101
|
Waldron C, Hughes J, Wallace E, Cahir C, Bennett K. Contexts and mechanisms relevant to General Practitioner (GP) based interventions to reduce adverse drug events (ADE) in community dwelling older adults: a rapid realist review. HRB Open Res 2022. [DOI: 10.12688/hrbopenres.13580.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Older adults in Ireland are at increased risk of adverse drug events (ADE) due, in part, to increasing rates of polypharmacy. Interventions to reduce ADE in community dwelling older adults (CDOA) have had limited success, therefore, new approaches are required. A realist review uses a different lens to examine why and how interventions were supposed to work rather than if, they worked. A rapid realist review (RRR) is a more focused and accelerated version. The aim of this RRR is to identify and examine the contexts and mechanisms that play a role in the outcomes relevant to reducing ADE in CDOA in the GP setting that could inform the development of interventions in Ireland. Methods: Six candidate theories (CT) were developed, based on knowledge of the field and recent literature, in relation to how interventions are expected to work. These formed the search strategy. Eighty full texts from 633 abstracts were reviewed, of which 27 were included. Snowballing added a further five articles, relevant policy documents increased the total number to 45. Data were extracted relevant to the theories under iteratively developed sub-themes using NVivo software. Results: Of the six theories, three theories, relating to GP engagement in interventions, relevance of health policy documents for older adults, and shared decision-making, provided data to guide future interventions to reduce ADEs for CDOA in an Irish setting. There was insufficient data for two theories, a third was rejected as existing barriers in the Irish setting made it impractical to use. Conclusions: To improve the success of Irish GP based interventions to reduce ADEs for CDOA, interventions must be relevant and easily applied in practice, supported by national policy and be adequately resourced. Future research is required to test our theories within a newly developed intervention.
Collapse
|
102
|
Cheng GJ, Wagner AL, O’Shea BQ, Joseph CA, Finlay JM, Kobayashi LC. Multimorbidity and Mental Health Trajectories Among Middle-Aged and Older U.S. Adults During the COVID-19 Pandemic: Longitudinal Findings From the COVID-19 Coping Study. Innov Aging 2022; 6:igac047. [PMID: 36035631 PMCID: PMC9403728 DOI: 10.1093/geroni/igac047] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Indexed: 11/15/2022] Open
Abstract
Background and Objectives This study aimed to examine the associations between multimorbidity at the COVID-19 pandemic onset and subsequent longitudinal trajectories of depressive symptoms, anxiety symptoms, and loneliness in middle-aged and older adults over a 12-month follow-up. Research Design and Methods Data were from monthly online questionnaires in the COVID-19 Coping Study of U.S. adults aged ≥55 from April/May 2020 through April/May 2021 (N = 4,024). Multimorbidity was defined as having ≥2 versus <2 chronic conditions at baseline. Mental health outcomes were assessed monthly as depressive symptoms (8-item Center for Epidemiologic Studies Depression scale), anxiety symptoms (5-item Beck Anxiety Inventory), and loneliness (3-item UCLA Loneliness Scale). We used multivariable-adjusted population- and attrition-weighted mixed-effects linear models to examine the longitudinal associations between multimorbidity and mental health symptoms. Results Multimorbidity at the pandemic onset was associated with elevated depressive (b = 0.37; 95% CI: 0.16–0.59) and anxiety (b = 0.39; 95% CI: 0.15–0.62) symptoms at baseline. Changes in symptoms for all three mental health outcomes were nonlinear over time, with worsening symptoms over the first 6 months of the pandemic (April/May to September/October 2020), followed by improvement in symptoms over the subsequent 6 months (September/October 2020 to April/May 2021). Middle-aged and older adults with multimorbidity experienced faster rates of change in anxiety symptoms and loneliness than those without multimorbidity, with persistently elevated mental health symptomatology throughout the follow-up. Discussion and Implications Results highlight the unique and persistent mental health risks experienced by middle-aged and older adults with multimorbidity during the COVID-19 pandemic. The observed improvements in symptoms underscore the mental resilience of these individuals, indicating their adaptation to the ongoing pandemic.
Collapse
Affiliation(s)
- Greta Jianjia Cheng
- Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan , USA
- Brain, Environment, Aging, and Mobility (BEAM) Lab, Department of Epidemiology, University of Pittsburgh School of Public Health , Pittsburgh, PA , USA
| | - Abram L Wagner
- Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan , USA
| | - Brendan Q O’Shea
- Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan , USA
| | - Carly A Joseph
- Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan , USA
| | - Jessica M Finlay
- Social Environment and Health Program, Institute for Social Research, University of Michigan , Ann Arbor, Michigan , USA
| | - Lindsay C Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health , Ann Arbor, Michigan , USA
| |
Collapse
|
103
|
Paukkonen L, Oikarinen A, Kähkönen O, Kaakinen P. Patient activation for self-management among adult patients with multimorbidity in primary healthcare settings. Health Sci Rep 2022; 5:e735. [PMID: 35873391 PMCID: PMC9297377 DOI: 10.1002/hsr2.735] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/24/2022] Open
Abstract
Background and Aims Multimorbidity is a major public health and healthcare challenge around the world, including in Finland. As multimorbidity necessitates self-management in everyday life, the effects of patient activation - a patient's knowledge, skills, and confidence in managing own health - on the capacity for self-management warrant study, especially in primary healthcare settings. This study aimed to assess patient activation among multimorbid primary healthcare patients, identify factors associated with patient activation, and determine whether patients with low and high activation differ in terms of health and self-management behavior, related perceptions, and health-related quality of life (HRQoL). Methods A cross-sectional survey was conducted among multimorbid patients who attended Finnish primary healthcare consultations (November 2019 to May 2020). The main outcome, patient activation, was assessed using the patient activation measure, PAM-13®. Responses from 122 patients were analyzed using descriptive statistics, t-tests, analysis of variance, linear modeling, the χ 2 test, and binary regression analysis. Results The mean score of patient activation was 56.12 (SD 12.82) on a scale 0-100 where ≤55.1 indicate low activation. The lower activation scores were significantly associated with old age, obesity, loneliness, and lower perceived health, functional ability, and vitality. Patients with low activation (47%) had significantly poorer physical activity, diets, adherence to care, and HRQoL, and significantly worse perceptions related to self-management including motivation and energy, sense of normality, and support from physicians, nurses, and close people. Conclusion Patient activation among multimorbid outpatients was rather low. Findings indicate that patients' perceptions of their health and psychosocial factors may be important for activation and that patients with low and high activation differ with respect to several health variables. Determining patient activation in multimorbid patients may facilitate adaptation of care to better meet patient capabilities and needs in clinical settings. Knowledge of a patient's activation level may also be useful when developing interventions and care strategies for this patient group.
Collapse
Affiliation(s)
- Leila Paukkonen
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
- Medical Research CentreOuluFinland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
- Medical Research CentreOuluFinland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
- Medical Research CentreOuluFinland
| | - Pirjo Kaakinen
- Research Unit of Nursing Science and Health ManagementUniversity of OuluOuluFinland
- Medical Research CentreOuluFinland
| |
Collapse
|
104
|
Reeve J, Maden M, Hill R, Turk A, Mahtani K, Wong G, Lasserson D, Krska J, Mangin D, Byng R, Wallace E, Ranson E. Deprescribing medicines in older people living with multimorbidity and polypharmacy: the TAILOR evidence synthesis. Health Technol Assess 2022; 26:1-148. [PMID: 35894932 PMCID: PMC9376985 DOI: 10.3310/aafo2475] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Tackling problematic polypharmacy requires tailoring the use of medicines to individual needs and circumstances. This may involve stopping medicines (deprescribing) but patients and clinicians report uncertainty on how best to do this. The TAILOR medication synthesis sought to help understand how best to support deprescribing in older people living with multimorbidity and polypharmacy. OBJECTIVES We identified two research questions: (1) what evidence exists to support the safe, effective and acceptable stopping of medication in this patient group, and (2) how, for whom and in what contexts can safe and effective tailoring of clinical decisions related to medication use work to produce desired outcomes? We thus described three objectives: (1) to undertake a robust scoping review of the literature on stopping medicines in this group to describe what is being done, where and for what effect; (2) to undertake a realist synthesis review to construct a programme theory that describes 'best practice' and helps explain the heterogeneity of deprescribing approaches; and (3) to translate findings into resources to support tailored prescribing in clinical practice. DATA SOURCES Experienced information specialists conducted comprehensive searches in MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Web of Science, EMBASE, The Cochrane Library (Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials), Joanna Briggs Institute Database of Systematic Reviews and Implementation Reports, Google (Google Inc., Mountain View, CA, USA) and Google Scholar (targeted searches). REVIEW METHODS The scoping review followed the five steps described by the Joanna Briggs Institute methodology for conducting a scoping review. The realist review followed the methodological and publication standards for realist reviews described by the Realist And Meta-narrative Evidence Syntheses: Evolving Standards (RAMESES) group. Patient and public involvement partners ensured that our analysis retained a patient-centred focus. RESULTS Our scoping review identified 9528 abstracts: 8847 were removed at screening and 662 were removed at full-text review. This left 20 studies (published between 2009 and 2020) that examined the effectiveness, safety and acceptability of deprescribing in adults (aged ≥ 50 years) with polypharmacy (five or more prescribed medications) and multimorbidity (two or more conditions). Our analysis revealed that deprescribing under research conditions mapped well to expert guidance on the steps needed for good clinical practice. Our findings offer evidence-informed support to clinicians regarding the safety, clinician acceptability and potential effectiveness of clinical decision-making that demonstrates a structured approach to deprescribing decisions. Our realist review identified 2602 studies with 119 included in the final analysis. The analysis outlined 34 context-mechanism-outcome configurations describing the knowledge work of tailored prescribing under eight headings related to organisational, health-care professional and patient factors, and interventions to improve deprescribing. We conclude that robust tailored deprescribing requires attention to providing an enabling infrastructure, access to data, tailored explanations and trust. LIMITATIONS Strict application of our definition of multimorbidity during the scoping review may have had an impact on the relevance of the review to clinical practice. The realist review was limited by the data (evidence) available. CONCLUSIONS Our combined reviews recognise deprescribing as a complex intervention and provide support for the safety of structured approaches to deprescribing, but also highlight the need to integrate patient-centred and contextual factors into best practice models. FUTURE WORK The TAILOR study has informed new funded research tackling deprescribing in sleep management, and professional education. Further research is being developed to implement tailored prescribing into routine primary care practice. STUDY REGISTRATION This study is registered as PROSPERO CRD42018107544 and PROSPERO CRD42018104176. FUNDING This project was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 26, No. 32. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Joanne Reeve
- Academy of Primary Care, Hull York Medical School, University of Hull, Hull, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Ruaraidh Hill
- Liverpool Reviews and Implementation Group, Institute of Population Health, University of Liverpool, Liverpool, UK
| | - Amadea Turk
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Kamal Mahtani
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Geoff Wong
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Dan Lasserson
- Health Sciences, Warwick Medical School, University of Warwick, Coventry, UK
| | - Janet Krska
- Medway School of Pharmacy, Universities of Greenwich and Kent, Chatham, UK
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Richard Byng
- Community and Primary Care Research Group, Peninsula Medical School, University of Plymouth, Plymouth, UK
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | |
Collapse
|
105
|
Aramrat C, Choksomngam Y, Jiraporncharoen W, Wiwatkunupakarn N, Pinyopornpanish K, Mallinson PAC, Kinra S, Angkurawaranon C. Advancing multimorbidity management in primary care: a narrative review. Prim Health Care Res Dev 2022; 23:e36. [PMID: 35775363 PMCID: PMC9309754 DOI: 10.1017/s1463423622000238] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 04/23/2022] [Accepted: 04/25/2022] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Multimorbidity, defined as the coexistence of two or more chronic conditions in the same individual, is becoming a crucial health issue in primary care. Patients with multimorbidity utilize health care at a higher rate and have higher mortality rates and poorer quality of life compared to patients with single diseases. AIMS To explore evidence on how to advance multimorbidity management, with a focus on primary care. Primary care is where a large number of patients with multimorbidity are managed and is considered to be a gatekeeper in many health systems. METHODS A narrative review was conducted using four major electronic databases consisting of PubMed, Cochrane, World Health Organization database, and Google scholar. In the first round of reviews, priority was given to review papers summarizing the current issues and challenges in the management of multimorbidity. Thematic analysis using an inductive approach was used to build a framework on how to advance management. The second round of review focused on original articles providing evidence within the primary care context. RESULTS The review found that advancing multimorbidity management in primary care requires a health system approach and a patient-centered approach. The health systems approach includes three major areas: (i) improves access to care, (ii) promotes generalism, and (iii) provides a decision support system. For the patient-centered approach, four key aspects are essential for multimorbidity management: (i) promoting doctor-patient relationship, (ii) prioritizing health problems and sharing decision-making, (iii) supporting self-management, and (iv) integrating care.Advancement of multimorbidity management in primary care requires integrating concepts of multimorbidity management guidelines with concepts of patient-centered and chronic care models. This simple integration provides an overarching framework for advancing the health care system, connecting the processes of individualized care plans, and integrating care with other providers, family members, and the community.
