute, Tortosa, Spain
| | - J Fernández-Saez
- Unitat de Suport a la Recerca Terres de l'Ebre, Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Grupo de investigación de Salud Pública, Universidad de Alicante, Spain
| | - M Mar Lleixà-Fortuño
- Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Hospital Verge de la Cinta, Tortosa, Spain
| | - Irene Albiol-Zaragoza
- Departament de Treball, Afers Socials i Famílies, Serveis Territorials de les Terres de l' Ebre, Amposta, Spain
| | - Vicente Gil-Guillen
- Family Medicine Department, Universidad Miguel Hernández, Ctra. Valencia, Sant Joan d'Alacant, Spain
| | | |
Collapse
|
56
|
Gallacher KI, Quinn T, Kidd L, Eton D, Dillon M, Elliot J, Johnston N, Erwin PJ, Mair F. Systematic review of patient-reported measures of treatment burden in stroke. BMJ Open 2019; 9:e029258. [PMID: 31533946 PMCID: PMC6756342 DOI: 10.1136/bmjopen-2019-029258] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Treatment burden is the workload of healthcare for people with long-term conditions (LTC) and its impact on well-being. A method of measurement is required to identify those experiencing high burden and to measure intervention efficacy. Our aim was to identify, examine and appraise validated patient-reported measures (PRMs) of treatment burden in stroke. Here, stroke serves as an exemplar LTC of older adults. DESIGN A systematic review of published studies that describe the development and validation of PRMs measuring treatment burden in stroke survivors. DATA SOURCES We searched MEDLINE, Embase, CINAHL and PsycINFO electronic databases. ELIGIBILITY CRITERIA Studies published between January 2000 and 12 April 2019 inclusive, in English language. No restrictions were set based on clinical setting or geographical location. DATA EXTRACTION AND SYNTHESIS Screening, data extraction and quality appraisal were conducted by two independent reviewers. Content of the PRMs was compared with a published taxonomy of treatment burden. Quality appraisal was conducted using International Society for Quality of Life Research standards. RESULTS From 3993 articles, 6 relevant PRMs were identified: 3 were stroke specific: The Satisfaction with Stroke Care questionnaire; The Stroke Patient-Reported Outcome Measure and The Barriers to Physical Activity after Stroke scale. Three were generic but validated in stroke: The WHO Quality of Life-100; The Patient's Questionnaire on Participation in Discharge Planning and The Chao Perception of Continuity scale. None comprehensively measured treatment burden. Examples of omitted burdens included developing coping strategies, managing finances and returning to driving. The most notable issue regarding quality appraisal was that three PRMs lacked any underpinning qualitative research relevant to the sample. CONCLUSION There is a need to develop a comprehensive PRM of treatment burden for use in stroke, with potential for use in other older populations.
Collapse
Affiliation(s)
- Katie I Gallacher
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Terry Quinn
- Department of Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Lisa Kidd
- Nursing & Healthcare School, School of Medicine, Dentistry and Nursing, University of Glasgow, Glasgow, UK
| | - David Eton
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, USA
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Jennifer Elliot
- Stroke and Brain Imaging, Institute of Neuroscience and Psychology, University of Glasgow, Glasgow, UK
| | - Natalie Johnston
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Patricia J Erwin
- Mayo Medical Libraries, Mayo Clinic College of Medicine, Rochester, Minnesota, USA
| | - Frances Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
57
|
Törnbom K, Lundälv J, Palstam A, Sunnerhagen KS. "My life after stroke through a camera lens"- A photovoice study on participation in Sweden. PLoS One 2019; 14:e0222099. [PMID: 31509564 PMCID: PMC6738637 DOI: 10.1371/journal.pone.0222099] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2019] [Accepted: 08/21/2019] [Indexed: 12/04/2022] Open
Abstract
Background An increasing number of people with stroke live in their communities, yet the understanding of how their reintegration into society can best be facilitated is incomplete. If needs are not sufficiently met and difficulties overcome, it may result in limited participation and decreased life satisfaction for this group. We aimed to understand life after stroke through the lens of participants’ cameras, and hence their views and experiences guided this study. Methods By the means of photovoice, an action research method, this study was conducted in a collaborative format with six women and five men after stroke. Participants photographed in everyday life for up to four weeks and then met to discuss all images in a focus group setting. Subsequently, participants gave feedback on the method and discussed the upcoming photography exhibition. All photos and the three focus group discussions were analyzed using a thematic analysis with an inductive approach. Results In the focus group discussions, life after stroke were conceptualized through five main themes: a driving force to participate in society; managing everyday life through inventiveness and persistent training; insufficient healthcare and rehabilitation in the long-term perspective; finding meaningful relationships and activities in daily life. Participants’ voices are made clear through selected photos, which aim to present each theme and make results easier to understand. Conclusions Participants found new ways to approach everyday life situations and had thereby regained a sense of control in life. However, it was evident that psychological processes towards adaptation were hindered by depression and that some individuals felt alone in an ongoing struggle. Additionally, available interventions a long time after stroke were not flexible enough to address all participants’ needs.
Collapse
Affiliation(s)
- Karin Törnbom
- Research group for Rehabilitation Medicine, Section for Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | - Jörgen Lundälv
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
| | - Annie Palstam
- Research group for Rehabilitation Medicine, Section for Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Katharina S. Sunnerhagen
- Research group for Rehabilitation Medicine, Section for Clinical Neuroscience, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Centre for Person-Centred Care (GPCC), University of Gothenburg, Gothenburg, Sweden
| |
Collapse
|
58
|
Boehmer KR, Dobler CC, Thota A, Branda M, Giblon R, Behnken E, Organick P, Allen SV, Shaw K, Montori VM. Changing conversations in primary care for patients living with chronic conditions: pilot and feasibility study of the ICAN Discussion Aid. BMJ Open 2019; 9:e029105. [PMID: 31481553 PMCID: PMC6731832 DOI: 10.1136/bmjopen-2019-029105] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To pilot test the impact of the ICAN Discussion Aid on clinical encounters. METHODS A pre-post study involving 11 clinicians and 100 patients was conducted at two primary care clinics within a single health system in the Midwest. The study examined clinicians' perceptions about ICAN feasibility, patients' and clinicians' perceptions about encounter success, videographic differences in encounter topics, and medication adherence 6 months after an ICAN encounter. RESULTS 39/40 control encounters and 45/60 ICAN encounters yielded usable data. Clinicians reported ICAN use was feasible. In ICAN encounters, patients discussed diet, being active and taking medications more. Clinicians scored themselves poorer regarding visit success than their patients scored them; this effect was more pronounced in ICAN encounters. ICAN did not improve 6-month medication adherence or lengthen visits. CONCLUSION This pilot study suggests that using ICAN in primary care is feasible, efficient and capable of modifying conversations. With lessons learned in this pilot, we are conducting a randomised trial of ICAN versus usual care in diverse clinical settings. TRIAL REGISTRATION NUMBER NCT02390570.
Collapse
Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudia C Dobler
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Evidence-Based Practice Center, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Anjali Thota
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Megan Branda
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Rachel Giblon
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota, USA
| | - Emma Behnken
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Paige Organick
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Summer V Allen
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
- Department of Family Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Kevin Shaw
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| |
Collapse
|
59
|
Arwert HJ, Groeneveld IF, Vliet Vlieland TPM, Meesters JJL. Health Care Use and Its Associated Factors 5-8 Years after Stroke. J Stroke Cerebrovasc Dis 2019; 28:104333. [PMID: 31455556 DOI: 10.1016/j.jstrokecerebrovasdis.2019.104333] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 05/06/2019] [Accepted: 07/27/2019] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To describe health care use and its associated factors in the chronic phase after stroke. METHODS Patients completed a questionnaire on health care use, 5-8 years after hospital admission for stroke. It comprised the number of visits to physicians or other health care professionals over the past 6 months (Physician-visits; Low ≤1 or High ≥2) and other health care professionals (Low = 0 or High ≥ 1). In addition the Longer-term Unmet Needs after Stroke (LUNS), Frenchay Activity Index (FAI) and Physical and Mental Component Summary Scales of the Short Form 12 (PCS and MCS) were administered. Their associations with health care use (high, low) were determined by means of logistic regression analysis, adjusted for sex and age. RESULTS Seventy-eight of 145 patients (54%) returned the questionnaires; mean time-since-stroke was 80.3 months (SD10.2), age-at-stroke 61.7 years (SD13.8), and 46 (59%) were male. Physician contacts concerned mainly the general practitioner (58; 79.5%). Forty-one (52.6%) and 37 (47.4%) of the patients had a high use of physician and other health professionals visits, respectively. Worse PCS scores were associated with both high use of physician and other health professionals visits (OR .931; 95%CI .877-.987 and OR .941; 95%CI .891-.993, respectively), whereas the FAI, MCS, or LUNS were not related to health care use. CONCLUSIONS Health care use after stroke is substantial and is related to physical aspects of health status, not to mental aspects, activities or unmet needs, suggesting a mismatch between patients' needs and care delivered.
Collapse
Affiliation(s)
- Henk J Arwert
- Basalt Rehabilitation Center, the Hague, the Netherlands; Haaglanden Medical Center, the Hague, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands.
| | | | - Thea P M Vliet Vlieland
- Basalt Rehabilitation Center, the Hague, the Netherlands; Basalt Rehabilitation Center, Leiden, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| | - Jorit J L Meesters
- Basalt Rehabilitation Center, the Hague, the Netherlands; Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
60
|
Aquino MRJ(RV, Turner GM, Mant J. Does characterising patterns of multimorbidity in stroke matter for developing collaborative care approaches in primary care? Prim Health Care Res Dev 2019; 20:e110. [PMID: 32800014 PMCID: PMC6635803 DOI: 10.1017/s1463423619000240] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Revised: 01/16/2019] [Accepted: 03/06/2019] [Indexed: 12/03/2022] Open
Abstract
Stroke and transient ischaemic attack (TIA) remain leading causes of mortality and morbidity globally. Although mortality rates have been in decline, the number of people affected by stroke has risen. These patients have a range of long-term needs and often present to primary care. Furthermore, many of these patients have multimorbidities which increase the complexity of their healthcare. Long-term impacts from stroke/TIA along with care needs for other morbidities can be challenging to address because care can involve different healthcare professionals, both specialist and generalist. In the ideal model of care, such professionals would work collaboratively to provide care. Despite the commonality of multimorbidity in stroke/TIA, gaps in the literature remain, particularly limited knowledge of pairings or clusters of comorbid conditions and the extent to which these are interrelated. Moreover, integrated care practices are less well understood and remain variable in practice. This article argues that it is important to understand (through research) patterns of multimorbidity, including number, common clusters and types of comorbidities, and current interprofessional practice to inform future directions to improve long-term care.
Collapse
Affiliation(s)
| | - Grace M Turner
- Research Fellow, Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Mant
- Professor of Primary Care Research, Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| |
Collapse
|
61
|
Affiliation(s)
- Katie I. Gallacher
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Bhautesh D. Jani
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Peter Hanlon
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Barbara I. Nicholl
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| | - Frances S. Mair
- From General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Scotland
| |
Collapse
|
62
|
Manning M, MacFarlane A, Hickey A, Franklin S. Perspectives of people with aphasia post-stroke towards personal recovery and living successfully: A systematic review and thematic synthesis. PLoS One 2019; 14:e0214200. [PMID: 30901359 PMCID: PMC6430359 DOI: 10.1371/journal.pone.0214200] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 03/08/2019] [Indexed: 12/30/2022] Open
Abstract
Background There is increased focus on supporting people with chronic conditions to live well via person-centred, integrated care. There is a growing body of qualitative literature examining the insider perspectives of people with post-stroke aphasia (PWA) on topics relating to personal recovery and living successfully (PR-LS). To date no synthesis has been conducted examining both internal and external, structural influences on living well. In this study, we aimed to advance theoretical understanding of how best to promote and support PR-LS by integrating the perspectives of PWA on a wide range of topics relating to PR-LS. This is essential for planning and delivering quality care. Methods and findings We conducted a systematic review, following PRISMA guidelines, and thematic synthesis. Following a search of 7 electronic databases, 31 articles were included and critically appraised using predetermined criteria. Inductive and iterative analysis generated 5 analytical themes about promoting PR-LS. Aphasia occurs in the context of a wider social network that provides valued support and social companionship and has its own need for formal support. PWA want to make a positive contribution to society. The participation of PWA is facilitated by enabling environments and opportunities. PWA benefit from access to a flexible, responsive, life-relevant range of services in the long-term post-stroke. Accessible information and collaborative interactions with aphasia-aware healthcare professionals empower PWA to take charge of their condition and to navigate the health system. Conclusion The findings highlight the need to consider wider attitudinal and structural influences on living well. PR-LS are promoted via responsive, long-term support for PWA, friends and family, and opportunities to participate autonomously and contribute to the community. Shortcomings in the quality of the existing evidence base must be addressed in future studies to ensure that PWA are meaningfully included in research and service development initiatives. Systematic review registration International Prospective Register of Systematic Reviews PROSPERO 2017: CRD42017056110.
Collapse
Affiliation(s)
- Molly Manning
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
- * E-mail:
| | - Anne MacFarlane
- Graduate Entry Medical School (GEMS), Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Republic of Ireland
| | - Anne Hickey
- Dept Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Sue Franklin
- School of Allied Health, Faculty of Education and Health Sciences, University of Limerick, Limerick, Republic of Ireland
| |
Collapse
|
63
|
Nordfonn OK, Morken IM, Bru LE, Husebø AML. Patients’ experience with heart failure treatment and self‐care—A qualitative study exploring the burden of treatment. J Clin Nurs 2019; 28:1782-1793. [DOI: 10.1111/jocn.14799] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 11/16/2018] [Accepted: 01/13/2019] [Indexed: 11/30/2022]
Affiliation(s)
- Oda Karin Nordfonn
- Faculty of Health Sciences University of Stavanger Stavanger Norway
- Department of Health and Caring Sciences Western Norway University of Applied Sciences Stord Norway
| | - Ingvild Margreta Morken
- Faculty of Health Sciences University of Stavanger Stavanger Norway
- Department of Cardiology Stavanger University Hospital Stavanger Norway
| | - Lars Edvin Bru
- Faculty of Health Sciences University of Stavanger Stavanger Norway
| | - Anne Marie Lunde Husebø
- Faculty of Health Sciences University of Stavanger Stavanger Norway
- Department of Gastroenterological Surgery Stavanger University Hospital Stavanger Norway
| |
Collapse
|
64
|
Lippiett KA, Richardson A, Myall M, Cummings A, May CR. Patients and informal caregivers' experiences of burden of treatment in lung cancer and chronic obstructive pulmonary disease (COPD): a systematic review and synthesis of qualitative research. BMJ Open 2019; 9:e020515. [PMID: 30813114 PMCID: PMC6377510 DOI: 10.1136/bmjopen-2017-020515] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVE To identify, characterise and explain common and specific features of the experience of treatment burden in relation to patients living with lung cancer or chronic obstructive pulmonary disease (COPD) and their informal caregivers. DESIGN Systematic review and interpretative synthesis of primary qualitative studies. Papers were analysed using constant comparison and directed qualitative content analysis. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science searched from January 2006 to December 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Primary qualitative studies in English where participants were patients with lung cancer or COPD and/or their informal caregivers, aged >18 years that contain descriptions of experiences of interacting with health or social care in Europe, North America and Australia. RESULTS We identified 127 articles with 1769 patients and 491 informal caregivers. Patients, informal caregivers and healthcare professionals (HCPs) acknowledged lung cancer's existential threat. Managing treatment workload was a priority in this condition, characterised by a short illness trajectory. Treatment workload was generally well supported by an immediacy of access to healthcare systems and a clear treatment pathway. Conversely, patients, informal caregivers and HCPs typically did not recognise or understand COPD. Treatment workload was balanced with the demands of everyday life throughout a characteristically long illness trajectory. Consequently, treatment workload was complicated by difficulties of access to, and navigation of, healthcare systems, and a fragmented treatment pathway. In both conditions, patients' capacity to manage workload was enhanced by the support of family and friends, peers and HCPs and diminished by illness/smoking-related stigma and social isolation. CONCLUSION This interpretative synthesis has affirmed significant differences in treatment workload between lung cancer and COPD. It has demonstrated the importance of the capacity patients have to manage their workload in both conditions. This suggests a workload which exceeds capacity may be a primary driver of treatment burden. PROSPERO REGISTRATION NUMBER CRD42016048191.
Collapse
Affiliation(s)
- Kate Alice Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Carl R May
- London School of Hygiene and Tropical Medicine, London, UK
| |
Collapse
|
65
|
Boehmer KR, Guerton NM, Soyring J, Hargraves I, Dick S, Montori VM. Capacity Coaching: A New Strategy for Coaching Patients Living With Multimorbidity and Organizing Their Care. Mayo Clin Proc 2019; 94:278-286. [PMID: 30711126 PMCID: PMC6388414 DOI: 10.1016/j.mayocp.2018.08.021] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Revised: 07/16/2018] [Accepted: 08/22/2018] [Indexed: 11/19/2022]
Abstract
The prevalence of chronic conditions is growing; to date, 1 in 4 Americans lives with at least one chronic condition. In the population aged 65 years and older, most live with multiple chronic conditions, or multimorbidity. Coaching interventions have been widely touted as a potential way to prevent chronic illness and as a way to help patients better self-manage their chronic illnesses. Health and Wellness Coaching (HWC) is now a respected discipline that offers certification, and HWC for patients with chronic conditions has demonstrated the potential to positively change behaviors and health outcomes. Yet, despite the enthusiasm and advancement of the discipline, the role of HWC has not been examined in light of the latest conceptual and theoretical work in the treatment of multimorbidity. In this article, we briefly describe HWC activities and the way in which they can be modified in alignment with the progress in the field of multimorbidity to form a new type of coaching, Capacity Coaching.
Collapse
Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN.
| | | | - Jason Soyring
- Dan Abraham Healthy Living Center, Mayo Clinic, Rochester, MN
| | - Ian Hargraves
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | - Sara Dick
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| |
Collapse
|
66
|
Lorenz EC, Egginton JS, Stegall MD, Cheville AL, Heilman RL, Nair SS, Mai ML, Eton DT. Patient experience after kidney transplant: a conceptual framework of treatment burden. J Patient Rep Outcomes 2019; 3:8. [PMID: 30701333 PMCID: PMC6353980 DOI: 10.1186/s41687-019-0095-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 01/15/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Kidney transplant recipients face a lifelong regimen of medications, health monitoring and medical appointments. This work involved in managing one's health and its impact on well-being are referred to as treatment burden. Excessive treatment burden can adversely impact adherence and quality of life. The aim of this study was to develop a conceptual framework of treatment burden after kidney transplantation. Qualitative interviews were conducted with kidney transplant recipients (n = 27) from three Mayo Clinic transplant centers. A semi-structured interview guide originally developed in patients with chronic conditions and tailored to the context of kidney transplantation was utilized. Themes of treatment burden after kidney transplantation were confirmed in two focus groups (n = 16). RESULTS Analyses confirmed three main themes of treatment burden after kidney transplantation: 1) work patients must do to care for their health (e.g., attending medical appointments, taking medications), 2) challenges/stressors that exacerbate felt burden (e.g., financial concerns, health system obstacles) 3) impacts of burden (e.g., role/social activity limitations). CONCLUSIONS Patients describe a significant amount of work involved in caring for their kidney transplants. This work is exacerbated by individual, interpersonal and system-related factors. The framework will be used as a foundation for a patient-reported measure of treatment burden to promote better care after kidney transplantation.
Collapse
Affiliation(s)
- Elizabeth C Lorenz
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA. .,Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA.
| | - Jason S Egginton
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA
| | - Mark D Stegall
- William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, 200 1st St. SW, Rochester, MN, 55905, USA
| | - Andrea L Cheville
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA
| | - Raymond L Heilman
- Mayo Clinic Arizona Transplant Center, Mayo Clinic, Phoenix, AZ, USA
| | | | - Martin L Mai
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - David T Eton
- Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, USA.,Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| |
Collapse
|
67
|
Loft MI, Poulsen I, Martinsen B, Mathiesen LL, Iversen HK, Esbensen BA. Strengthening nursing role and functions in stroke rehabilitation 24/7: A mixed-methods study assessing the feasibility and acceptability of an educational intervention programme. Nurs Open 2019; 6:162-174. [PMID: 30534406 PMCID: PMC6279726 DOI: 10.1002/nop2.202] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 04/24/2018] [Accepted: 08/06/2018] [Indexed: 11/06/2022] Open
Abstract
AIM To assess the feasibility of a nursing educational intervention for inpatient stroke rehabilitation and its acceptability from the nursing staff's perspective. BACKGROUND There is currently a lack of interventions that integrate the diversity of nurses' role and functions in stroke rehabilitation and explore their effect on patient outcomes. DESIGN We used a convergent, parallel, mixed-method design with data interviews and questionnaires. METHODS Data collection was undertaken between February - July 2016. Data from questionnaires (N = 31) were analysed using descriptive statistics. The interviews (N = 10) were analysed using deductive content analysis. RESULTS There was a high level of satisfaction with the educational programme in terms of its acceptability and feasibility. The qualitative findings disclosed the nursing staff's experiences with the educational programme. Mixed-methods analysis showed confirmatory results that were convergent and expanded. Only minor adjustments are required before an effect study can be conducted.
Collapse
Affiliation(s)
| | - Ingrid Poulsen
- Research Unit on Brain Injury Rehabilitation Copenhagen (RuBRIC), Clinic of NeurorehabilitationTBI Unit RigshospitaletHvidovreDenmark
- Department of Nursing Science, Institute of Public HealthAarhus UniversityCopenhagenDenmark
| | - Bente Martinsen
- Department of Nursing Science, Institute of Public HealthAarhus UniversityCopenhagenDenmark
| | | | - Helle Klingenberg Iversen
- Department of NeurologyRigshospitaletGlostrupDenmark
- Clinical Research, Faculty of Health and Medical SciencesUniversity of CopenhagenGlostrupDenmark
| | - Bente Appel Esbensen
- Copenhagen Centre for Arthritis Research (COPECARE)Centre for Rheumatology and Spine Diseases VRR, Head and Orthopaedics Centre, RigshospitaletGlostrupDenmark
- Faculty of Health and Medical Sciences, Department of Clinical MedicineUniversity of CopenhagenGlostrupDenmark
| |
Collapse
|
68
|
Ørtenblad L, Meillier L, Jønsson AR. Multi-morbidity: A patient perspective on navigating the health care system and everyday life. Chronic Illn 2018; 14:271-282. [PMID: 28914088 DOI: 10.1177/1742395317731607] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE The importance of everyday life when managing the burden of treatment is rarely studied. This article explores the burden of treatment among people with multi-morbidity by investigating the tension between everyday life and the health care system. METHOD This was an ethnographic study using individual interviews and participant-observations. An inductive analytical approach was applied, moving from observations and results to broader generalisations. RESULTS People with multi-morbidity experience dilemmas related to their individual priorities in everyday life and the management of their treatment burdens. Dilemmas were identified within three domains: family and social life; work life; agendas and set goals in appointments with health professionals. Individual resources and priorities in everyday life play a dominant role in resolving dilemmas and navigating the tension between everyday life and the health care system. DISCUSSION People with multi-morbidity are seldom supported by health professionals in resolving the dilemmas they must face. This study suggests an increased focus on patient-centredness and argues in favour of planning health care through cooperation between health professionals and people with multi-morbidity in a way that integrates both health and everyday life priorities.