Collapse
Affiliation(s)
- Chanchanok Aramrat
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Yanee Choksomngam
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Wichuda Jiraporncharoen
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Nutchar Wiwatkunupakarn
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | | | - Poppy Alice Carson Mallinson
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Sanjay Kinra
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Chaisiri Angkurawaranon
- Department of Family Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
- Global Health and Chronic Conditions Research Group, Chiang Mai University, Chiang MaiThailand
| |
Collapse
|
106
|
Sadarangani T, Perissinotto C, Boafo J, Zhong J, Yu G. Multimorbidity patterns in adult day health center clients with dementia: a latent class analysis. BMC Geriatr 2022; 22:514. [PMID: 35733122 PMCID: PMC9216285 DOI: 10.1186/s12877-022-03206-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Accepted: 04/13/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Persons living with dementia (PLWD) in adult day centers (ADCs) represent a complex and vulnerable population whose well-being is at risk based on numerous factors. Greater knowledge of the interaction between dementia, chronic conditions, and social determinants of health would enable ADCs to identify and target the use of their resources to better support clients in need of in-depth intervention. The purpose of this paper is to (a) classify PLWD in ADCs according to their level of medical complexity and (b) identify the demographic, functional, and clinical characteristics of those with the highest degree of medical complexity. METHODS This was a secondary data analysis of 3052 clients with a dementia diagnosis from 53 ADCs across the state of California between 2012 and 2019. The most common diagnosis codes were organized into 28 disease categories to enable a latent class analysis (LCA). Chi-square test, analysis of variance (ANOVA), and Kruskal-Wallis tests were conducted to examine differences among latent classes with respect to clinical and functional characteristics. RESULTS An optimal 4-class solution was chosen to reflect chronic conditions among PLWD: high medical complexity, moderate medical complexity, low medical complexity, and no medical complexity. Those in the high medical complexity were taking an average of 12.72 (+/- 6.52) medications and attending the ADC an average of 3.98 days (+/- 1.31) per week-values that exceeded any other class. They also experienced hospitalizations more than any other group (19.0%) and met requirements for the nursing facility level of care (77.4%). In addition, the group experienced the greatest frequency of bladder (57.5%) and bowel (15.7%) incontinence. CONCLUSIONS Our results illustrate a high degree of medical complexity among PLWD in ADCs. A majority of PLWD not only have multimorbidity but are socially disadvantaged. Our results demonstrate that a comprehensive multidisciplinary approach that involves community partners such as ADCs is critically needed that addresses functional decline, loneliness, social isolation, and multimorbidity which can negatively impact PLWD.
Collapse
Affiliation(s)
- Tina Sadarangani
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010 USA
| | - Carla Perissinotto
- University of California San Francisco School of Medicine, Division of Geriatrics, 490 Illinois Street, San Francisco, CA 94158 USA
| | - Jonelle Boafo
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010 USA
| | - Jie Zhong
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010 USA
| | - Gary Yu
- New York University Rory Meyers College of Nursing, 433 First Avenue, New York, NY 10010 USA
| |
Collapse
|
107
|
Multimorbidity patterns across race/ethnicity as stratified by age and obesity. Sci Rep 2022; 12:9716. [PMID: 35690677 PMCID: PMC9188579 DOI: 10.1038/s41598-022-13733-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 05/12/2022] [Indexed: 11/08/2022] Open
Abstract
The objective of our study is to assess differences in prevalence of multimorbidity by race/ethnicity. We applied the FP-growth algorithm on middle-aged and elderly cohorts stratified by race/ethnicity, age, and obesity level. We used 2016–2017 data from the Cerner HealthFacts electronic health record data warehouse. We identified disease combinations that are shared by all races/ethnicities, those shared by some, and those that are unique to one group for each age/obesity level. Our findings demonstrate that even after stratifying by age and obesity, there are differences in multimorbidity prevalence across races/ethnicities. There are multimorbidity combinations distinct to some racial groups—many of which are understudied. Some multimorbidities are shared by some but not all races/ethnicities. African Americans presented with the most distinct multimorbidities at an earlier age. The identification of prevalent multimorbidity combinations amongst subpopulations provides information specific to their unique clinical needs.
Collapse
|
108
|
Chen JJ, Liu LF, Chang SM. Approaching person-centered long-term care: The trajectories of intrinsic capacity and functional decline in Taiwan. Geriatr Gerontol Int 2022; 22:516-522. [PMID: 35633201 DOI: 10.1111/ggi.14391] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 03/13/2022] [Accepted: 04/02/2022] [Indexed: 11/04/2022]
Abstract
AIM To examine the longitudinal trajectory of intrinsic capacity over a 3-year period among long-term care recipients in Taiwan, its association with functional decline and the onset of severe dependency. METHODS A total of 9448 individuals aged ≥50 years utilizing home and community-based long-term care services with complete data from three separate evaluations in Taiwan were included in the study. We carried out a latent class linear mixed model to identify heterogeneous patterns of intrinsic capacity over time, a mixed-effects model to investigate their impact on activities of daily living and a Kaplan-Meier analysis to examine the onset year of severe dependency among different intrinsic capacity classes. RESULTS The results identified four classes sharing similar longitudinal the intrinsic capacity trajectories: "high-stable" (20.13%), "normal-stable" (40.58%), "sensory-dysfunction" (29.53%) and "all-dysfunction" (9.76%). Individuals with predisposing characteristics were associated with lower activities of daily living, with the exception of age and education level. In addition, the poor intrinsic capacity class (b from -16.94 to -6.61, P < 0.001) had a worse evolution in terms of activity of daily living scores, and was associated with an earlier onset of severe dependency in 2.5 years in the all-dysfunction class. CONCLUSIONS Heterogeneous patterns of intrinsic capacity that delay further functional decline are promising markers of function trajectories for a person-centered care approach in long-term care services. Targeting the needs of intrinsic capacity groups to prevent functional decline offer insights into: (i) strengthening function-centered care modalities to delay severe dependency as individuals get older; and (ii) validating regular monitoring intrinsic capacity as an early warning system to achieve healthy aging. Geriatr Gerontol Int 2022; ••: ••-••.
Collapse
Affiliation(s)
- Jia-Jen Chen
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Li-Fan Liu
- Institute of Gerontology, College of Medicine, National Cheng Kung University, Tainan City, Taiwan
| | - Sheng-Mao Chang
- Department of Statistics, National Taipei University, Taipei City, Taiwan
| |
Collapse
|
109
|
Ó Ciardha D, Blake AM, Creane D, Callaghan MÓ, Darker C. Can a practice pharmacist improve prescribing safety and reduce costs in polypharmacy patients? A pilot study of an intervention in an Irish general practice setting. BMJ Open 2022; 12:e050261. [PMID: 35623753 PMCID: PMC9150158 DOI: 10.1136/bmjopen-2021-050261] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES This study aimed to develop and assess the feasibility and cost impact of an intervention involving a practice pharmacist embedded in general practice to improve prescribing safety, deprescribe where appropriate and reduce costs. SETTING Four-doctor suburban general practice. PARTICIPANTS Inclusion criteria: patients receiving 10+ repeat drugs per month. EXCLUSION CRITERIA deceased, <18 years of age, nursing home resident, no longer attending, late-stage life-limiting condition, unsuitable on clinical/capacity grounds. 137 patients were eligible. 78 were recruited as participants, all of whom completed the study. INTERVENTION Pharmacist conducting holistic medication reviews in the study group over a 6-month period. PRIMARY OUTCOME MEASURES Anonymised medication changes, cost, biochemical monitoring and clinical measurements data were collected. Cost analysis of having a pharmacist as part of the general practice team was calculated. RESULTS In total, 198 potentially inappropriate prescriptions (PIPs), and 163 opportunities for deprescribing were identified; 127 PIPs (64.1%) were actioned; 104 deprescribing opportunities were actioned (63.8%). The pharmacist identified 101 instances in which further investigations were warranted prior to prescription issue, of which 80 were actioned (79.2%). It was calculated that monthly savings of €1252 were made as a result of deprescribing. CONCLUSIONS This study has shown that the integration of pharmacists within general practice in Ireland is feasible and is an effective means of improving prescribing safety and implementing deprescribing through medication reviews. The combination of safety and cost concerns support taking a holistic approach to deprescribing with the patient. This study highlights the ease with which a pharmacist could integrate into the general practice setting in Ireland and points to how this could be sustainably funded.