Collapse
Affiliation(s)
- Lisbeth Ørtenblad
- 1 Public Health and Health Services Research, DEFACTUM, Aarhus N., Denmark
| | - Lucette Meillier
- 1 Public Health and Health Services Research, DEFACTUM, Aarhus N., Denmark
| | | |
Collapse
|
69
|
Ofori-Asenso R, Zomer E, Chin KL, Si S, Markey P, Tacey M, Curtis AJ, Zoungas S, Liew D. Effect of Comorbidity Assessed by the Charlson Comorbidity Index on the Length of Stay, Costs and Mortality among Older Adults Hospitalised for Acute Stroke. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15112532. [PMID: 30424531 PMCID: PMC6267000 DOI: 10.3390/ijerph15112532] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 11/07/2018] [Accepted: 11/07/2018] [Indexed: 11/16/2022]
Abstract
The burden of comorbidity among stroke patients is high. The aim of this study was to examine the effect of comorbidity on the length of stay (LOS), costs, and mortality among older adults hospitalised for acute stroke. Among 776 older adults (mean age 80.1 ± 8.3 years; 46.7% female) hospitalised for acute stroke during July 2013 to December 2015 at a tertiary hospital in Melbourne, Australia, we collected data on LOS, costs, and discharge outcomes. Comorbidity was assessed via the Charlson Comorbidity Index (CCI), where a CCI score of 0⁻1 was considered low and a CCI ≥ 2 was high. Negative binomial regression and quantile regression were applied to examine the association between CCI and LOS and cost, respectively. Survival was evaluated with the Kaplan⁻Meier and Cox regression analyses. The median LOS was 1.1 days longer for patients with high CCI than for those with low CCI. In-hospital mortality rate was 18.2% (22.1% for high CCI versus 11.8% for low CCI, p < 0.0001). After controlling for confounders, high CCI was associated with longer LOS (incidence rate ratio [IRR]; 1.35, p < 0.0001) and increased likelihood of in-hospital death (hazard ratio [HR]; 1.91, p = 0.003). The adjusted median, 25th, and 75th percentile costs were AUD$2483 (26.1%), AUD$1446 (28.1%), and AUD$3140 (27.9%) higher for patients with high CCI than for those with low CCI. Among older adults hospitalised for acute stroke, higher global comorbidity (CCI ≥ 2) was associated adverse clinical outcomes. Measures to better manage comorbidities should be considered as part of wider strategies towards mitigating the social and economic impacts of stroke.
Collapse
Affiliation(s)
- Richard Ofori-Asenso
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
- Epidemiological Modelling Unit, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Ella Zomer
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Ken Lee Chin
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Si Si
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Peter Markey
- Alfred Hospital, Melbourne, VIC 3004, Australia.
| | - Mark Tacey
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Andrea J Curtis
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Sophia Zoungas
- Division of Metabolism, Ageing and Genomics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| | - Danny Liew
- Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC 3004, Australia.
| |
Collapse
|
70
|
Barclay-Moss KM, Lannin NA, Grabsch B, Kilkenny M, Cadilhac DA. Stroke survivor follow-up in a national registry: Lessons learnt from respondents who completed telephone interviews. Int J Stroke 2018; 14:112-114. [PMID: 30362905 DOI: 10.1177/1747493018806190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The Australian Stroke Clinical Registry (AuSCR) collects patient-reported outcomes at 90-180 days post-stroke. During telephone interviews, stroke survivors or their carers/family members often explain why they did not respond to a previously mailed survey. This feedback is useful to explore respondents' experiences of the follow-up process. Three main reasons for not returning surveys included: health-related time constraints, confusion about survey questions, and stroke denial. Such information is helpful in improving procedures for clinical quality disease registries and researchers using postal questionnaires.
Collapse
Affiliation(s)
- Karen M Barclay-Moss
- 1 Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Natasha A Lannin
- 2 School of Allied Health, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia.,3 Alfred Health, Melbourne, VIC, Australia
| | - Brenda Grabsch
- 1 Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia
| | - Monique Kilkenny
- 1 Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia.,4 Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A Cadilhac
- 1 Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, VIC, Australia.,4 Stroke & Ageing Research, Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| |
Collapse
|
71
|
Roberti J, Cummings A, Myall M, Harvey J, Lippiett K, Hunt K, Cicora F, Alonso JP, May CR. Work of being an adult patient with chronic kidney disease: a systematic review of qualitative studies. BMJ Open 2018; 8:e023507. [PMID: 30181188 PMCID: PMC6129107 DOI: 10.1136/bmjopen-2018-023507] [Citation(s) in RCA: 72] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 06/28/2018] [Accepted: 08/08/2018] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Chronic kidney disease (CKD) requires patients and caregivers to invest in self-care and self-management of their disease. We aimed to describe the work for adult patients that follows from these investments and develop an understanding of burden of treatment (BoT). METHODS Systematic review of qualitative primary studies that builds on EXPERTS1 Protocol, PROSPERO registration number: CRD42014014547. We included research published in English, Spanish and Portuguese, from 2000 to present, describing experience of illness and healthcare of people with CKD and caregivers. Searches were conducted in MEDLINE, Embase, CINAHL Plus, PsycINFO, Scopus, Scientific Electronic Library Online and Red de Revistas Científicas de América Latina y el Caribe, España y Portugal. Content was analysed with theoretical framework using middle-range theories. RESULTS Searches resulted in 260 studies from 30 countries (5115 patients and 1071 carers). Socioeconomic status was central to the experience of CKD, especially in its advanced stages when renal replacement treatment is necessary. Unfunded healthcare was fragmented and of indeterminate duration, with patients often depending on emergency care. Treatment could lead to unemployment, and in turn, to uninsurance or underinsurance. Patients feared catastrophic events because of diminished financial capacity and made strenuous efforts to prevent them. Transportation to and from haemodialysis centre, with variable availability and cost, was a common problem, aggravated for patients in non-urban areas, or with young children, and low resources. Additional work for those uninsured or underinsured included fund-raising. Transplanted patients needed to manage finances and responsibilities in an uncertain context. Information on the disease, treatment options and immunosuppressants side effects was a widespread problem. CONCLUSIONS Being a person with end-stage kidney disease always implied high burden, time-consuming, invasive and exhausting tasks, impacting on all aspects of patients' and caregivers' lives. Further research on BoT could inform healthcare professionals and policy makers about factors that shape patients' trajectories and contribute towards a better illness experience for those living with CKD. PROSPERO REGISTRATION NUMBER CRD42014014547.
Collapse
Affiliation(s)
- Javier Roberti
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Kate Lippiett
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Katherine Hunt
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Federico Cicora
- FINAER, Foundation for Research and Assistance of Kidney Disease, Buenos Aires, Argentina
| | - Juan Pedro Alonso
- Faculty of Social Sciences, Universidad de Buenos Aires, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, Faculty of Epidemiology and Population Health, London, UK
| |
Collapse
|
72
|
Zidan A, Awaisu A, El-Hajj MS, Al-Abdulla SA, Figueroa DCR, Kheir N. Medication-Related Burden among Patients with Chronic Disease Conditions: Perspectives of Patients Attending Non-Communicable Disease Clinics in a Primary Healthcare Setting in Qatar. PHARMACY 2018; 6:pharmacy6030085. [PMID: 30104554 PMCID: PMC6165107 DOI: 10.3390/pharmacy6030085] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Revised: 07/30/2018] [Accepted: 08/08/2018] [Indexed: 11/16/2022] Open
Abstract
This study aimed to assess perceived medication-related burden among patients with multiple non-communicable diseases (NCDs) and to investigate the association between perceived burden and adherence to medication therapy. Using a cross-sectional study in three primary care clinics in Qatar, medication-related burden was measured using the Living with Medicines Questionnaire (LMQ) among adults with diabetes, with or without other comorbidities. Adherence was measured using the Adherence to Refills and Medications Scale (ARMS). Two hundred and ninety-three eligible patients participated in the study. The majority of them reported experiencing minimal (66.8%) to moderate (24.1%) medication-related burden. There was a significant positive correlation between the scores of the LMQ (medication-related burden) and ARMS (medication adherence), rs (253) = 0.317, p < 0.0005.
Collapse
Affiliation(s)
- Amani Zidan
- College of Pharmacy, Qatar University, Doha 2713, Qatar.
| | - Ahmed Awaisu
- College of Pharmacy, Qatar University, Doha 2713, Qatar.
| | | | | | | | - Nadir Kheir
- School of Pharmacy, Faculty of Medical and Health Sciences, University of Auckland, Auckland 1010, New Zealand.
| |
Collapse
|
73
|
Loft MI, Martinsen B, Esbensen BA, Mathiesen LL, Iversen HK, Poulsen I. Strengthening the role and functions of nursing staff in inpatient stroke rehabilitation: developing a complex intervention using the Behaviour Change Wheel. Int J Qual Stud Health Well-being 2018; 12:1392218. [PMID: 29088984 PMCID: PMC7011965 DOI: 10.1080/17482631.2017.1392218] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Purpose: Over the past two decades, attempts have been made to describe the nurse’s role and functions in the inpatient stroke rehabilitation; however, the nursing contribution is neither clear nor well-defined. Previous studies have highlighted the need for research aimed at developing interventions in the neuro-nursing area. The objective of this paper was to describe the development of a nursing intervention aimed at optimising the inpatient rehabilitation of stroke patients by strengthening the role and functions of nursing staff. Method: A systematic approach was used, consistent with the framework for developing and evaluating complex interventions by the UK’s Medical Research Council (MRC). Based on qualitative methods and using the Behaviour Change Wheel’s (BCW) stepwise approach, we sought behaviours related to nursing staffs’ roles and functions. Results: We conducted a behavioural analysis to explain why nursing staff were or were not engaged in these behaviours. The nursing staff’s Capability, Opportunity and Motivation were analysed with regard to working systematically with a rehabilitative approach and working deliberately and systematically with the patient’s goals. Conclusion: We developed the educational intervention Rehabilitation 24/7. Following the MRC and the BCW frameworks is resource-consuming, but offers a way of developing a practical, well-structured intervention that is theory- and evidence based.
Collapse
Affiliation(s)
- Mia Ingerslev Loft
- a Department of Neurology , Rigshospitalet, Copenhagen University Hospital , Glostrup , Denmark.,b Department of Public Health , Section of Nursing, Aarhus University , Aarhus , Denmark
| | - Bente Martinsen
- b Department of Public Health , Section of Nursing, Aarhus University , Aarhus , Denmark
| | - Bente Appel Esbensen
- c Copenhagen Centre for Arthritis Research (COPECARE) , Centre for Rheumatology and Spine Diseases, VRR Head and Orthopaedics Centre , Glostrup , Rigshospitalet , Denmark.,d Department of Clinical Medicine , Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Lone L Mathiesen
- a Department of Neurology , Rigshospitalet, Copenhagen University Hospital , Glostrup , Denmark
| | - Helle K Iversen
- a Department of Neurology , Rigshospitalet, Copenhagen University Hospital , Glostrup , Denmark.,d Department of Clinical Medicine , Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark
| | - Ingrid Poulsen
- b Department of Public Health , Section of Nursing, Aarhus University , Aarhus , Denmark.,e Research Unit on Brain Injury Rehabilitation Copenhagen (RuBRIC) , Clinic of Neurorehabilitaion , Hvidovre , TBI unit Rigshospitalet , Denmark
| |
Collapse
|
74
|
Treatment Burden and Chronic Illness: Who is at Most Risk? PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2018; 9:559-569. [PMID: 27142372 DOI: 10.1007/s40271-016-0175-y] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a need to ascertain the type and level of treatment burden experienced by people with co-morbidities. This is important to identify the characteristics of participants who are at most risk of treatment burden. OBJECTIVE The aim of this study is to identify the characteristics of participants who are at most risk of treatment burden. METHODS This cross-sectional study was part of a larger project and recruitment was conducted across four Australian regions: rural, semi-rural and metropolitan. Participants were asked about their treatment burden using an adapted version of a measure, which included the following five dimensions: medication, time and administrative, lifestyle change, social life and financial burden. RESULTS In total, 581 participants with various chronic health conditions reported a mean global treatment burden of 56.5 out of 150 (standard deviation = 34.5). Number of chronic conditions (β = .34, p < 0.01), age, (β = -.27, p < 0.01), the presence of an unpaid carer (β = .22, p < 0.001) and the presence of diabetes mellitus and other endocrine conditions (β = .13, p < 0.01) were significant predictors of overall treatment burden. For the five dimensions of treatment burden, social, medicine and administrative burden were predicted by the same cluster of variables: number of conditions, age, presence of an unpaid carer and diabetes. However, in addition to these variables, financial dimensions were also predicted by education level, ethnicity and health insurance. Educational level also influenced lifestyle burden. CONCLUSION A substantial proportion of community-dwelling adults with chronic conditions have considerable levels of treatment burden. Specifically, health professionals should provide greater focus on managing overall treatment burden for persons who are of young age, have an endocrine condition or an unpaid carer, or a combination of these factors.
Collapse
|
75
|
Pindus DM, Mullis R, Lim L, Wellwood I, Rundell AV, Abd Aziz NA, Mant J. Stroke survivors' and informal caregivers' experiences of primary care and community healthcare services - A systematic review and meta-ethnography. PLoS One 2018; 13:e0192533. [PMID: 29466383 PMCID: PMC5821463 DOI: 10.1371/journal.pone.0192533] [Citation(s) in RCA: 132] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Accepted: 01/25/2018] [Indexed: 11/28/2022] Open
Abstract
Objective To describe and explain stroke survivors and informal caregivers’ experiences of primary care and community healthcare services. To offer potential solutions for how negative experiences could be addressed by healthcare services. Design Systematic review and meta-ethnography. Data sources Medline, CINAHL, Embase and PsycINFO databases (literature searched until May 2015, published studies ranged from 1996 to 2015). Eligibility criteria Primary qualitative studies focused on adult community-dwelling stroke survivors’ and/or informal caregivers’ experiences of primary care and/or community healthcare services. Data synthesis A set of common second order constructs (original authors’ interpretations of participants’ experiences) were identified across the studies and used to develop a novel integrative account of the data (third order constructs). Study quality was assessed using the Critical Appraisal Skills Programme checklist. Relevance was assessed using Dixon-Woods’ criteria. Results 51 studies (including 168 stroke survivors and 328 caregivers) were synthesised. We developed three inter-dependent third order constructs: (1) marginalisation of stroke survivors and caregivers by healthcare services, (2) passivity versus proactivity in the relationship between health services and the patient/caregiver dyad, and (3) fluidity of stroke related needs for both patient and caregiver. Issues of continuity of care, limitations in access to services and inadequate information provision drove perceptions of marginalisation and passivity of services for both patients and caregivers. Fluidity was apparent through changing information needs and psychological adaptation to living with long-term consequences of stroke. Limitations Potential limitations of qualitative research such as limited generalisability and inability to provide firm answers are offset by the consistency of the findings across a range of countries and healthcare systems. Conclusions Stroke survivors and caregivers feel abandoned because they have become marginalised by services and they do not have the knowledge or skills to re-engage. This can be addressed by: (1) increasing stroke specific health literacy by targeted and timely information provision, and (2) improving continuity of care between specialist and generalist services. Systematic review registration number PROSPERO 2015:CRD42015026602
Collapse
Affiliation(s)
- Dominika M. Pindus
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Ricky Mullis
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Lisa Lim
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Ian Wellwood
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - A. Viona Rundell
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
| | - Noor Azah Abd Aziz
- Department of Family Medicine, National University of Malaysia, Bandar Tun Razak Cheras, Kuala Lumpur, Malaysia
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Worts’ Causeway, Cambridge CB1 8RN, United Kingdom
- * E-mail:
| |
Collapse
|
76
|
Gallacher KI, McQueenie R, Nicholl B, Jani BD, Lee D, Mair FS. Risk factors and mortality associated with multimorbidity in people with stroke or transient ischaemic attack: a study of 8,751 UK Biobank participants. JOURNAL OF COMORBIDITY 2018; 8:1-8. [PMID: 29492397 PMCID: PMC5827474 DOI: 10.15256/joc.2018.8.129] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Accepted: 01/30/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Multimorbidity is common in stroke, but the risk factors and effects on mortality remain poorly understood. OBJECTIVE To examine multimorbidity and its associations with sociodemographic/lifestyle risk factors and all-cause mortality in UK Biobank participants with stroke or transient ischaemic attack (TIA). DESIGN Data were obtained from an anonymized community cohort aged 40-72 years. Overall, 42 comorbidities were self-reported by those with stroke or TIA. Relative risk ratios demonstrated associations between participant characteristics and number of comorbidities. Hazard ratios demonstrated associations between the number and type of comorbidities and all-cause mortality. Results were adjusted for age, sex, socioeconomic status, smoking, and alcohol intake. Data were linked to national mortality data. Median follow-up was 7 years. RESULTS Of 8,751 participants (mean age 60.9±6.7 years) with stroke or TIA, the all-cause mortality rate over 7 years was 8.4%. Over 85% reported ≥1 comorbidities. Age, socioeconomic deprivation, smoking and less frequent alcohol intake were associated with higher levels of multimorbidity. Increasing multimorbidity was associated with higher all-cause mortality. Mortality risk was double for those with ≥5 comorbidities compared to those with none. Having cancer, coronary heart disease, diabetes, or chronic obstructive pulmonary disease significantly increased mortality risk. Presence of any cardiometabolic comorbidity significantly increased mortality risk, as did any non-cardiometabolic comorbidity. CONCLUSIONS In stroke survivors, the number of comorbidities may be a more helpful predictor of mortality than type of condition. Stroke guidelines should take greater account of comorbidities, and interventions are needed that improve outcomes for people with multimorbidity and stroke.
Collapse
Affiliation(s)
- Katie I. Gallacher
- General Practice and Primary Care, Institute
of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ross McQueenie
- General Practice and Primary Care, Institute
of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Barbara Nicholl
- General Practice and Primary Care, Institute
of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Bhautesh D. Jani
- General Practice and Primary Care, Institute
of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Duncan Lee
- School of Mathematics and Statistics,
University of Glasgow, Glasgow, UK
| | - Frances S. Mair
- General Practice and Primary Care, Institute
of Health and Wellbeing, University of Glasgow, Glasgow, UK
| |
Collapse
|
77
|
van der Laan DM, Elders PJM, Boons CCLM, Nijpels G, Krska J, Hugtenburg JG. The impact of cardiovascular medication use on patients' daily lives: a cross-sectional study. Int J Clin Pharm 2018; 40:412-420. [PMID: 29435910 PMCID: PMC5918518 DOI: 10.1007/s11096-018-0601-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Accepted: 01/30/2018] [Indexed: 01/25/2023]
Abstract
Background The management of multiple long-term medicines of patients with chronic diseases creates a burden for patients. However, limited research is performed on its impact on patients’ daily lives. Objective The aim of this study was to explore the impact of cardiovascular medication on different daily life aspects and to examine differences of these aspects between adherent and non-adherent patients. Setting Two community pharmacies in the Netherlands. Method In this cross-sectional study patients (≥ 45 years) using cardiovascular medication participated. Two equally group sized samples of patients non-adherent as assessed with pharmacy refill data, and patients adherent were selected. Main outcome measure Data were collected by means of the Living with Medicines Questionnaire measuring the impact of medicines use on patients’ daily lives. Results In total, 196 patients participated, including 96 non-adherent patients. Substantial proportions of patients experienced medication-related burden on different daily life aspects. This burden was mainly related to the acceptance of long-term medicine use, medication-related concerns or dissatisfaction, the interference of medicines with social and daily lives, and the interaction and communication with health care providers. No statistically significant results were found when comparing the impact on patients’ daily lives between adherent and nonadherent patients. Conclusion Health care providers should acknowledge the impact of multiple long-term medicines on patient’s daily lives and should make an effort to diminish patients’ medication-related burden by improving patient–provider relationships and by providing adequate treatment information incorporating patients’ individual circumstances. This may facilitate the integration of long-term medicine use in patients’ daily lives.
Collapse
Affiliation(s)
- Danielle M van der Laan
- Department of Clinical Pharmacology and Pharmacy and the Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands.
| | - Petra J M Elders
- Department of General Practice and Elderly Care Medicine and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Christel C L M Boons
- Department of Clinical Pharmacology and Pharmacy and the Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| | - Giel Nijpels
- Department of General Practice and Elderly Care Medicine and the Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - Janet Krska
- Medway School of Pharmacy, Universities of Greenwich and Kent, Chatham Maritime, Kent, UK
| | - Jacqueline G Hugtenburg
- Department of Clinical Pharmacology and Pharmacy and the Amsterdam Public Health Research Institute, VU University Medical Center, De Boelelaan 1117, Amsterdam, 1081 HV, The Netherlands
| |
Collapse
|
78
|
Boehmer KR, Abu Dabrh AM, Gionfriddo MR, Erwin P, Montori VM. Does the chronic care model meet the emerging needs of people living with multimorbidity? A systematic review and thematic synthesis. PLoS One 2018; 13:e0190852. [PMID: 29420543 PMCID: PMC5805171 DOI: 10.1371/journal.pone.0190852] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2017] [Accepted: 12/21/2017] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND The Chronic Care Model (CCM) emerged in the 1990s as an approach to re-organize primary care and implement critical elements that enable it to proactively attend to patients with chronic conditions. The chronic care landscape has evolved further, as most patients now present with multiple chronic conditions and increasing psychosocial complexity. These patients face accumulating and overwhelming complexity resulting from the sum of uncoordinated responses to each of their problems. Minimally Disruptive Medicine (MDM) was proposed to respond to this challenge, aiming at improving outcomes that matter to patients with the smallest burden of treatment. We sought to critically appraise the extent to which MDM constructs (e.g., reducing patient work, improving patients' capacity) have been adopted within CCM implementations. METHODS We conducted a systematic review and qualitative thematic synthesis of reports of CCM implementations published from 2011-2016. RESULTS CCM implementations were mostly aligned with the healthcare system's goals, condition-specific, and targeted disease-specific outcomes or healthcare utilization. No CCM implementation addressed patient work. Few reduced treatment workload without adding additional tasks. Implementations supported patient capacity by offering information, but rarely offered practical resources (e.g., financial assistance, transportation), helped patients reframe their biography with chronic illness, or assisted them in engaging with a supportive social network. Few implementations aimed at improving functional status or quality of life, and only one-third of studies were targeted for patients of low socioeconomic status. CONCLUSION MDM provides a lens to operationalize how to care for patients with multiple chronic conditions, but its constructs remain mostly absent from how implementations of the CCM are currently reported. Improvements to the primary care of patients with multimorbidity may benefit from the application of MDM, and the current CCM implementations that do apply MDM constructs should be considered exemplars for future implementation work.