Collapse
Affiliation(s)
- Darach Ó Ciardha
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Anne-Marie Blake
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Dylan Creane
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Michael Ó Callaghan
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| | - Catherine Darker
- Institute of Population Health, Trinity College Dublin School of Medicine, Dublin, Ireland
| |
Collapse
|
110
|
Shang X, Zhang X, Huang Y, Zhu Z, Zhang X, Liu S, Liu J, Tang S, Wang W, Yu H, Ge Z, He M. Temporal trajectories of important diseases in the life course and premature mortality in the UK Biobank. BMC Med 2022; 20:185. [PMID: 35619136 PMCID: PMC9137080 DOI: 10.1186/s12916-022-02384-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 04/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known regarding life-course trajectories of important diseases. We aimed to identify diseases that were strongly associated with mortality and test temporal trajectories of these diseases before mortality. METHODS Our analysis was based on UK Biobank. Diseases were identified using questionnaires, nurses' interviews, or inpatient data. Mortality register data were used to identify mortality up to January 2021. The association between 60 individual diseases at baseline and in the life course and incident mortality was examined using Cox proportional regression models. Those diseases with great contribution to mortality were identified and disease trajectories in life course were then derived. RESULTS During a median follow-up of 11.8 years, 31,373 individuals (median age at death (interquartile range): 70.7 (65.3-74.8) years, 59.4% male) died of all-cause mortality (with complete data on diagnosis date of disease), with 16,237 dying with cancer and 6702 with cardiovascular disease (CVD). We identified 37 diseases including cancers and heart diseases that were associated with an increased risk of mortality independent of other diseases (hazard ratio ranged from 1.09 to 7.77). Among those who died during follow-up, 2.2% did not have a diagnosis of any disease of interest and 90.1% were diagnosed with two or more diseases in their life course. Individuals who were diagnosed with more diseases in their life course were more likely to have longer longevity. Cancer was more likely to be diagnosed following hypertension, hypercholesterolemia, CVD, or digestive disorders and more likely to be diagnosed ahead of CVD, chronic kidney disease (CKD), or digestive disorders. CVD was more likely to be diagnosed following hypertension, hypercholesterolemia, or digestive disorders and more likely to be diagnosed ahead of cancer or CKD. Hypertension was more likely to precede other diseases, and CKD was more likely to be diagnosed as the last disease before more mortality. CONCLUSIONS There are significant interplays between cancer and CVD for mortality. Cancer and CVD were frequently clustered with hypertension, CKD, and digestive disorders with CKD highly being diagnosed as the last disease in the life course. Our findings underline the importance of health checks among middle-aged adults for the prevention of premature mortality.
Collapse
Affiliation(s)
- Xianwen Shang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, Guangzhou, 510080, China. .,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China. .,Centre for Eye Research Australia, Melbourne, VIC, 3002, Australia.
| | - Xueli Zhang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, Guangzhou, 510080, China
| | - Yu Huang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, Guangzhou, 510080, China.,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Zhuoting Zhu
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, Guangzhou, 510080, China.,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China.,Centre for Eye Research Australia, Melbourne, VIC, 3002, Australia
| | - Xiayin Zhang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, Guangzhou, 510080, China.,Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510080, China
| | - Shunming Liu
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, Guangzhou, 510080, China
| | - Jiahao Liu
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, 3010, Australia
| | - Shulin Tang
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, Guangzhou, 510080, China
| | - Wei Wang
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China
| | - Honghua Yu
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, Guangzhou, 510080, China
| | - Zongyuan Ge
- Monash e-Research Center, Faculty of Engineering, Airdoc Research, Nvidia AI Technology Research Center, Monash University, Melbourne, VIC, 3800, Australia
| | - Mingguang He
- Department of Ophthalmology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangdong Eye Institute, Guangzhou, 510080, China. .,Centre for Eye Research Australia, Melbourne, VIC, 3002, Australia. .,State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-sen University, Guangzhou, 510060, China.
| |
Collapse
|
111
|
Ljungholm L, Edin-Liljegren A, Ekstedt M, Klinga C. What is needed for continuity of care and how can we achieve it? - Perceptions among multiprofessionals on the chronic care trajectory. BMC Health Serv Res 2022; 22:686. [PMID: 35606787 PMCID: PMC9125858 DOI: 10.1186/s12913-022-08023-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 04/27/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Continuity of care (CoC) implies delivery of services in a coherent, logical and timely fashion. Continuity is conceptualized as multidimensional, encompassing three specific domains - relational, management and informational continuity - with emphasis placed on their interrelations, i.e., how they affect and are affected by each other. This study sought to investigate professionals' perceptions of the prerequisites of CoC within and between organizations and how CoC can be realized for people with complex care needs. METHODS This study had a qualitative design using individual, paired and focus group interviews with a purposeful sample of professionals involved in the chain of care for patients with chronic conditions across healthcare and social care services from three different geographical areas in Sweden, covering both urban and rural areas. Transcripts from interviews with 34 informants were analysed using conventional content analysis. RESULTS CoC was found to be dependent on professional and cross-disciplinary cooperation at the micro, meso and macro system levels. Continuity is dependent on long-term and person-centred relationships (micro level), dynamic stability in organizational structures (meso level) and joint responsibility for cohesive care and enabling of uniform solutions for knowledge and information exchange (macro level). CONCLUSIONS Achieving CoC that creates coherent and long-term person-centred care requires knowledge- and information-sharing that transcends disciplinary and organizational boundaries. Collaborative accountability is needed both horizontally and vertically across micro, meso and macro system levels, rather than a focus on personal responsibility and relationships at the micro level.
Collapse
Affiliation(s)
- Linda Ljungholm
- Department of Health and Caring Sciences, Linnaeus University, Pedalstråket 13, S-39182 Kalmar, Sweden
| | - Anette Edin-Liljegren
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
- The Centre for Rural Medicine, Research and Development Unit, Region Västerbotten, Storuman, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Linnaeus University, Pedalstråket 13, S-39182 Kalmar, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
| | - Charlotte Klinga
- Department of Health and Caring Sciences, Linnaeus University, Pedalstråket 13, S-39182 Kalmar, Sweden
- Department of Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
- Research and Development Unit for Elderly Persons (FOU Nu) Region Stockholm, Stockholm, Sweden
| |
Collapse
|
112
|
Longhini J, Canzan F, Mezzalira E, Saiani L, Ambrosi E. Organisational models in primary health care to manage chronic conditions: A scoping review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e565-e588. [PMID: 34672051 DOI: 10.1111/hsc.13611] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Revised: 10/06/2021] [Accepted: 10/08/2021] [Indexed: 06/13/2023]
Abstract
Chronic diseases are increasing incessantly, and more efforts are needed in order to develop effective organisational models in primary health care, which may address the challenges posed by the consequent multimorbidity. The aim of this study was to assess and map methods, interventions and outcomes investigated over the last decade regarding the effectiveness of chronic care organisational models in primary care settings. We conducted a scoping review including systematic reviews, clinical trials, and observational studies, published from 2010 to 2020, that evaluated the effectiveness of organisational models for chronic conditions in primary care settings, including home care, community, and general practice. We included 67 international studies out of the 6,540 retrieved studies. The prevalent study design was the observational design (25 studies, 37.3%), and 62 studies (92.5%) were conducted on the adult population. Four main models emerged, called complex integrated care models. These included models grounded on the Chronic Care Model framework and similar, case or care management, and models centred on involvement of pharmacists or community health workers. Across the organisational models, self-management support and multidisciplinary teams were the most common components. Clinical outcomes have been investigated the most, while caregiver outcomes have been detected in the minority of cases. Almost one-third of the included studies reported only significant effects in the outcomes. No sufficient data were available to determine the most effective models of care. However, more complex models seem to lead to better outcomes. In conclusion, in the development of more comprehensive organisational models to manage chronic conditions in primary health care, more efforts are needed on the paediatric population, on the inclusion of caregiver outcomes in the effectiveness evaluation of organisational models and on the involvement of social community resources. As regarding the studies investigating organisational models, more detailed descriptions should be provided with regard to interventions, and the training, roles and responsibilities of health and lay figures in delivering care.
Collapse
Affiliation(s)
- Jessica Longhini
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Federica Canzan
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisabetta Mezzalira
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Luisa Saiani
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Elisa Ambrosi
- Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| |
Collapse
|
113
|
Dorrington S, Carr E, Stevelink SAM, Dregan A, Woodhead C, Das-Munshi J, Ashworth M, Broadbent M, Madan I, Hatch SL, Hotopf M. Multimorbidity and fit note receipt in working-age adults with long-term health conditions. Psychol Med 2022; 52:1156-1165. [PMID: 32895068 DOI: 10.1017/s0033291720002937] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Research on sickness absence has typically focussed on single diagnoses, despite increasing recognition that long-term health conditions are highly multimorbid and clusters comprising coexisting mental and physical conditions are associated with poorer clinical and functional outcomes. The digitisation of sickness certification in the UK offers an opportunity to address sickness absence in a large primary care population. METHODS Lambeth Datanet is a primary care database which collects individual-level data on general practitioner consultations, prescriptions, Quality and Outcomes Framework diagnostic data, sickness certification (fit note receipt) and demographic information (including age, gender, self-identified ethnicity, and truncated postcode). We analysed 326 415 people's records covering a 40-month period from January 2014 to April 2017. RESULTS We found significant variation in multimorbidity by demographic variables, most notably by self-defined ethnicity. Multimorbid health conditions were associated with increased fit note receipt. Comorbid depression had the largest impact on first fit note receipt, more than any other comorbid diagnoses. Highest rates of first fit note receipt after adjustment for demographics were for comorbid epilepsy and rheumatoid arthritis (HR 4.69; 95% CI 1.73-12.68), followed by epilepsy and depression (HR 4.19; 95% CI 3.60-4.87), chronic pain and depression (HR 4.14; 95% CI 3.69-4.65), cardiac condition and depression (HR 4.08; 95% CI 3.36-4.95). CONCLUSIONS Our results show striking variation in multimorbid conditions by gender, deprivation and ethnicity, and highlight the importance of multimorbidity, in particular comorbid depression, as a leading cause of disability among working-age adults.
Collapse
Affiliation(s)
- Sarah Dorrington
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Ewan Carr
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Sharon A M Stevelink
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- King's Centre for Military Health Research, Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Alex Dregan
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Charlotte Woodhead
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Jayati Das-Munshi
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Mark Ashworth
- School of Population Health and Environmental Sciences, King's College London, Guy's Campus, Addison House, London SE1 1UL, UK
| | | | - Ira Madan
- Department of Occupational Health, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Stephani L Hatch
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
| | - Matthew Hotopf
- Institute of Psychiatry, Psychology & Neuroscience King's College London, 16 De Crespigny Park, London SE5 8AF, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| |
Collapse
|
114
|
Hynes L, Murphy AW, Hart N, Kirwan C, Mulligan S, Leathem C, McQuillan L, Maxwell M, Carr E, Walkin S, McCarthy C, Bradley C, Byrne M, Smith SM, Hughes C, Corry M, Kearney PM, McCarthy G, Cupples M, Gillespie P, Newell J, Glynn L, Alvarez-Iglesias A, Sinnott C. The MultimorbiditY COllaborative Medication Review And DEcision Making (MyComrade) study: a protocol for a cross-border pilot cluster randomised controlled trial. Pilot Feasibility Stud 2022; 8:73. [PMID: 35346380 PMCID: PMC8958932 DOI: 10.1186/s40814-022-01018-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/02/2022] [Indexed: 12/12/2022] Open
Abstract
Background While international guidelines recommend medication reviews as part of the management of multimorbidity, evidence on how to implement reviews in practice in primary care is lacking. The MultimorbiditY Collaborative Medication Review And Decision Making (MyComrade) intervention is an evidence-based, theoretically informed novel intervention which aims to support the conduct of medication reviews for patients with multimorbidity in primary care. Our aim in this pilot study is to evaluate the feasibility of a trial of the intervention with unique modifications accounting for contextual variations in two neighbouring health systems (Republic of Ireland (ROI) and Northern Ireland (NI)). Methods A pilot cluster randomised controlled trial will be conducted, using a mixed-methods process evaluation to investigate the feasibility of a trial of the MyComrade intervention based on pre-defined progression criteria. A total of 16 practices will be recruited (eight in ROI; eight in NI), and four practices in each jurisdiction will be randomly allocated to intervention or control. Twenty people living with multimorbidity and prescribed ≥ 10 repeat medications will be recruited from each practice prior to practice randomisation. In intervention practices, the MyComrade intervention will be delivered by pairs of general practitioners (GPs) in ROI, and a GP and practice-based pharmacist (PBP) in NI. The GPs/GP and PBP will schedule the time to review the medications together using a checklist. Usual care will proceed in practices in the control arm. Data will be collected via electronic health records and postal questionnaires at recruitment and 4 and 8 months after randomisation. Qualitative interviews to assess the feasibility and acceptability of the intervention and explore experiences related to multimorbidity management will be conducted with a purposive sample of GPs, PBPs, practice administration staff and patients in intervention and control practices. The feasibility of conducting a health economic evaluation as part of a future definitive trial will be assessed. Discussion The findings of this pilot study will assess the feasibility of a trial of the MyComrade intervention in two different health systems. Evaluation of the progression criteria will guide the decision to progress to a definitive trial and inform trial design. The findings will also contribute to the growing evidence-base related to intervention development and feasibility studies. Trial registration ISRCTN Registry, ISRCTN80017020. Date of confirmation is 4/11/2019. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-01018-y.
Collapse
Affiliation(s)
- Lisa Hynes
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland.
| | - Andrew W Murphy
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland
| | - Nigel Hart
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Collette Kirwan
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland
| | - Sarah Mulligan
- Sligo Medical Academy, National University of Ireland, Galway, Ireland
| | - Claire Leathem
- Northern Ireland Clinical Research Network (Primary Care), Belfast, Northern Ireland
| | - Laura McQuillan
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Marina Maxwell
- Northern Ireland Clinical Research Network (Primary Care), Belfast, Northern Ireland
| | - Emma Carr
- Health Research Board Primary Care Clinical Trials Network Ireland, National University of Ireland, Galway, Ireland
| | - Scott Walkin
- Sligo Medical Academy, National University of Ireland, Galway, Ireland
| | - Caroline McCarthy
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Molly Byrne
- Health Behaviour Change Research Group, School of Psychology, National University of Ireland, Galway, Ireland
| | - Susan M Smith
- HRB Centre for Primary Care Research, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Carmel Hughes
- School of Pharmacy, Queen's University, Belfast, Northern Ireland
| | - Maura Corry
- General Practice Federation, Belfast, Northern Ireland
| | | | | | - Margaret Cupples
- School of Medicine, Dentistry & Biomedical Sciences, Queen's University, Belfast, Northern Ireland
| | - Paddy Gillespie
- J.E. Cairnes School of Business and Economics, National University of Ireland, Galway, Ireland
| | - John Newell
- School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland
| | - Liam Glynn
- School of Medicine, University of Limerick, Limerick, Ireland
| | | | - Carol Sinnott
- THIS Institute, University of Cambridge, Cambridge, UK
| |
Collapse
|
115
|
Wang T, Bendayan R, Msosa Y, Pritchard M, Roberts A, Stewart R, Dobson R. Patient-centric characterization of multimorbidity trajectories in patients with severe mental illnesses: A temporal bipartite network modeling approach. J Biomed Inform 2022; 127:104010. [PMID: 35151869 PMCID: PMC8894882 DOI: 10.1016/j.jbi.2022.104010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 11/30/2021] [Accepted: 01/30/2022] [Indexed: 11/25/2022]
Abstract
Multimorbidity is a major factor contributing to increased mortality among people with severe mental illnesses (SMI). Previous studies either focus on estimating prevalence of a disease in a population without considering relationships between diseases or ignore heterogeneity of individual patients in examining disease progression by looking merely at aggregates across a whole cohort. Here, we present a temporal bipartite network model to jointly represent detailed information on both individual patients and diseases, which allows us to systematically characterize disease trajectories from both patient and disease centric perspectives. We apply this approach to a large set of longitudinal diagnostic records for patients with SMI collected through a data linkage between electronic health records from a large UK mental health hospital and English national hospital administrative database. We find that the resulting diagnosis networks show disassortative mixing by degree, suggesting that patients affected by a small number of diseases tend to suffer from prevalent diseases. Factors that determine the network structures include an individual's age, gender and ethnicity. Our analysis on network evolution further shows that patients and diseases become more interconnected over the illness duration of SMI, which is largely driven by the process that patients with similar attributes tend to suffer from the same conditions. Our analytic approach provides a guide for future patient-centric research on multimorbidity trajectories and contributes to achieving precision medicine.
Collapse
Affiliation(s)
- Tao Wang
- Department of Biostatistics and Health Informatics, King's College London, Denmark Hill, London SE5 8AF, United Kingdom.
| | - Rebecca Bendayan
- Department of Biostatistics and Health Informatics, King's College London, Denmark Hill, London SE5 8AF, United Kingdom; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Yamiko Msosa
- Department of Biostatistics and Health Informatics, King's College London, Denmark Hill, London SE5 8AF, United Kingdom
| | - Megan Pritchard
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Angus Roberts
- Department of Biostatistics and Health Informatics, King's College London, Denmark Hill, London SE5 8AF, United Kingdom; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom
| | - Robert Stewart
- National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Department of Psychological Medicine, King's College London, Denmark Hill, London SE5 8AF, United Kingdom
| | - Richard Dobson
- Department of Biostatistics and Health Informatics, King's College London, Denmark Hill, London SE5 8AF, United Kingdom; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley National Health Service (NHS) Foundation Trust, Denmark Hill, London SE5 8AZ, United Kingdom; Institute of Health Informatics, University College London, Euston Road, London NW1 2DA, United Kingdom; Health Data Research UK London, University College London, Euston Road, London NW1 2DA, United Kingdom
| |
Collapse
|
116
|
Nissen NK, Aarhus R, Ørtenblad L. Dynamics of a specialized and complex health care system: Exploring general practitioners' management of multimorbidity. Chronic Illn 2022; 18:155-168. [PMID: 32498609 DOI: 10.1177/1742395320928403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To explore general practitioners' (GPs') experiences of cooperation with hospital-based physicians regarding multimorbid patients and to identify challenges as well as strategies in managing such challenges.Study setting: Three medical practices in a provincial town in Denmark. STUDY DESIGN A qualitative methodological design was used with explorative data collection among GPs.Data collection/Extraction methods: Participant observation, qualitative interviews and a focus group interview were conducted. Interpretive description was used as the analytical framework.Principal findings: The GPs appreciated cooperating with physicians in optimizing treatment of multimorbid patients. However, three main challenges were experienced: insufficient communication and coordination; unclear divisions of roles and responsibilities; and differences in the way of approaching patients. The GPs navigated these challenges and complexities by taking advantage of their personal relationships and by developing creative and patient-centred ad hoc solutions to difficulties in cross-sectorial cooperation. A hospital initiative to support care for multimorbid patients has not been adopted by the GPs as a preferred strategy. CONCLUSIONS The structures of the health care system severely challenged cooperation regarding multimorbid patients; nevertheless, these GPs were aware of the advantages of cooperation, and their mainstay strategy in this involved personalized solutions and flexibility.
Collapse
Affiliation(s)
| | - Rikke Aarhus
- Diagnostic Centre, Silkeborg Hospital, Silkeborg, Denmark
| | - Lisbeth Ørtenblad
- Public Health and Rehabilitation Research, DEFACTUM, Aarhus, Denmark
| |
Collapse
|
117
|
Fleitas Alfonzo L, King T, You E, Contreras-Suarez D, Zulkelfi S, Singh A. Theoretical explanations for socioeconomic inequalities in multimorbidity: a scoping review. BMJ Open 2022; 12:e055264. [PMID: 35197348 PMCID: PMC8882654 DOI: 10.1136/bmjopen-2021-055264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 01/27/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To document socioepidemiological theories used to explain the relationship between socioeconomic disadvantage and multimorbidity. DESIGN Scoping review. METHODS A search strategy was developed and then applied to multiple electronic databases including Medline, Embase, PsychInfo, Web of Science, Scielo, Applied Social Sciences, ERIC, Humanities Index and Sociological Abstracts. After the selection of studies, data were extracted using a data charting plan. The last search was performed on the 28 September 2021. Extracted data included: study design, country, population subgroups, measures of socioeconomic inequality, assessment of multimorbidity and conclusion on the association between socioeconomic variables and multimorbidity. Included studies were further assessed on their use of theory, type of theories used and context of application. Finally, we conducted a meta-narrative synthesis to summarise the results. RESULTS A total of 64 studies were included in the review. Of these, 33 papers included theories as explanations for the association between socioeconomic position and multimorbidity. Within this group, 16 explicitly stated those theories and five tested at least one theory. Behavioural theories (health behaviours) were the most frequently used, followed by materialist (access to health resources) and psychosocial (stress pathways) theories. Most studies used theories as post hoc explanations for their findings or for study rationale. Supportive evidence was found for the role of material, behavioural and life course theories in explaining the relationship between social inequalities and multimorbidity. CONCLUSION Given the widely reported social inequalities in multimorbidity and its increasing public health burden, there is a critical gap in evidence on pathways from socioeconomic disadvantage to multimorbidity. Generating evidence of these pathways will guide the development of intervention and public policies to prevent multimorbidity among people living in social disadvantage. Material, behavioural and life course pathways can be targeted to reduce the negative effect of low socioeconomic position on multimorbidity.