Collapse
Affiliation(s)
- Kasey R. Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Abd Moain Abu Dabrh
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of Family Medicine, Mayo Clinic Florida, Jacksonville, Florida, United States of America
| | - Michael R. Gionfriddo
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Center for Pharmacy Innovation and Outcomes, Geisinger, Forty Fort, Pennsylvania, United States of America
| | - Patricia Erwin
- Mayo Medical Libraries, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Victor M. Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| |
Collapse
|
79
|
Affiliation(s)
- Katie Gallacher
- From the Institute of Health and Well Being (K.G.) and Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, United Kingdom
| | - Terence J. Quinn
- From the Institute of Health and Well Being (K.G.) and Institute of Cardiovascular and Medical Sciences (T.J.Q.), University of Glasgow, United Kingdom
| |
Collapse
|
80
|
Gallacher KI, May CR, Langhorne P, Mair FS. A conceptual model of treatment burden and patient capacity in stroke. BMC FAMILY PRACTICE 2018; 19:9. [PMID: 29316892 PMCID: PMC5759246 DOI: 10.1186/s12875-017-0691-4] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Accepted: 12/08/2017] [Indexed: 11/10/2022]
Abstract
BACKGROUND Treatment burden is the workload of healthcare experienced by those with long-term conditions and the impact that this has on well-being. Treatment burden can negatively impact on quality of life and adherence to treatments. Individuals are likely to differ in their ability to manage health problems and follow treatments, defined as patient capacity. This has been under investigated in stroke. The aim of this paper is to create a conceptual model of treatment burden and patient capacity for people who have had a stroke through exploration of their experiences of healthcare. METHODS Interviews were conducted at home with 29 individuals who have had a stroke. These were recorded and transcribed verbatim. Fifteen explored treatment burden and were analysed by framework analysis underpinned by Normalisation Process Theory (NPT). Fourteen explored patient capacity and were analysed by thematic analysis. Taxonomies of treatment burden and patient capacity were created and a conceptual model produced. RESULTS Mean age was 68 years. Sixteen were men and 13 women. The following broad areas of treatment burden were identified: making sense of stroke management and planning care; interacting with others including health professionals, family and other stroke patients; enacting management strategies; and reflecting on management. Treatment burdens were identified as arising from either: the workload of healthcare; or the endurance of care deficiencies. Six factors were identified that influence patient capacity: personal attributes and skills; physical and cognitive abilities; support network; financial status; life workload, and environment. CONCLUSIONS Healthcare workload and the presence of care deficiencies can influence and be influenced by patient capacity. The quality and configuration of health and social care services has considerable influence on treatment burden and patient capacity. Findings have important implications for the design of clinical guidelines and healthcare delivery, highlighting issues such as the importance of good care co-ordination.
Collapse
Affiliation(s)
- Katie I Gallacher
- Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, Scotland
| | - Carl R May
- Health Sciences, University of Southampton, Southampton, England
| | - Peter Langhorne
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland
| | - Frances S Mair
- Institute of Health and Wellbeing, University of Glasgow, 1 Horselethill Road, Glasgow, G12 9LX, Scotland.
| |
Collapse
|
81
|
Cummings A, Lund S, Campling N, May C, Richardson A, Myall M. Implementing communication and decision-making interventions directed at goals of care: a theory-led scoping review. BMJ Open 2017; 7:e017056. [PMID: 28988176 PMCID: PMC5640076 DOI: 10.1136/bmjopen-2017-017056] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To identify the factors that promote and inhibit the implementation of interventions that improve communication and decision-making directed at goals of care in the event of acute clinical deterioration. DESIGN AND METHODS A scoping review was undertaken based on the methodological framework of Arksey and O'Malley for conducting this type of review. Searches were carried out in Medline and Cumulative Index to Nursing and Allied Health Literature (CINAHL) to identify peer-reviewed papers and in Google to identify grey literature. Searches were limited to those published in the English language from 2000 onwards. Inclusion and exclusion criteria were applied, and only papers that had a specific focus on implementation in practice were selected. Data extracted were treated as qualitative and subjected to directed content analysis. A theory-informed coding framework using Normalisation Process Theory (NPT) was applied to characterise and explain implementation processes. RESULTS Searches identified 2619 citations, 43 of which met the inclusion criteria. Analysis generated six themes fundamental to successful implementation of goals of care interventions: (1) input into development; (2) key clinical proponents; (3) training and education; (4) intervention workability and functionality; (5) setting and context; and (6) perceived value and appraisal. CONCLUSIONS A broad and diverse literature focusing on implementation of goals of care interventions was identified. Our review recognised these interventions as both complex and contentious in nature, making their incorporation into routine clinical practice dependent on a number of factors. Implementing such interventions presents challenges at individual, organisational and systems levels, which make them difficult to introduce and embed. We have identified a series of factors that influence successful implementation and our analysis has distilled key learning points, conceptualised as a set of propositions, we consider relevant to implementing other complex and contentious interventions.
Collapse
Affiliation(s)
- Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Susi Lund
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Natasha Campling
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Carl May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
- University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
- University Hospital Southampton, NHS Foundation Trust, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| |
Collapse
|
82
|
O'Donnell CA, Mair FS, Dowrick C, Brún MOD, Brún TD, Burns N, Lionis C, Saridaki A, Papadakaki M, Muijsenbergh MVD, Weel-Baumgarten EV, Gravenhorst K, Cooper L, Princz C, Teunissen E, Mareeuw FVDD, Vlahadi M, Spiegel W, MacFarlane A. Supporting the use of theory in cross-country health services research: a participatory qualitative approach using Normalisation Process Theory as an example. BMJ Open 2017; 7:e014289. [PMID: 28827231 PMCID: PMC5724160 DOI: 10.1136/bmjopen-2016-014289] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To describe and reflect on the process of designing and delivering a training programme supporting the use of theory, in this case Normalisation Process Theory (NPT), in a multisite cross-country health services research study. DESIGN Participatory research approach using qualitative methods. SETTING Six European primary care settings involving research teams from Austria, England, Greece, Ireland, The Netherlands and Scotland. PARTICIPANTS RESTORE research team consisting of 8 project applicants, all senior primary care academics, and 10 researchers. Professional backgrounds included general practitioners/family doctors, social/cultural anthropologists, sociologists and health services/primary care researchers. PRIMARY OUTCOME MEASURES Views of all research team members (n=18) were assessed using qualitative evaluation methods, analysed qualitatively by the trainers after each session. RESULTS Most of the team had no experience of using NPT and many had not applied theory to prospective, qualitative research projects. Early training proved didactic and overloaded participants with information. Drawing on RESTORE's methodological approach of Participatory Learning and Action, workshops using role play, experiential interactive exercises and light-hearted examples not directly related to the study subject matter were developed. Evaluation showed the study team quickly grew in knowledge and confidence in applying theory to fieldwork.Recommendations applicable to other studies include: accepting that theory application is not a linear process, that time is needed to address researcher concerns with the process, and that experiential, interactive learning is a key device in building conceptual and practical knowledge. An unanticipated benefit was the smooth transition to cross-country qualitative coding of study data. CONCLUSION A structured programme of training enhanced and supported the prospective application of a theory, NPT, to our work but raised challenges. These were not unique to NPT but could arise with the application of any theory, especially in large multisite, international projects. The lessons learnt are applicable to other theoretically informed studies.
Collapse
Affiliation(s)
- Catherine A O'Donnell
- General Practice and Primary Care, Institute of Health and Wellbeing, College of MVLS, University of Glasgow, Glasgow, UK
| | - Frances S Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, College of MVLS, University of Glasgow, Glasgow, UK
| | - Christopher Dowrick
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Mary O'Reilly-de Brún
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Tomas de Brún
- Discipline of General Practice, School of Medicine, National University of Ireland, Galway, Ireland
| | - Nicola Burns
- General Practice and Primary Care, Institute of Health and Wellbeing, College of MVLS, University of Glasgow, Glasgow, UK
- Faculty of Health and Medicine, Lancaster Medical School, Furness College, University of Lancaster, Lancaster, UK
| | | | | | - Maria Papadakaki
- Faculty of Medicine, University of Crete, Heraklion, Greece
- Department of Social Work, School of Health and Social Welfare, Technological Educational Institute of Crete, Heraklion, Greece
| | - Maria van den Muijsenbergh
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Pharos Centre of Expertise on Health Disparities, Utrecht, The Netherlands
| | - Evelyn van Weel-Baumgarten
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | - Katja Gravenhorst
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Lucy Cooper
- Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Christine Princz
- Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Erik Teunissen
- Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
| | | | - Maria Vlahadi
- Faculty of Medicine, University of Crete, Heraklion, Greece
| | - Wolfgang Spiegel
- Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Anne MacFarlane
- Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| |
Collapse
|
83
|
Management of Acute Stroke in the Older Person. Geriatrics (Basel) 2017; 2:geriatrics2030027. [PMID: 31011037 PMCID: PMC6371128 DOI: 10.3390/geriatrics2030027] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Revised: 07/21/2017] [Accepted: 07/31/2017] [Indexed: 12/27/2022] Open
Abstract
The majority of people who suffer a stroke are older adults. The last two decades have brought major progress in the diagnosis and management of stroke, which has led to significant reductions in mortality, long-term disability, and the need for institutional care. However, acute, interventional and preventative treatments have mostly been trialled in younger age groups. In this article we will provide an overview of the evidence for acute stroke treatments in relation to age, discuss special considerations in the older person, and contemplate patient choice, quality of life, and end-of-life-decisions.