Collapse
Affiliation(s)
- Ludmila Fleitas Alfonzo
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tania King
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Emily You
- Academic Unit for Psychiatry of Old Age, Department of Psychiatry, The University of Melbourne Faculty of Medicine Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Diana Contreras-Suarez
- Melbourne Institute: Applied Economic and Social Research, University of Melbourne, Melbourne, Victoria, Australia
| | - Syafiqah Zulkelfi
- Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Ankur Singh
- Centre of Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| |
Collapse
|
118
|
Shared decision-making between older people with multimorbidity and GPs: focus group study. Br J Gen Pract 2022; 72:e609-e618. [PMID: 35379603 PMCID: PMC8999685 DOI: 10.3399/bjgp.2021.0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/06/2022] [Indexed: 11/04/2022] Open
Abstract
Background Shared decision making (SDM), utilising the expertise of both patient and clinician, is a key feature of good-quality patient care. Multimorbidity can complicate SDM, yet few studies have explored this dynamic for older patients with multimorbidity in general practice. Aim To explore factors influencing SDM from the perspectives of older patients with multimorbidity and GPs, to inform improvements in personalised care. Design and setting Qualitative study. General practices (rural and urban) in Devon, England. Method Four focus groups: two with patients (aged ≥65 years with multimorbidity) and two with GPs. Data were coded inductively by applying thematic analysis. Results Patient acknowledgement of clinician medicolegal vulnerability in the context of multimorbidity, and their recognition of this as a barrier to SDM, is a new finding. Medicolegal vulnerability was a unifying theme for other reported barriers to SDM. These included expectations for GPs to follow clinical guidelines, challenges encountered in applying guidelines and in communicating clinical uncertainty, and limited clinician self-efficacy for SDM. Increasing consultation duration and improving continuity were viewed as facilitators. Conclusion Clinician perceptions of medicolegal vulnerability are recognised by both patients and GPs as a barrier to SDM and should be addressed to optimise delivery of personalised care. Greater awareness of multimorbidity guidelines is needed. Educating clinicians in the communication of uncertainty should be a core component of SDM training. The incorrect perception that most clinicians already effectively facilitate SDM should be addressed to improve the uptake of personalised care interventions.
Collapse
|
119
|
How do multi-morbidity and polypharmacy affect general practice attendance and referral rates? A retrospective analysis of consultations. PLoS One 2022; 17:e0263258. [PMID: 35113926 PMCID: PMC8812985 DOI: 10.1371/journal.pone.0263258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 01/15/2022] [Indexed: 11/29/2022] Open
Abstract
Background As prevalence of multimorbidity and polypharmacy rise, health care systems must respond to these challenges. Data is needed from general practice regarding the impact of age, number of chronic illnesses and medications on specific metrics of healthcare utilisation. Methods This was a retrospective study of general practices in a university-affiliated education and research network, consisting of 72 practices. Records from a random sample of 100 patients aged 50 years and over who attended each participating practice in the previous two years were analysed. Through manual record searching, data were collected on patient demographics, number of chronic illnesses and medications, numbers of attendances to the general practitioner (GP), practice nurse, home visits and referrals to a hospital doctor. Attendance and referral rates were expressed per person-years for each demographic variable and the ratio of attendance to referral rate was also calculated. Results Of the 72 practices invited to participate, 68 (94%) accepted, providing complete data on a total of 6603 patients’ records and 89,667 consultations with the GP or practice nurse; 50.1% of patients had been referred to hospital in the previous two years. The attendance rate to general practice was 4.94 per person per year and the referral rate to the hospital was 0.6 per person per year, giving a ratio of over eight attendances for every referral. Increasing age, number of chronic illnesses and number of medications were associated with increased attendance rates to the GP and practice nurse and home visits but did not significantly increase the ratio of attendance to referral rate. Discussion As age, morbidity and number of medications rise, so too do all types of consultations in general practice. However, the rate of referral remains relatively stable. General practice must be supported to provide person centred care to an ageing population with rising rates of multi-morbidity and polypharmacy.
Collapse
|
120
|
Goto T, Mori K, Nakayama T, Yamamoto J, Shintani Y, Wakami K, Fukuta H, Seo Y, Ohte N. Multimorbidity, polypharmacy, and mortality in older patients with pacemakers. J Arrhythm 2022; 38:145-154. [PMID: 35222761 PMCID: PMC8851581 DOI: 10.1002/joa3.12660] [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: 08/26/2021] [Revised: 10/31/2021] [Accepted: 11/15/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The prevalence of multimorbidity and polypharmacy and its association with all-cause mortality in older patients with pacemakers are largely unknown. We aimed to clarify the prevalence of multimorbidity and polypharmacy, and its association with all-cause mortality in patients ≥75 years of age with pacemakers. METHODS We retrospectively investigated 256 patients aged ≥75 years (mean age 84.0 ± 5.3 years; 45.7% male) with newly implanted pacemakers. The study endpoint was all-cause mortality ("with events"). Multimorbidity was defined as a Charlson Comorbidity Index ≥3. Polypharmacy was defined as the use of ≥5 medications. RESULTS During the follow-up period (median, 3.1 years), 60 all-cause deaths were reported. The Charlson Comorbidity Index (2.9 ± 1.9 vs. 1.7 ± 1.7, p < .001) and prevalence of multimorbidity (56.7% vs. 26.0%, p < .001) were significantly higher in deceased patients than in survivors. The number of drugs (6.9 ± 3.0 vs. 5.9 ± 3.3, p = .03) and the prevalence of polypharmacy (78.3% vs. 63.8%, p = .04) were significantly higher in patients with events than in those without events. The event-free survival rate was significantly higher among patients without multimorbidity than in those with multimorbidity (log-rank, p < .001), and was also significantly higher among patients without polypharmacy than in those with polypharmacy (log-rank, p < .001). Multimorbidity (hazard ratio [HR]: 3.21; 95% confidence interval [CI]: 1.85-5.58; p < .001) and polypharmacy (HR: 1.97; 95% CI: 1.03-3.77; p = .04) were independent predictors of all-cause mortality. CONCLUSIONS Multimorbidity and its associated polypharmacy, which are common in the older population, are prevalent in patients with pacemakers and are independent predictors of poor prognosis.
Collapse
Affiliation(s)
- Toshihiko Goto
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Kento Mori
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Takafumi Nakayama
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Junki Yamamoto
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Yasuhiro Shintani
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Kazuaki Wakami
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Hidekatsu Fukuta
- Clinical Research Management CenterNagoya City University HospitalNagoyaJapan
| | - Yoshihiro Seo
- Department of CardiologyNagoya City University Graduate School of Medical SciencesNagoyaJapan
| | - Nobuyuki Ohte
- Department of Cardiovascular MedicineNagoya City University East Medical CenterNagoyaJapan
| |
Collapse
|
121
|
Schulze J, Glassen K, Pohontsch NJ, Blozik E, Eißing T, Breckner A, Höflich C, Rakebrandt A, Schäfer I, Szecsenyi J, Scherer M, Lühmann D. Measuring the quality of care for older adults with multimorbidity: Results of the MULTIqual project. THE GERONTOLOGIST 2022; 62:1135-1146. [PMID: 35090014 PMCID: PMC9451020 DOI: 10.1093/geront/gnac013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Objectives Providing health care for older adults with multimorbidity is often complex, challenging, and prone to fragmentation. Although clinical decision making should take into account treatment interactions, individual burden, and resources, current approaches to assessing quality of care mostly rely on indicators for single conditions. The aim of this project was to develop a set of generic quality indicators for the management of patients aged 65 and older with multimorbidity that can be used in both health care research and clinical practice. Research Design and Methods Based on the findings of a systematic literature review and eight focus groups with patients with multimorbidity and their family members, we developed candidate indicators. Identified aspects of quality were mapped to core domains of health care to obtain a guiding framework for quality-of-care assessment. Using nominal group technique, indicators were rated by a multidisciplinary expert panel (n = 23) following standardized criteria. Results We derived 47 candidate quality indicators from the literature and 4 additional indicators from the results of the focus groups. The expert panel selected a set of 25 indicators, which can be assigned to the levels of patient factors, patient–provider communication, and context and organizational structures of the conceptual framework. Discussion and Implications We developed a comprehensive indicator set for the management of multimorbidity that can help to highlight areas with potential for improving the quality of care and support application of multimorbidity guidelines. Furthermore, this study may serve as a blueprint for participatory designs in the development of quality indicators.
Collapse
Affiliation(s)
- Josefine Schulze
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Glassen
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Nadine Janis Pohontsch
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Eva Blozik
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Tabea Eißing
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Charlotte Höflich
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rakebrandt
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingmar Schäfer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dagmar Lühmann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
122
|
Alfano P, Cuttitta G, Audino P, Fazio G, La Grutta S, Marcantonio S, Bucchieri S. Relationship between Multimorbidity and Quality of Life in a Primary Care Setting: The Mediating Role of Dyspnea. J Clin Med 2022; 11:jcm11030656. [PMID: 35160105 PMCID: PMC8837036 DOI: 10.3390/jcm11030656] [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: 12/21/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner’s surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40–88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health “PCS” and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV1/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with (p < 0.001) and without AO (p < 0.001); mMRC and PCS were inversely related in subjects with (p = 0.001) and without AO (p < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient’s global health.
Collapse
Affiliation(s)
- Pietro Alfano
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
- Correspondence:
| | - Giuseppina Cuttitta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
| | - Palma Audino
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
| | - Giovanni Fazio
- Triolo Zanca Clinic, Piazza Fonderia 23, 90133 Palermo, Italy;
| | - Sabina La Grutta
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy;
| | - Salvatore Marcantonio
- Quality, Planning and Strategic Support Area, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy;
| | | | - Salvatore Bucchieri
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
| |
Collapse
|
123
|
Corry DAS, Carter G, Doyle F, McGlade K, O'Halloran P, Wallace E, Brazil K. Lessons from a feasibility study testing an anticipatory care planning intervention for older adults at risk of functional decline: feedback from implementing stakeholders. Pilot Feasibility Stud 2022; 8:10. [PMID: 35045877 PMCID: PMC8767659 DOI: 10.1186/s40814-022-00973-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 01/11/2022] [Indexed: 11/14/2022] Open
Abstract
Background Anticipatory care is becoming increasingly important in effectively managing complex multimorbidity in aging populations, preventing further functional decline, and avoiding hospital admissions. This study aimed to elicit the feedback of participating general practitioners, practice managers, nurses and an adjunct pharmacist on the implementation strengths and limitations of a nurse-led, person-centered anticipatory care planning (ACP) intervention for older people at risk of functional decline in a primary care setting. The findings have implications for a full trial and intervention design. Methods As part of a feasibility cluster randomized controlled trial (cRCT) testing the ACP intervention, we sought feedback from implementing stakeholders: general practitioners (N = 3), practice staff (N = 3), research nurses (N = 5), and adjunct pharmacist (N = 1) in both the Republic of Ireland (ROI) and Northern Ireland (NI), UK. Following written, informed consent, they were interviewed to investigate their experience of participating in the implementation of the ACP intervention as part of the feasibility trial, and elicit any recommendations for a full trial. Using the Consolidated Framework for Implementation Research, thematic analysis was employed to analyze data. The intervention consisted of home visits by specially trained nurses who assessed participants’ health, discussed with them their health goals and plans, and devised an anticipatory care plan following consultation with participants’ General Practitioners and the adjunct clinical pharmacist. Results Participating stakeholders indicated that the strengths of the implementation process included the training provided to the nurses, constructive collaboration of the research team, and structure of implementation process. Perceived limitations included the selection process and screening tool, communication between the research team and the nurses, the assessment questionnaire, and the final document left with the patient, as well as lack of access to medical records for the adjunct pharmacist. Recommendations include better communication and team-wide consensus on alterations to procedure and documents, and standardized protocols for patient selection, data collection, and reporting for research nurses. Conclusions The findings have identified strengths of the implementation process on which to build, and recognized limitations which can now be addressed to ensure improved efficiency and effectiveness in future trials. Trial registration Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s40814-022-00973-w.
Collapse
Affiliation(s)
- Dagmar Anna S Corry
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK. .,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Gillian Carter
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Frank Doyle
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Kieran McGlade
- School of Medicine, Dentistry, and Biomedical Sciences, Queen's University Belfast, Dunluce Health Centre, Belfast, Northern Ireland, UK
| | - Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Emma Wallace
- Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland.,Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Kevin Brazil
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK. .,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| |
Collapse
|
124
|
Aoki T, Fujinuma Y, Matsushima M. Associations of primary care structures with polypharmacy and patient-reported indicators in patients with complex multimorbidity: a multicentre cross-sectional study in Japan. BMJ Open 2022; 12:e054348. [PMID: 34996796 PMCID: PMC8744111 DOI: 10.1136/bmjopen-2021-054348] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
OBJECTIVES Evidence supporting the effects of primary care structures on the quality of care for patients with complex multimorbidity, which is one of the most important challenges facing primary care, is scarce internationally. This study aimed to examine the associations of the types of primary care facilities with polypharmacy and patient-reported indicators in patients with complex multimorbidity, with a focus on differences between community clinics and hospitals. DESIGN Multicentre cross-sectional study. SETTING A total of 25 primary care facilities (19 community clinics and 6 small- and medium-sized hospitals). PARTICIPANTS Adult outpatients with complex multimorbidity, which was defined as the co-occurrence of three or more chronic conditions affecting three or more different body systems within one person. PRIMARY OUTCOME MEASURE Polypharmacy, the Patient-Reported Experience Measure using the Japanese version of Primary Care Assessment Tool Short Form (JPCAT-SF) and the Patient-Reported Outcome Measure using self-rated health status (SRH). RESULTS Data were analysed for 492 patients with complex multimorbidity. After adjustment for possible confounders and clustering within facilities, clinic-based primary care practices were significantly associated with a lower prevalence of polypharmacy, higher JPCAT-SF scores in coordination and community orientation, and a lower prevalence of poor or fair SRH compared with hospital-based primary care practices. In contrast, the JPCAT-SF score in first contact was significantly lower in clinic-based practices. The associations between the types of primary care facilities and JPCAT-SF scores in longitudinality and comprehensiveness were not statistically significant. CONCLUSIONS Clinic-based primary care practices were associated with a lower prevalence of polypharmacy, better patient experience of coordination and community orientation, and better SRH in patients with complex multimorbidity compared with hospital-based primary care practices. In the primary care setting, small and tight teams may improve the quality of care for patients with complex multimorbidity.
Collapse
Affiliation(s)
- Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuki Fujinuma
- Centre for Family Medicine Development, Japanese Health and Welfare Co-operative Federation, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Tokyo, Japan
| |
Collapse
|
125
|
Peurois M, Chopin M, Texier-Legendre G, Angoulvant C, Bellanger W, Bègue C, Ramond-Roquin A. To which non-physician health professionals do French general practitioners refer their patients to and what factors are associated with these referrals? Secondary analysis of the French national cross-sectional ECOGEN study. BMC Health Serv Res 2022; 22:25. [PMID: 34983505 PMCID: PMC8729109 DOI: 10.1186/s12913-021-07285-4] [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: 06/25/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background Multiprofessional practice is a key component in primary care. Examining general practitioner (GP) referral frequency to non-physician health professionals (NPHP) can provide information about how primary care is organised and works which is useful for policymakers. Our study aimed to describe French GP referral frequency to various NPHPs in France and identify associated factors. Methods This is an ancillary study to the observational, cross-sectional (ECOGEN) study conducted in 2011/2012 in France among 128 GPs. Data about consultations using the standardised International Classification of Primary Care (ICPC-2), and patient and GP characteristics were collected from 20,613 GP consultations. Referrals were identified through inductive and deductive approaches using ICPC-2 codes, keywords, and deep, open manual searches. Referral frequency was described overall and per NPHP. Patient, GP, and consultation-related factors associated with referral rates were described for the three most frequently identified NPHPs. To minimise potential sources of bias, this observational study followed the STROBE guidelines. Results French GPs referred 6.8% of patients to NPHPs, with physiotherapists, podiatrists, and nurses accounting for 85.2% of referrals. Older patients, retired patients, multiple health problems managed, and longer consultation durations were found to be associated with higher referral rates (p < 0.001). Specific trends were observed for nurse, physiotherapist, and podiatrist referrals. Women (p < 0.001) and regular patients (p = 0.002) were more likely to receive physiotherapy referrals while people with no professional activity were less likely (p < 0.001). Female GPs and those working in urban practices were more likely to issue a physiotherapy referral (p < 0.001), while GPs working in rural practices (p < 0.001) and those with higher annual consultation numbers (p = 0.002) were more likely to refer to a nurse. Working in multiprofessional centres appeared to have little impact on referral rates, being only slightly associated with podiatrist referrals (p = 0.003). Conclusions Referral frequency is more associated with patient characteristics and clinical situations than GP-related factors suggesting patients needing referral most are most often referred. Furthermore, the three NPHPs that GPs refer to the most are those for which a referral is required for reimbursement in France, suggesting that health system legislation and NPHP reimbursement are strong determinants for referrals.
Collapse
Affiliation(s)
- Matthieu Peurois
- Département de médecine générale, Univ Angers, F-49000, Angers, France
| | - Matthieu Chopin
- Département de médecine générale, Univ Angers, F-49000, Angers, France
| | | | - Cécile Angoulvant
- Département de médecine générale, Univ Angers, F-49000, Angers, France
| | - William Bellanger
- Département de médecine générale, Univ Angers, F-49000, Angers, France
| | - Cyril Bègue
- Département de médecine générale, Univ Angers, F-49000, Angers, France.,Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, SFR ICAT, F-49000, Angers, France
| | - Aline Ramond-Roquin
- Département de médecine générale, Univ Angers, F-49000, Angers, France. .,Univ Angers, Univ Rennes, EHESP, Inserm, IRSET-ESTER, SFR ICAT, F-49000, Angers, France. .,Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Québec, Canada.
| |
Collapse
|
126
|
Gurgel do Amaral MS, Reijneveld SA, Meems LMG, Almansa J, Navis GJ, de Winter AF. Multimorbidity prevalence and patterns and their associations with health literacy among chronic kidney disease patients. J Nephrol 2022; 35:1709-1719. [PMID: 34985613 PMCID: PMC9300533 DOI: 10.1007/s40620-021-01229-1] [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: 10/21/2021] [Accepted: 12/09/2021] [Indexed: 11/05/2022]
Abstract
Background Health literacy is the ability to deal with information related to one’s health. Patients with low health literacy have poor disease-management skills for chronic diseases, such as chronic kidney disease (CKD). This could influence the number and combination of their diseases. Methods We included adult patients with CKD stages 1–5 from the Lifelines Study (n = 2,742). We assessed the association between low health literacy and the number and patterns of comorbidities, considering them globally and stratified by age and sex, using multinomial logistic regression and latent class analysis, respectively. Results Low health literacy was associated with a higher number of comorbidities in the crude models, and after adjustment for age, sex, eGFR, smoking, and BMI. In the crude model, the OR for low health literacy increased from 1.71 (1.25–2.33) for two comorbidities to 2.71 (2.00–3.68) for four comorbidities. In the fully-adjusted model, the associations remained significant with a maximum OR of 1.70 (1.16–2.49) for four comorbidities. The patterns of multimorbidity were similar for low and adequate health literacy, overall and by sex, bur tended to be different for patients older than 65. Older patients with low health literacy had higher comorbidity prevalence and a relatively greater share of cardiovascular, psychiatric, and central nervous system diseases. Conclusions Among CKD patients, low health literacy is associated with more multimorbidity. Health literacy is not associated with patterns of multimorbidity in younger patients, but a difference was observed in older ones. Improving low health literacy could be an intervention efficient also in decreasing multimorbidity in CKD patients. Graphical abstract ![]()
Supplementary Information The online version contains supplementary material available at 10.1007/s40620-021-01229-1.
Collapse
Affiliation(s)
- M S Gurgel do Amaral
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, room 617, 9713GZ, Groningen, The Netherlands.
| | - S A Reijneveld
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, room 617, 9713GZ, Groningen, The Netherlands
| | - L M G Meems
- Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - J Almansa
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, room 617, 9713GZ, Groningen, The Netherlands
| | - G J Navis
- Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - A F de Winter
- Department of Health Sciences, Community and Occupational Medicine, University of Groningen, University Medical Center Groningen, Hanzeplein 1, Building 3217, room 617, 9713GZ, Groningen, The Netherlands
| |
Collapse
|
127
|
A cluster analysis of device-measured physical activity behaviours and the association with chronic conditions, multi-morbidity and healthcare utilisation in adults aged 45 years and older. Prev Med Rep 2022; 24:101641. [PMID: 34976692 PMCID: PMC8684033 DOI: 10.1016/j.pmedr.2021.101641] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Revised: 10/06/2021] [Accepted: 11/13/2021] [Indexed: 02/06/2023] Open
Abstract
Most adults do not meet physical activity guidelines with negative implications for health. The aim of this study was to profile adults using multiple physical activity behaviours and to investigate associations with chronic conditions, multi-morbidity and healthcare utilisation. The study used data generated from a sample of adults aged 45 years and older (N = 485), recruited to the Move for Life randomised control trial. Participants wore an accelerometer for eight consecutive days. Hierarchical cluster analysis was conducted using the variables: moderate to vigorous intensity physical activity, light intensity physical activity, step count, waking sedentary time, standing time and bed hours. Descriptive statistics were used to investigate associations with self-reported number of chronic illnesses, multi-morbidity and healthcare utilisation. Four distinct physical activity behaviour profiles were identified: inactive-sedentary (n = 50, 10.3%), low activity (n = 295, 60.8%), active (n = 111, 22.9%) and very active (n = 29, 6%). The inactive-sedentary cluster had the highest prevalence of chronic illnesses, in particular, mental illness (p = 0.006) and chronic lung disease (p = 0.032), as well as multi-morbidity, complex multi-morbidity and healthcare utilisation. The prevalence of any practice nurse visit (p = 0.033), outpatient attendances (p = 0.04) and hospital admission (p = 0.034) were higher in less active clusters. The results have provided an insight into how physical activity behaviour is associated with chronic illness and healthcare utilisation. A group within the group has been identified that is more likely to be unwell. Provisions need to be made to reduce barriers for participation in physical activity for adults with complex multi-morbidity and very low physical activity.