Collapse
|
84
|
Lin Y, Myall M, Jarrett N. Uncovering the decision-making work of transferring dying patients home from critical care units: An integrative review. J Adv Nurs 2017. [DOI: 10.1111/jan.13368] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Yanxia Lin
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Michelle Myall
- Faculty of Health Sciences; University of Southampton; Southampton UK
| | - Nikki Jarrett
- Faculty of Health Sciences; University of Southampton; Southampton UK
| |
Collapse
|
85
|
Hunt KJ, May CR. Managing expectations: cognitive authority and experienced control in complex healthcare processes. BMC Health Serv Res 2017; 17:459. [PMID: 28679376 PMCID: PMC5498980 DOI: 10.1186/s12913-017-2366-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Accepted: 06/08/2017] [Indexed: 11/29/2022] Open
Abstract
Background Balancing the normative expectations of others (accountabilities) against the personal and distributed resources available to meet them (capacity) is a ubiquitous feature of social relations in many settings. This is an important problem in the management of long–term conditions, because of widespread problems of non-adherence to treatment regimens. Using long-term conditions as an example, we set out middle range theory of this balancing work. Methods A middle-range theory was constructed four stages. First, a qualitative elicitation study of men with heart failure was used to develop general propositions about patient and care giver experience, and about the ways that the organisation and delivery of care affected this. Second, these propositions were developed and confirmed through a systematic review of qualitative research literature. Third, theoretical propositions and constructs were built, refined and presented as a logic model associated with two main theoretical propositions. Finally, a construct validation exercise was undertaken, in which construct definitions informed reanalysis of a set of systematic reviews of studies of patient and caregiver experiences of heart failure that had been included in an earlier meta-review. Results Cognitive Authority Theory identifies, characterises and explains negotiation processes in in which people manage their relations with the expectations of normative systems – like those encountered in the management of long-term conditions. Here, their cognitive authority is the product of an assessment of competence, trustworthiness and credibility made about a person by other participants in a healthcare process; and their experienced control is a function of the degree to which they successfully manage the external process-specific limiting factors that make it difficult to otherwise perform in their role. Conclusion Cognitive Authority Theory assists in explaining how participants in complex social processes manage important relational aspects of inequalities in power and expertise. It can play an important part in understanding the dynamics of participation in healthcare processes. It suggests ways in which these burdens may lead to relationally induced non-adherence to treatment regimens and self-care programmes, and points to targets where intervention may reduce these adverse outcomes.
Collapse
Affiliation(s)
- Katherine J Hunt
- Faculty of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Highfield, Southampton, SO17 1BJ, UK.,NIHR CLAHRC Wessex, Southampton, UK
| | - Carl R May
- Faculty of Health Sciences, University of Southampton, Building 67 (Nightingale), University Road, Highfield, Southampton, SO17 1BJ, UK. .,NIHR CLAHRC Wessex, Southampton, UK. .,University Hospital Southampton NHS Foundation Trust, Southampton, UK.
| |
Collapse
|
86
|
Mathew AR, Heckman BW, Meier E, Carpenter MJ. Development and initial validation of a cessation fatigue scale. Drug Alcohol Depend 2017; 176:102-108. [PMID: 28531766 PMCID: PMC5802379 DOI: 10.1016/j.drugalcdep.2017.01.047] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 01/25/2017] [Accepted: 01/28/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Smoking cessation fatigue, or tiredness of attempting to quit smoking, has been posited as a latent construct encompassing loss of motivation, loss of hope in cessation success, decreased self-efficacy, and exhaustion of self-control resources. Despite the potential clinical impact of characterizing cessation fatigue, there is currently no validated measure to assess it. Using a rational scale development approach, we developed a cessation fatigue measure and examined its reliability and construct validity in relation to a) smokers' experience of a recently failed quit attempt (QA) and b) readiness to engage in a subsequent QA. METHODS Data were drawn from an online cross-sectional survey of 484 smokers who relapsed from a QA within the past 30days. RESULTS Exploratory factor analysis identified three factors within the 17-item Cessation Fatigue Scale (CFS), which we labeled: emotional exhaustion, pessimism, and devaluation. High internal consistency was observed for each factor and across the full scale. As expected, CFS overall was positively associated with withdrawal severity and difficulty quitting. CFS was negatively associated with previously validated measures of intention to quit, self-efficacy, and abstinence-related motivational engagement, even after adjusting for nicotine dependence. CONCLUSIONS Findings provide initial validation for a new tool to assess cessation fatigue and contribute needed information on a theory-driven component of cessation-related motivation and relapse risk.
Collapse
Affiliation(s)
- Amanda R Mathew
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, 680 N Lakeshore Drive, Suite 1400, Chicago, IL 60611, USA.
| | - Bryan W Heckman
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA; Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA
| | - Ellen Meier
- Department of Psychiatry, University of Minnesota, F282/2A West Building, 2450 Riverside Avenue South, Minneapolis, MN 55454, USA
| | - Matthew J Carpenter
- Department of Psychiatry and Behavioral Sciences, Medical University of South Carolina, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA; Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas St., MSC 955, Charleston, SC 29425, USA
| |
Collapse
|
87
|
Abstract
Objective To synthesize existing qualitative literature on patient-experienced burden of treatment in multimorbid patients. Methods A literature search identified available qualitative studies on the topic of burden of treatment in multimorbidity and meta-ethnography was applied as method. The authors’ original findings were preserved, but also synthesized to new interpretations to investigate the concept of the burden of treatment using the Cumulative Complexity Model. Results Nine qualitative studies were identified. The majority of the 1367 participants from 34 different countries were multimorbid. The treatment burden components, experienced by patients, were identified for each study. The components financial burden, lack of knowledge, diet and exercise, medication burden and frequent healthcare reminding patients of their health problem were found to attract additional attention from the multimorbid patients. In studies conducted in the US and Australia the financial burden and the time and travel burden were found most straining to patients with deprived socioeconomic status. The burden of treatment was found to be a complex concept consisting of many different components and factors interacting with each other. The size of the burden was associated to the workload of demands (number of conditions, number of medications and health status), the capacity (cognitive, physical and financial resources, educational level, cultural background, age, gender and employment conditions) and the context (structure of healthcare and social support). Patients seem to use strategies such as prioritizing between treatments to diminish the workload and mobilizing and coordinating resources to improve their ability to manage the burden of treatment. They try to routinize and integrate the treatment into their daily lives, which might be a way to maintain the balance between workload and capacity. Conclusions Healthcare providers need to increase the focus on minimizing multimorbid patients’ burden of treatment. Findings in this review suggest that the weight of the burden needs to be established in the individual patient and components of the burden must be identified.
Collapse
|
88
|
Harb N, Foster JM, Dobler CC. Patient-perceived treatment burden of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2017; 12:1641-1652. [PMID: 28615937 PMCID: PMC5459974 DOI: 10.2147/copd.s130353] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While chronic morbidity and mortality from COPD is well documented, little is known about the treatment burden faced by patients with COPD. SUBJECTS AND METHODS Patients with severe airflow obstruction (forced expiratory volume in 1 second [FEV1] <50% predicted) representing different age-groups, sex, and number of comorbidities participated in a semistructured interview. Interviews were conducted until thematic saturation was reached. Interviews were recorded, transcribed, and analyzed thematically using an established treatment-burden framework. RESULTS A total of 26 patients (42% male, mean age 66.7±9.8 years) with severe (n=15) or very severe (n=11) airflow limitation (mean FEV1 32.1%±9.65% predicted) were interviewed. Participants struggled with various treatment-burden domains, predominantly with changing health behaviors, such as smoking cessation and exercise. Interviewees often only ceased smoking after a major health event, despite being advised to do so earlier by a doctor. Recommended exercise regimens, such as pulmonary rehabilitation classes, were curtailed, although some patients replaced them with light home-based exercise. Interviewees had difficulty attending medical appointments, often relying on others to transport them. Overall, COPD patients indicated they were not willing to accept the burden of treatments where they perceived minimal benefit. CONCLUSION This study describes the substantial treatment burden experienced by patients with COPD. Medical advice may be rejected by patients if the benefit of following the advice is perceived as insufficient. Health professionals need to recognize treatment burden as a source of nonadherence, and should tailor treatment discussions to fit patients' values and capacity to achieve optimal patient outcomes.
Collapse
Affiliation(s)
- Nathan Harb
- South Western Sydney Clinical School, University of New South Wales.,Department of Respiratory Medicine, Liverpool Hospital
| | - Juliet M Foster
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Claudia C Dobler
- South Western Sydney Clinical School, University of New South Wales.,Department of Respiratory Medicine, Liverpool Hospital.,Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| |
Collapse
|
89
|
Nanninga CS, Meijering L, Postema K, Schönherr MC, Lettinga AT. Unpacking community mobility: a preliminary study into the embodied experiences of stroke survivors. Disabil Rehabil 2017; 40:2015-2024. [DOI: 10.1080/09638288.2017.1323031] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Christa S. Nanninga
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Haren, The Netherlands
| | - Louise Meijering
- Population Research Centre, Urban and Regional Studies Institute, Faculty of Spatial Sciences, University of Groningen, Groningen, The Netherlands
| | - Klaas Postema
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Marleen C. Schönherr
- Department of Rehabilitation Medicine, Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Haren, The Netherlands
| | - Ant T. Lettinga
- Center for Rehabilitation, University Medical Center Groningen, University of Groningen, Haren, The Netherlands
| |
Collapse
|
90
|
Cox A, Lucas G, Marcu A, Piano M, Grosvenor W, Mold F, Maguire R, Ream E. Cancer Survivors' Experience With Telehealth: A Systematic Review and Thematic Synthesis. J Med Internet Res 2017; 19:e11. [PMID: 28069561 PMCID: PMC5259589 DOI: 10.2196/jmir.6575] [Citation(s) in RCA: 197] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 11/14/2016] [Accepted: 11/23/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Net survival rates of cancer are increasing worldwide, placing a strain on health service provision. There is a drive to transfer the care of cancer survivors-individuals living with and beyond cancer-to the community and encourage them to play an active role in their own care. Telehealth, the use of technology in remote exchange of data and communication between patients and health care professionals (HCPs), is an important contributor to this evolving model of care. Telehealth interventions are "complex," and understanding patient experiences of them is important in evaluating their impact. However, a wider view of patient experience is lacking as qualitative studies detailing cancer survivor engagement with telehealth are yet to be synthesized. OBJECTIVE To systematically identify, appraise, and synthesize qualitative research evidence on the experiences of adult cancer survivors participating in telehealth interventions, to characterize the patient experience of telehealth interventions for this group. METHODS Medline (PubMed), PsychINFO, Cumulative Index for Nursing and Allied Health Professionals (CINAHL), Embase, and Cochrane Central Register of Controlled Trials were searched on August 14, 2015, and March 8, 2016, for English-language papers published between 2006 and 2016. Inclusion criteria were as follows: adult cancer survivors aged 18 years and over, cancer diagnosis, experience of participating in a telehealth intervention (defined as remote communication or remote monitoring with an HCP delivered by telephone, Internet, or hand-held or mobile technology), and reporting qualitative data including verbatim quotes. An adapted Critical Appraisal Skill Programme (CASP) checklist for qualitative research was used to assess paper quality. The results section of each included article was coded line by line, and all papers underwent inductive analysis, involving comparison, reexamination, and grouping of codes to develop descriptive themes. Analytical themes were developed through an iterative process of reflection on, and interpretation of, the descriptive themes within and across studies. RESULTS Across the 22 included papers, 3 analytical themes emerged, each with 3 descriptive subthemes: (1) influence of telehealth on the disrupted lives of cancer survivors (convenience, independence, and burden); (2) personalized care across physical distance (time, space, and the human factor); and (3) remote reassurance-a safety net of health care professional connection (active connection, passive connection, and slipping through the net). Telehealth interventions represent a convenient approach, which can potentially minimize treatment burden and disruption to cancer survivors' lives. Telehealth interventions can facilitate an experience of personalized care and reassurance for those living with and beyond cancer; however, it is important to consider individual factors when tailoring interventions to ensure engagement promotes benefit rather than burden. CONCLUSIONS Telehealth interventions can provide cancer survivors with independence and reassurance. Future telehealth interventions need to be developed iteratively in collaboration with a broad range of cancer survivors to maximize engagement and benefit.