Collapse
|
128
|
Voloshyna L, Voloshyn O, Senyuk B, Buzdugan I. SPICES: MODERN VIEWS ON THE APPLICATION THROUGH THE PRISM OF POLY- AND COMORBIDITY OF PATIENTS AND INFECTIOUS PANDEMICS (LITERATURE REVIEW AND DISCUSSION). WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2293-2298. [PMID: 36378711 DOI: 10.36740/wlek202209220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The aim: To substantiate the need of wider use of species in dietician rehabilitation of patients with poly- and comorbidity, postcovid syndrome based on the analysis of the latest scientific achievements with the study of their pharmacological properties. PATIENTS AND METHODS Materials and methods: The information search in printed and electronic editions, search scientific bases with application of methods of the analysis, comparison and generalization of information data is carried out. CONCLUSION Conclusions: New scientific data on the pharmacological properties of spices give grounds to use them more widely in the rehabilitation of patients with poly- and comorbidities and infectious processes.
Collapse
Affiliation(s)
| | | | - Bogdana Senyuk
- BUKOVINIAN STATE MEDICAL UNIVERSITY, CHERNIVTSI, UKRAINE
| | - Inna Buzdugan
- BUKOVINIAN STATE MEDICAL UNIVERSITY, CHERNIVTSI, UKRAINE
| |
Collapse
|
129
|
Nicolaus S, Crelier B, Donzé JD, Aubert CE. Definition of patient complexity in adults: A narrative review. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221081288. [PMID: 35586038 PMCID: PMC9106317 DOI: 10.1177/26335565221081288] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 01/31/2022] [Indexed: 11/17/2022]
Abstract
Background Better identification of complex patients could help to improve their care. However, the definition of patient complexity itself is far from obvious. We conducted a narrative review to identify, describe, and synthesize the definitions of patient complexity used in the last 25 years. Methods We searched PubMed for articles published in English between January 1995 and September 2020, defining patient complexity. We extended the search to the references of the included articles. We assessed the domains presented in the definitions, and classified the definitions as based on (1) medical aspects (e.g., number of conditions) or (2) medical and/or non-medical aspects (e.g., socio-economic status). We assessed whether the definition was based on a tool (e.g., index) or conceptual model. Results Among 83 articles, there was marked heterogeneity in the patient complexity definitions. Domains contributing to complexity included health, demographics, behavior, socio-economic factors, healthcare system, medical decision-making, and environment. Patient complexity was defined according to medical aspects in 30 (36.1%) articles, and to medical and/or non-medical aspects in 53 (63.9%) articles. A tool was used in 36 (43.4%) articles, and a conceptual model in seven (8.4%) articles. Conclusion A consensus concerning the definition of patient complexity was lacking. Most definitions incorporated non-medical factors in the definition, underlining the importance of accounting not only for medical but also for non-medical aspects, as well as for their interrelationship.
Collapse
Affiliation(s)
- Stefanie Nicolaus
- Department of General Internal Medicine, Biel Hospital, Biel, Switzerland
| | - Baptiste Crelier
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland
| | - Jacques D Donzé
- Department of Medicine, Neuchâtel Hospital Network, Neuchâtel, Switzerland
- Division of General Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
- Division of Internal Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Carole E Aubert
- Department of General Internal Medicine, Bern University Hospital, Inselspital, University of Bern, Inselspital, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
- Center for Clinical Management Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI, USA
- Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI, USA
| |
Collapse
|
130
|
Dai D, Sharma A, Alvarez PJ, Woods SD. Multiple comorbid conditions and healthcare resource utilization among adult patients with hyperkalemia: A retrospective observational cohort study using association rule mining. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221098832. [PMID: 35586031 PMCID: PMC9112318 DOI: 10.1177/26335565221098832] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 04/19/2022] [Indexed: 12/21/2022]
Abstract
Objectives To estimate the prevalence of specific comorbid conditions (CCs) and multiple comorbid conditions (MCCs) among adult patients with hyperkalemia and examine the associations between MCCs and healthcare resource utilization (HRU) and costs. Methods This retrospective observational cohort study was conducted using a large administrative claims database. We identified patients with hyperkalemia (ICD-10-CM: E87.5; or serum potassium >5.0 mEq/L; or NDC codes for either patiromer or sodium polystyrene sulfonate) during the study period (1/1/2016–6/30/2019). The earliest service/claim date with evidence of hyperkalemia was identified as index date. Qualified patients had ≥12 months of enrolment before and after index date, ≥18 years of age. Comorbid conditions were assessed using all data within 12 months prior to the index date. Healthcare resource utilization and costs were estimated using all data within 12 months after the index date. Association rule mining was applied to identify MCCs. Generalized linear models were used to examine the associations between MCCs and HRU and costs. Results Of 22,154 patients with hyperkalemia, 94% had ≥3 CCs. The most common individual CCs were chronic kidney disease (CKD, 85%), hypertension (HTN, 83%), hyperlipidemia (HLD, 81%), and diabetes mellitus (DM, 47%). The most common dyad combination of CCs was CKD+HTN (71%). The most common triad combination was CKD+HTN+HLD (62%). The most common quartet combination was CKD+HTN+HLD+DM (36%). The increased number of CCs were significantly associated with increased ED visits, length of hospital stays, and total healthcare costs (all p-value < 0.0001). Conclusions MCCs are very prevalent among patients with hyperkalemia and are strongly associated with HRU and costs.
Collapse
Affiliation(s)
- Dingwei Dai
- CVS Health Clinical Trial Services LLC, Woonsocket, RI, USA
| | - Ajay Sharma
- CVS Health Clinical Trial Services LLC, Woonsocket, RI, USA
| | - Paula J Alvarez
- Managed Care Health Outcomes, Vifor Pharma Inc., Redwood City, CA, USA
| | - Steven D Woods
- Managed Care Health Outcomes, Vifor Pharma Inc., Redwood City, CA, USA
| |
Collapse
|
131
|
Lopes Lima M, Bordin D, Fernandes Furquim RC, Andreani Cabral LP, Muller EV, Berger Fadel C. Caminho na rede formal de cuidado em saúde de pacientes pós-alta hospitalar segundo multimorbidade. REVISTA CUIDARTE 2022. [DOI: 10.15649/cuidarte.1279] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Introdução: A gestão de informações associadas à multimorbidade na atenção hospitalar é relevante para o planejamento de estratégias de prevenção de agravos à saúde em pacientes de maior risco, a fim de oportunizar a organização de sistemas de saúde de modo eficiente. Objetivo: O presente trabalho objetivoudelinear o caminho formal percorrido por pacientes com e sem multimorbidade, considerando o uso da rede pública de saúde após a internação hospitalar. Materiais e métodos: Realizou-se um estudo quantitativo, transversal, descritivo, utilizando dados primários de 445 pacientes internados em um hospital universitário, no ano de 2018. Os dados foram coletados através de análise do prontuário médico e entrevista telefônica. Os resultados foram analisados por meio de frequência absoluta e relativa. Resultados: Desenvolveu-se um fluxograma, representando os pontos da rede de saúde utilizados pelo paciente após a alta hospitalar, segundo multimorbidade. Verificou-se uma alta prevalência de encaminhamento (com multimorbidade (CM) 93,52%; sem multimorbidade (SM) 97,71%) e comparecimento na atenção secundária à saúde (CM 86,15%; SM 89,63%), um baixo encaminhamento (CM 42,45%; SM 36,27%) e comparecimento na atenção primária à saúde (CM 61,29%; SM 64,81%), e considerando os 3 níveis de atenção juntos, houve um baixo comparecimento (CM 17,98%; SM 21,89%) para ambos os grupos investigados. Discussão: Entende-se que a semelhança de comparecimento em todos os pontos da rede por ambos os grupos é um problema, por tratar de forma igual populações desiguais e consequentemente com necessidades diversas. Conclusões: Sinaliza-se a importância de maior incentivo ao acompanhamento de pacientes com multimorbidade na rede primária de saúde, especialmente no período de pós-alta hospitalar, e a necessidade de fortalecimento da Rede de Atenção à Saúde.
Collapse
|
132
|
Impact of COVID-19 on individuals with multimorbidity in primary care. Br J Gen Pract 2021; 72:38-39. [PMID: 34972805 PMCID: PMC8714529 DOI: 10.3399/bjgp22x718229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
|
133
|
Ekstedt M, Kirsebom M, Lindqvist G, Kneck Å, Frykholm O, Flink M, Wannheden C. Design and Development of an eHealth Service for Collaborative Self-Management among Older Adults with Chronic Diseases: A Theory-Driven User-Centered Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:ijerph19010391. [PMID: 35010652 PMCID: PMC8744716 DOI: 10.3390/ijerph19010391] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Revised: 12/23/2021] [Accepted: 12/28/2021] [Indexed: 05/07/2023]
Abstract
The increasing prevalence of chronic conditions and multimorbidity poses great challenges to healthcare systems. As patients' engagement in self-managing their chronic conditions becomes increasingly important, eHealth interventions are a promising resource for the provision of adequate and timely support. However, there is inconclusive evidence about how to design eHealth services to meet the complex needs of patients. This study applied an evidence-based and theory-informed user-centered design approach in three phases to identify the needs of older adults and healthcare professionals in the collaborative management of multimorbidity (phase 1), develop an eHealth service to address these needs (phase 2), and test the feasibility and acceptance of the eHealth service in a clinical setting (phase 3). Twenty-two user needs were identified and a web-based application-ePATH (electronic Patient Activation in Treatment at Home)-with separate user interfaces for patients and healthcare professionals was developed. The feasibility study with two nurses and five patients led to a redesign and highlighted the importance of adequately addressing not only varying user needs but also the complex nature of healthcare organizations when implementing new services and processes in chronic care management.