Collapse
Affiliation(s)
- Anna Cox
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Grace Lucas
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Afrodita Marcu
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Marianne Piano
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Wendy Grosvenor
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Freda Mold
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Roma Maguire
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| | - Emma Ream
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, United Kingdom
| |
Collapse
|
91
|
Krska J, Katusiime B, Corlett SA. Validation of an instrument to measure patients' experiences of medicine use: the Living with Medicines Questionnaire. Patient Prefer Adherence 2017; 11:671-679. [PMID: 28405159 PMCID: PMC5378470 DOI: 10.2147/ppa.s126647] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Medicine-related burden is an increasingly recognized concept, stemming from the rising tide of polypharmacy, which may impact on patient behaviors, including nonadherence. No instruments currently exist which specifically measure medicine-related burden. The Living with Medicines Questionnaire (LMQ) was developed for this purpose. OBJECTIVE This study validated the LMQ in a sample of adults using regular prescription medicines in the UK. METHODS Questionnaires were distributed in community pharmacies and public places in southeast England or online through UK health websites and social media. A total of 1,177 were returned: 507 (43.1%) from pharmacy distribution and 670 (56.9%) online. Construct validity was assessed by principal components analysis and item reduction undertaken on the original 60-item pool. Known-groups analysis assessed differences in mean total scores between participants using different numbers of medicines and between those who did or did not require assistance with medicine use. Internal consistency was assessed by Cronbach's alpha. Free-text comments were analyzed thematically to substantiate underlying dimensions. RESULTS A 42-item, eight-factor structure comprising intercorrelated dimensions (patient-doctor relationships and communication about medicines, patient-pharmacist communication about medicines, interferences with daily life, practical difficulties, effectiveness, acceptance of medicine use, autonomy/control over medicines and concerns about medicine use) was derived, which explained 57.4% of the total variation. Six of the eight subscales had acceptable internal consistency (α>0.7). More positive experiences were observed among patients using eight or fewer medicines compared to nine or more, and those independent with managing/using their medicines versus those requiring assistance. Free-text comments, provided by almost a third of the respondents, supported the domains identified. CONCLUSION The resultant LMQ-2 is a valid and reliable multidimensional measure of prescription medicine use experiences, which covers more diverse domains than existing questionnaires. However, further validation work is necessary.
Collapse
Affiliation(s)
- Janet Krska
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham Maritime, UK
- Correspondence: Janet Krska, Medway School of Pharmacy, The Universities of Greenwich and Kent at Medway, Anson Building, Central Avenue, Chatham Maritime, Kent, ME4 4TB, UK, Tel +44 1634 202 950, Email
| | - Barbra Katusiime
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham Maritime, UK
| | - Sarah A Corlett
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham Maritime, UK
| |
Collapse
|
92
|
Overbeck G, Davidsen AS, Kousgaard MB. Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review. Implement Sci 2016; 11:165. [PMID: 28031028 PMCID: PMC5192575 DOI: 10.1186/s13012-016-0519-y] [Citation(s) in RCA: 79] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Accepted: 11/01/2016] [Indexed: 12/26/2022] Open
Abstract
Background Collaborative care is an increasingly popular approach for improving quality of care for people with mental health problems through an intensified and structured collaboration between primary care providers and health professionals with specialized psychiatric expertise. Trials have shown significant positive effects for patients suffering from depression, but since collaborative care is a complex intervention, it is important to understand the factors which affect its implementation. We present a qualitative systematic review of the enablers and barriers to implementing collaborative care for patients with anxiety and depression. Methods We developed a comprehensive search strategy in cooperation with a research librarian and performed a search in five databases (EMBASE, PubMed, PsycINFO, ProQuest, and CINAHL). All authors independently screened titles and abstracts and reviewed full-text articles. Studies were included if they were published in English and based on the original qualitative data on the implementation of a collaborative care intervention targeted at depression or anxiety in an adult patient population in a high-income country. Our subsequent analysis employed the normalization process theory (NPT). Results We included 17 studies in our review of which 11 were conducted in the USA, five in the UK, and one in Canada. We identified several barriers and enablers within the four major analytical dimensions of NPT. Securing buy-in among primary care providers was found to be critical but sometimes difficult. Enablers included physician champions, reimbursement for extra work, and feedback on the effectiveness of collaborative care. The social and professional skills of the care managers seemed critical for integrating collaborative care in the primary health care clinic. Day-to-day implementation was also found to be facilitated by the care managers being located in the clinic since this supports regular face-to-face interactions between physicians and care managers. Conclusions The following areas require special attention when planning collaborative care interventions: effective educational programs, especially for care managers; issues of reimbursement in relation to primary care providers; good systems for communication and monitoring; and promoting face-to-face interaction between care managers and physicians, preferably through co-location. There is a need for well-sampled, in-depth qualitative studies on the implementation of collaborative care in settings outside the USA and the UK. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0519-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Gritt Overbeck
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, København, Denmark.
| | - Annette Sofie Davidsen
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, København, Denmark
| | - Marius Brostrøm Kousgaard
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, København, Denmark
| |
Collapse
|
93
|
Olaiya MT, Cadilhac DA, Kim J, Ung D, Nelson MR, Srikanth VK, Bladin CF, Gerraty RP, Fitzgerald SM, Phan TG, Frayne J, Thrift AG. Nurse-Led Intervention to Improve Knowledge of Medications in Survivors of Stroke or Transient Ischemic Attack: A Cluster Randomized Controlled Trial. Front Neurol 2016; 7:205. [PMID: 27917150 PMCID: PMC5114293 DOI: 10.3389/fneur.2016.00205] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Accepted: 11/02/2016] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Limited evidence exists on effective interventions to improve knowledge of preventive medications in patients with chronic diseases, such as stroke. We investigated the effectiveness of a nurse-led intervention, where a component was to improve knowledge of prevention medications, in patients with stroke or transient ischemic attack (TIA). METHODS Prospective sub-study of the Shared Team Approach between Nurses and Doctors for Improved Risk Factor Management, a randomized controlled trial of risk factor management. We recruited patients aged ≥18 years and hospitalized for stroke/TIA. The intervention comprised an individualized management program, involving nurse-led education, and management plan with medical specialist oversight. The outcome, participants' knowledge of secondary prevention medications at 12 months, was assessed using questionnaires. A score of ≥5 was considered as good knowledge. Effectiveness of the intervention on knowledge of medications was determined using logistic regression. RESULTS Between May 2014 and January 2015, 142 consecutive participants from the main trial were included in this sub-study, 64 to usual care and 78 to the intervention (median age 68.9 years, 68% males, and 79% ischemic stroke). In multivariable analyses, we found no significant difference between intervention groups in knowledge of medications. Factors independently associated with good knowledge (score ≥5) at 12 months included higher socioeconomic position (OR 4.79, 95% CI 1.76, 13.07), greater functional ability (OR 1.69, 95% CI 1.17, 2.45), being married/living with a partner (OR 3.12, 95% CI 1.10, 8.87), and using instructions on pill bottle/package as an administration aid (OR 4.82, 95% CI 1.76, 13.22). Being aged ≥65 years was associated with poorer knowledge of medications (OR 0.24, 95% CI 0.08, 0.71), while knowledge was worse among those taking three medications (OR 0.15, 95% CI 0.03, 0.66) or ≥4 medications (OR 0.09, 95% CI 0.02, 0.44), when compared to participants taking fewer (≤2) prevention medications. CONCLUSION There was no evidence that the nurse-led intervention was effective for improving knowledge of secondary prevention medications in patients with stroke/TIA at 12 months. However, older patients and those taking more medications should be particularly targeted for more intensive education. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry (ACTRN12688000166370).
Collapse
Affiliation(s)
- Muideen T. Olaiya
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Dominique A. Cadilhac
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - Joosup Kim
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Stroke Division, The Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia
| | - David Ung
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, Hobart, TAS, Australia
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Velandai K. Srikanth
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
- Menzies Institute for Medical Research, Hobart, TAS, Australia
| | | | | | - Sharyn M. Fitzgerald
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Thanh G. Phan
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| | - Judith Frayne
- Department of Neurology, Alfred Hospital, Prahan, VIC, Australia
| | - Amanda G. Thrift
- Stroke and Ageing Research Centre, School of Clinical Sciences at Monash Health, Monash University, Clayton, VIC, Australia
| |
Collapse
|
94
|
May CR, Cummings A, Myall M, Harvey J, Pope C, Griffiths P, Roderick P, Arber M, Boehmer K, Mair FS, Richardson A. Experiences of long-term life-limiting conditions among patients and carers: what can we learn from a meta-review of systematic reviews of qualitative studies of chronic heart failure, chronic obstructive pulmonary disease and chronic kidney disease? BMJ Open 2016; 6:e011694. [PMID: 27707824 PMCID: PMC5073552 DOI: 10.1136/bmjopen-2016-011694] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Revised: 08/24/2016] [Accepted: 08/26/2016] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES To summarise and synthesise published qualitative studies to characterise factors that shape patient and caregiver experiences of chronic heart failure (CHF), chronic obstructive pulmonary disease (COPD) and chronic kidney disease (CKD). DESIGN Meta-review of qualitative systematic reviews and metasyntheses. Papers analysed using content analysis. DATA SOURCES CINAHL, EMBASE, MEDLINE, PsychINFO, Scopus and Web of Science were searched from January 2000 to April 2015. ELIGIBILITY CRITERIA FOR SELECTING STUDIES Systematic reviews and qualitative metasyntheses where the participants were patients, caregivers and which described experiences of care for CHF, COPD and CKD in primary and secondary care who were aged ≥18 years. RESULTS Searches identified 5420 articles, 53 of which met inclusion criteria. Reviews showed that patients' and caregivers' help seeking and decision-making were shaped by their degree of structural advantage (socioeconomic status, spatial location, health service quality); their degree of interactional advantage (cognitive advantage, affective state and interaction quality) and their degree of structural resilience (adaptation to adversity, competence in managing care and caregiver response to demands). CONCLUSIONS To the best of our knowledge, this is the first synthesis of qualitative systematic reviews in the field. An important outcome of this overview is an emphasis on what patients and caregivers value and on attributes of healthcare systems, relationships and practices that affect the distressing effects and consequences of pathophysiological deterioration in CHF, COPD and CKD. Interventions that seek to empower individual patients may have limited effectiveness for those who are most affected by the combined weight of structural, relational and practical disadvantage identified in this overview. We identify potential targets for interventions that could address these disadvantages. SYSTEMATIC REVIEW REGISTRATION NUMBER PROSPERO CRD42014014547.
Collapse
Affiliation(s)
- Carl R May
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Amanda Cummings
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Michelle Myall
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jonathan Harvey
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Catherine Pope
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Peter Griffiths
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Paul Roderick
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
- Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Mick Arber
- York Health Economics Consortium, University of York, York, UK
| | - Kasey Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, Minnesota, USA
| | - Frances S Mair
- Department of General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alison Richardson
- Faculty of Health Sciences, University of Southampton, Southampton, UK
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
- University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
95
|
Katusiime B, Corlett S, Reeve J, Krska J. Measuring medicine-related experiences from the patient perspective: a systematic review. Patient Relat Outcome Meas 2016; 7:157-171. [PMID: 27785116 PMCID: PMC5063133 DOI: 10.2147/prom.s102198] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND There is an increasing drive to measure and so improve patients' experiences and outcomes of health care. This also applies to medicines, given their ubiquity as health care interventions. Patients' experiences of using medicines vary, and instruments which measure these are seen as an essential component to improve care. We aimed to identify generic measures of patients' experiences of using prescription medicines and to examine their properties and suitability for use in research or practice. METHODS Multiple electronic databases were searched: MEDLINE, Embase, PsycINFO, PsycARTICLES, CINHAL Plus, PROQOLID®, and Google Scholar. We identified, critically appraised, and summarized generic questionnaires assessing one or more aspects of the medicine use experience among adult patients using prescription medicines for chronic conditions, and the process of questionnaire development, degree of patient involvement, and/or validation processes. RESULTS Fifteen questionnaires were included. Of these, nine measures were multidimensional, covering various aspects of medicine use. Six instruments covered only a single domain, assessing a specific facet of using medicines. Domains covered were the following: effectiveness; convenience, practicalities, and/or managing medicines; information, knowledge, and/or understanding; side effects; relationships and/or communication with health professionals; impact on daily living and/or social life; general satisfaction; attitudes; beliefs, concerns, and/or perceptions; medical follow-up and/or adherence-related issues; treatment- and/or medicine-related burden, perceived control, or autonomy; self-confidence about medicine use; availability and accessibility; and medicine-related quality of life. None of the identified questionnaires covered all domains. Instruments varied in the extent of patient involvement in both their development and validation. CONCLUSION There is a scarcity of psychometrically sound, comprehensive, and generic measures of experiences of using prescription medicines among adult patients living with chronic illnesses. There is a need for further development and/or validation of existing instruments suitable for use in this population.
Collapse
Affiliation(s)
- Barbra Katusiime
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Maritime, Kent, UK
| | - Sarah Corlett
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Maritime, Kent, UK
| | - Joanne Reeve
- Warwick Medical School, University of Warwick, Coventry, UK
| | - Janet Krska
- Medway School of Pharmacy, The Universities of Kent and Greenwich, Chatham, Maritime, Kent, UK
| |
Collapse
|
96
|
Lind Irgens E, Henriksen N, Moe S. Acquired brain injury rehabilitation: dilemmas in neurological physiotherapy across healthcare settings. EUROPEAN JOURNAL OF PHYSIOTHERAPY 2016. [DOI: 10.1080/21679169.2016.1181206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
97
|
Boehmer KR, Hargraves IG, Allen SV, Matthews MR, Maher C, Montori VM. Meaningful conversations in living with and treating chronic conditions: development of the ICAN discussion aid. BMC Health Serv Res 2016; 16:514. [PMID: 27663302 PMCID: PMC5034671 DOI: 10.1186/s12913-016-1742-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2016] [Accepted: 06/18/2016] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The needs of the growing population of complex patients with multiple chronic conditions calls for a different approach to care. Clinical teams need to acknowledge, respect, and support the work that patients do and the capacity they mobilize to enact this work, and to adapt and self-manage. Tools that enable this approach to care are needed. METHODS Using user-centered design principles, we set out to create a discussion aid for use by patients, clinicians, and other health professionals during clinical encounters. We observed clinical encounters, visited patient homes, and dialogued with patient support groups. We then developed and tested prototypes in routine clinical practice. Then we refined a final prototype with extensive stakeholder feedback. RESULTS From this process resulted the ICAN Discussion Aid, a tool completed by the patient and reviewed during the consultation in which patients classified domains that contribute to capacity as sources of burden or satisfaction; clinical demands were also classified as sources of help or burden. The clinical review facilitated by ICAN generates hypotheses regarding why some treatment plans may be problematic and may not be enacted in the patient's situation. CONCLUSION We successfully created a discussion aid to elucidate and share insights about the capacity patients have to enact the treatment plan and hypotheses as to why this plan may or may not be enacted. Next steps involve the evaluation of the impact of the ICAN Discussion Aid on clinical encounters with a variety of health professionals and the impact of ICAN-informed treatment plans on patient-important outcomes.
Collapse
Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Ian G Hargraves
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Summer V Allen
- Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Marc R Matthews
- Department of Family Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Christina Maher
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| |
Collapse
|
98
|
O’Connor S, Hanlon P, O’Donnell CA, Garcia S, Glanville J, Mair FS. Understanding factors affecting patient and public engagement and recruitment to digital health interventions: a systematic review of qualitative studies. BMC Med Inform Decis Mak 2016; 16:120. [PMID: 27630020 PMCID: PMC5024516 DOI: 10.1186/s12911-016-0359-3] [Citation(s) in RCA: 313] [Impact Index Per Article: 39.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/03/2016] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Numerous types of digital health interventions (DHIs) are available to patients and the public but many factors affect their ability to engage and enrol in them. This systematic review aims to identify and synthesise the qualitative literature on barriers and facilitators to engagement and recruitment to DHIs to inform future implementation efforts. METHODS PubMed, MEDLINE, CINAHL, Embase, Scopus and the ACM Digital Library were searched for English language qualitative studies from 2000 - 2015 that discussed factors affecting engagement and enrolment in a range of DHIs (e.g. 'telemedicine', 'mobile applications', 'personal health record', 'social networking'). Text mining and additional search strategies were used to identify 1,448 records. Two reviewers independently carried out paper screening, quality assessment, data extraction and analysis. Data was analysed using framework synthesis, informed by Normalization Process Theory, and Burden of Treatment Theory helped conceptualise the interpretation of results. RESULTS Nineteen publications were included in the review. Four overarching themes that affect patient and public engagement and enrolment in DHIs emerged; 1) personal agency and motivation; 2) personal life and values; 3) the engagement and recruitment approach; and 4) the quality of the DHI. The review also summarises engagement and recruitment strategies used. A preliminary DIgital Health EnGagement MOdel (DIEGO) was developed to highlight the key processes involved. Existing knowledge gaps are identified and a number of recommendations made for future research. Study limitations include English language publications and exclusion of grey literature. CONCLUSION This review summarises and highlights the complexity of digital health engagement and recruitment processes and outlines issues that need to be addressed before patients and the public commit to digital health and it can be implemented effectively. More work is needed to create successful engagement strategies and better quality digital solutions that are personalised where possible and to gain clinical accreditation and endorsement when appropriate. More investment is also needed to improve computer literacy and ensure technologies are accessible and affordable for those who wish to sign up to them. SYSTEMATIC REVIEW REGISTRATION International Prospective Register of Systematic Reviews CRD42015029846.
Collapse
Affiliation(s)
- Siobhan O’Connor
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Peter Hanlon
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
| | - Catherine A. O’Donnell
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
| | | | | | - Frances S. Mair
- General Practice and Primary Care, Institute of Health and Wellbeing, University of Glasgow, 1 Horslethill Rd, Glasgow, G12 9LX UK
| |
Collapse
|
99
|
Reeve J, Cooper L, Harrington S, Rosbottom P, Watkins J. Developing, delivering and evaluating primary mental health care: the co-production of a new complex intervention. BMC Health Serv Res 2016; 16:470. [PMID: 27600512 PMCID: PMC5012043 DOI: 10.1186/s12913-016-1726-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Accepted: 08/27/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Health services face the challenges created by complex problems, and so need complex intervention solutions. However they also experience ongoing difficulties in translating findings from research in this area in to quality improvement changes on the ground. BounceBack was a service development innovation project which sought to examine this issue through the implementation and evaluation in a primary care setting of a novel complex intervention. METHODS The project was a collaboration between a local mental health charity, an academic unit, and GP practices. The aim was to translate the charity's model of care into practice-based evidence describing delivery and impact. Normalisation Process Theory (NPT) was used to support the implementation of the new model of primary mental health care into six GP practices. An integrated process evaluation evaluated the process and impact of care. RESULTS Implementation quickly stalled as we identified problems with the described model of care when applied in a changing and variable primary care context. The team therefore switched to using the NPT framework to support the systematic identification and modification of the components of the complex intervention: including the core components that made it distinct (the consultation approach) and the variable components (organisational issues) that made it work in practice. The extra work significantly reduced the time available for outcome evaluation. However findings demonstrated moderately successful implementation of the model and a suggestion of hypothesised changes in outcomes. CONCLUSIONS The BounceBack project demonstrates the development of a complex intervention from practice. It highlights the use of Normalisation Process Theory to support development, and not just implementation, of a complex intervention; and describes the use of the research process in the generation of practice-based evidence. Implications for future translational complex intervention research supporting practice change through scholarship are discussed.
Collapse
Affiliation(s)
- Joanne Reeve
- Warwick Medical School, Warwick University, Coventry, CV4 7AL UK
- Division of Health Sciences Research, Liverpool University, Liverpool, L69 3GL UK
- http://www2.warwick.ac.uk/fac/med/staff/jreeve
| | - Lucy Cooper
- Division of Health Sciences Research, Liverpool University, Liverpool, L69 3GL UK
| | - Sean Harrington
- AiW Health, 38-44 Woodside Business Park, Birkenhead, Wirral CH41 1EL UK
| | - Peter Rosbottom
- AiW Health, 38-44 Woodside Business Park, Birkenhead, Wirral CH41 1EL UK
| | - Jane Watkins
- AiW Health, 38-44 Woodside Business Park, Birkenhead, Wirral CH41 1EL UK
| |
Collapse
|
100
|
Du HS, Ma JJ, Li M. High-quality Health Information Provision for Stroke Patients. Chin Med J (Engl) 2016; 129:2115-22. [PMID: 27569241 PMCID: PMC5009598 DOI: 10.4103/0366-6999.189065] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2016] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE High-quality information provision can allow stroke patients to effectively participate in healthcare decision-making, better manage the stroke, and make a good recovery. In this study, we reviewed information needs of stroke patients, methods for providing information to patients, and considerations needed by the information providers. DATA SOURCES The literature concerning or including information provision for patients with stroke in English was collected from PubMed published from 1990 to 2015. STUDY SELECTION We included all the relevant articles on information provision for stroke patients in English, with no limitation of study design. RESULTS Stroke is a major public health concern worldwide. High-quality and effective health information provision plays an essential role in helping patients to actively take part in decision-making and healthcare, and empowering them to effectively self-manage their long-standing chronic conditions. Different methods for providing information to patients have their relative merits and suitability, and as a result, the effective strategies taken by health professionals may include providing high-quality information, meeting patients' individual needs, using suitable methods in providing information, and maintaining active involvement of patients. CONCLUSIONS It is suggested that to enable stroke patients to access high-quality health information, greater efforts need to be made to ensure patients to receive accurate and current evidence-based information which meets their individual needs. Health professionals should use suitable information delivery methods, and actively involve stroke patients in information provision.
Collapse
Affiliation(s)
- Hong-Sheng Du
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin 300192, China
| | - Jing-Jian Ma
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin 300192, China
| | - Mu Li
- Department of Neurosurgery, Tianjin First Central Hospital, Tianjin 300192, China
| |
Collapse
|