Collapse
Affiliation(s)
- Mirjam Ekstedt
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 391 82 Kalmar, Sweden
- Correspondence: (M.E.); (C.W.); Tel.: +46-(0)480-44-63-99 (M.E.); +46-(0)8-524-839-34 (C.W.)
| | - Marie Kirsebom
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden; (M.K.); (G.L.)
| | - Gunilla Lindqvist
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 351 95 Växjö, Sweden; (M.K.); (G.L.)
| | - Åsa Kneck
- Department of Health Care Sciences, Ersta Sköndal Bräcke University College, Stigbergsgatan 30, Box 111 89, 100 61 Stockholm, Sweden;
| | - Oscar Frykholm
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, 141 83 Stockholm, Sweden;
- Women’s Health and Allied Health Professionals Theme, Karolinska University Hospital, 141 86 Stockholm, Sweden
| | - Carolina Wannheden
- Department Learning, Informatics, Management and Ethics, Medical Management Centre, Karolinska Institutet, 171 77 Stockholm, Sweden;
- Correspondence: (M.E.); (C.W.); Tel.: +46-(0)480-44-63-99 (M.E.); +46-(0)8-524-839-34 (C.W.)
| |
Collapse
|
134
|
Feng X, Kelly M, Sarma H. The association between educational level and multimorbidity among adults in Southeast Asia: A systematic review. PLoS One 2021; 16:e0261584. [PMID: 34929020 PMCID: PMC8687566 DOI: 10.1371/journal.pone.0261584] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/03/2021] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In Southeast Asia, the prevalence of multimorbidity is gradually increasing. This paper aimed to investigate the association between educational level and multimorbidity among over 15-years old adults in Southeast Asia. METHODS We conducted a systematic review of published observational studies. Studies were selected according to eligibility criteria of addressing definition and prevalence of multimorbidity and associations between level of education and multimorbidity in Southeast Asia. The Newcastle-Ottawa Scale (NOS) was used to measure the quality and risk of bias. The methodology has been published in PROSPERO with registered number ID: CRD42021259311. RESULTS Eighteen studies were included in the data synthesis. The results are presented using narrative synthesis due to the heterogeneity of differences in exposures, outcomes, and methodology. The prevalence of multimorbidity ranged from 1.7% to 72.6% among over 18 years-old adults and from 1.5% to 51.5% among older people (≥ 60 years). There were three association patterns linking between multimorbidity and education in these studies: (1) higher education reducing odds of multimorbidity, (2) higher education increasing odds of multimorbidity and (3) education having no association with multimorbidity. The association between educational attainment and multimorbidity also varies widely across countries. In Singapore, three cross-sectional studies showed that education had no association with multimorbidity among adults. However, in Indonesia, four cross-sectional studies found higher educated persons to have higher odds of multimorbidity among over 40-years-old persons. CONCLUSIONS Published studies have shown inconsistent associations between education and multimorbidity because of different national contexts and the lack of relevant research in the region concerned. Enhancing objective data collection such as physical examinations would be necessary for studies of the connection between multimorbidity and education. It can be hypothesised that more empirical research would reveal that a sound educational system can help people prevent multimorbidity.
Collapse
Affiliation(s)
- Xiyu Feng
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Matthew Kelly
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Haribondhu Sarma
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
| |
Collapse
|
135
|
Cilluffo S, Bassola B, Pucciarelli G, Vellone E, Lusignani M. Mutuality in nursing: A conceptual framework on the relationship between patient and nurse. J Adv Nurs 2021; 78:1718-1730. [PMID: 34873740 DOI: 10.1111/jan.15129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/12/2021] [Accepted: 11/27/2021] [Indexed: 11/27/2022]
Abstract
AIMS To describe and develop a conceptual framework for the process of mutuality between nurse and patient. DESIGN This was a qualitative study with a grounded theory (GT) design following the constructivist approach of Charmaz (SAGE handbook of research, 2014). METHODS A sample of 33 patients with one or more chronic diseases and 35 nurses were interviewed between July and October 2020. Comparative and simultaneous data analyses were conducted. Theoretical sampling and saturation of categories were used to define the sample size. RESULTS A conceptual framework for mutuality between nurse (mean age 42 SD ±7 years, 89% female) and patient (mean age 63 SD ±8 years, 42% female) was developed, including the mutuality process, potential influencing factors for both nurses and patients, and outcomes. The mutuality process was characterised by three dimensions: developing and going beyond, being a reference, and deciding and sharing care. Influencing factors for nurses were personal characteristics and professional organisation, while for patients these were age and past experiences. Nurse outcomes were satisfaction and quality of life; patient outcomes were improved self-care and reduction of hospitalisation and emergency admissions. CONCLUSION This study described a new conceptual framework for mutuality between nurse and patient, which could improve our understanding of the relationship between nurses and patients, thus enhancing both nurse and patient outcomes.
Collapse
Affiliation(s)
- Silvia Cilluffo
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy.,School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Barbara Bassola
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy
| | - Gianluca Pucciarelli
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Ercole Vellone
- Department of Biomedicine and Prevention, University of Rome "Tor Vergata", Rome, Italy
| | - Maura Lusignani
- School of Nursing, Niguarda Hospital, University of Milan, Milan, Italy.,Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| |
Collapse
|
136
|
Breckner A, Roth C, Glassen K, Wensing M. Self-management perspectives of elderly patients with multimorbidity and practitioners - status, challenges and further support needed? BMC FAMILY PRACTICE 2021; 22:238. [PMID: 34836506 PMCID: PMC8624621 DOI: 10.1186/s12875-021-01584-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022]
Abstract
Background Patients with multimorbidity (here defined as three or more chronic conditions) require constant treatment and care. Furthermore, they have to manage their health and diseases in daily life. Offering support to patients’ medical self-management is an important task of primary care. The aim of this study was to explore, what further support is needed from the perspective of patients’ and primary care practitioners. Methods A qualitative study using individual semi-structed interviews with 17 patients with multimorbidity and 7 practitioners (4 primary care physicians and 3 practice assistants) was conducted in Germany. Data were audio-recorded, pseudonymised and transcribed verbatim. Data analysis was performed using qualitative content analysis to structure data into themes and subthemes. All data were managed and organised in MAXQDA. Results The three broad themes: current status, challenges and further support emerged. Patients reported on unfulfilled needs regarding role or emotional management, like coping with loneliness, loss of independence and, changing habits. The importance of social contact was highlighted by patients and practitioners. Patients articulated further support from their primary care practitioners on coping with the disease. Practitioners’ wished for further support in aspects of social participation, public transport, and community resources. Conclusion Challenges regarding self-management of elderly patients with multimorbidity may be addressed by harnessing social support and community initiatives.
Collapse
Affiliation(s)
- Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katharina Glassen
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| |
Collapse
|
137
|
Fortin M, Stewart M, Almirall J, Berbiche D, Bélanger M, Katz A, Ryan BL, Wong ST, Zwarenstein M. One year follow-up and exploratory analysis of a patient-centered interdisciplinary care intervention for multimorbidity. JOURNAL OF COMORBIDITY 2021; 11:26335565211039780. [PMID: 34820337 PMCID: PMC8606917 DOI: 10.1177/26335565211039780] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 07/16/2021] [Accepted: 07/28/2021] [Indexed: 11/16/2022]
Abstract
Context Interventions for people with multimorbidity have obtained mixed results. We aimed to document the long-term effect of an intervention for people with multimorbidity. Methods 284 patients (18-80 years) presenting three or more chronic conditions were recruited from seven family medicine groups in the Saguenay-Lac St-Jean region, Quebec, Canada. The patient-centered intervention was based on motivational approach and self-management support. Outcomes were evaluated in a one-year pre-post study design with questionnaires that included the Health Education Questionnaire (heiQ), the Self-Efficacy for Managing Chronic Diseases, the Veteran RAND-12 Health Survey (VR-12), the EuroQoL 5-Domains questionnaire, the Kessler six item Psychological Stress Scale, and measures of smoking habit, physical activity, healthy eating and alcohol consumption. Subgroup analyses by age, number of conditions, sex, and income were also conducted. Results The heiQ domain of emotional wellbeing improved significantly. Improvement was also observed for the VR-12 and the K6. Among the health behaviours, only healthy eating was improved. Subgroup analyses in this exploratory study suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviours. Conclusion One year after the intervention, participants significantly improved a variety of outcomes. Subgroup analyses suggest that younger patients, those with lower number of chronic conditions or higher incomes may respond better in relation to self-management, health status and health behaviours. This suggests that future interventions should be tailored to patients' characteristics including age, sex, income and number of conditions.
Collapse
Affiliation(s)
| | | | | | | | | | - Alan Katz
- University of Manitoba, Winnipeg, MB, Canada
| | | | | | | |
Collapse
|
138
|
Shi X, Lima SMDS, Mota CMDM, Lu Y, Stafford RS, Pereira CV. Prevalence of Multimorbidity of Chronic Noncommunicable Diseases in Brazil: Population-Based Study. JMIR Public Health Surveill 2021; 7:e29693. [PMID: 34842558 PMCID: PMC8663437 DOI: 10.2196/29693] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 07/29/2021] [Accepted: 08/05/2021] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Multimorbidity is the co-occurrence of two or more chronic diseases. OBJECTIVE This study, based on self-reported medical diagnosis, aims to investigate the dynamic distribution of multimorbidity across sociodemographic levels and its impacts on health-related issues over 15 years in Brazil using national data. METHODS Data were analyzed using descriptive statistics, hypothesis tests, and logistic regression. The study sample comprised 679,572 adults (18-59 years of age) and 115,699 elderly people (≥60 years of age) from the two latest cross-sectional, multiple-cohort, national-based studies: the National Sample Household Survey (PNAD) of 1998, 2003, and 2008, and the Brazilian National Health Survey (PNS) of 2013. RESULTS Overall, the risk of multimorbidity in adults was 1.7 times higher in women (odds ratio [OR] 1.73, 95% CI 1.67-1.79) and 1.3 times higher among people without education (OR 1.34, 95% CI 1.28-1.41). Multiple chronic diseases considerably increased with age in Brazil, and people between 50 and 59 years old were about 12 times more likely to have multimorbidity than adults between 18 and 29 years of age (OR 11.89, 95% CI 11.27-12.55). Seniors with multimorbidity had more than twice the likelihood of receiving health assistance in community services or clinics (OR 2.16, 95% CI 2.02-2.31) and of being hospitalized (OR 2.37, 95% CI 2.21-2.56). The subjective well-being of adults with multimorbidity was often worse than people without multiple chronic diseases (OR=12.85, 95% CI: 12.07-13.68). These patterns were similar across all 4 cohorts analyzed and were relatively stable over 15 years. CONCLUSIONS Our study shows little variation in the prevalence of the multimorbidity of chronic diseases in Brazil over time, but there are differences in the prevalence of multimorbidity across different social groups. It is hoped that the analysis of multimorbidity from the two latest Brazil national surveys will support policy making on epidemic prevention and management.
Collapse
Affiliation(s)
- Xin Shi
- School of Maths and Information Science, Shandong Technology and Business University, Yantai, China.,Business School, Manchester Metropolitan University, Manchester, United Kingdom
| | | | | | - Ying Lu
- Department of Biomedical Data Science, School of Medicine, Stanford University, Stanford, CA, United States
| | - Randall S Stafford
- Department of Medicine, School of Medicine, Stanford University, Stanford, CA, United States
| | | |
Collapse
|
139
|
Graupensperger S, Sweet SN, Evans MB. Multimorbidity of overweight and obesity alongside anxiety and depressive disorders in individuals with spinal cord injury. J Spinal Cord Med 2021; 44:992-1000. [PMID: 30183556 PMCID: PMC8725715 DOI: 10.1080/10790268.2018.1507801] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To compare the prevalence of anxiety/depression and overweight/obesity (Aim 1) and the multimorbidity of these conditions (Aim 2) in a sample of adults with and without spinal cord injury (SCI). Aim 3 was to examine whether overweight/obese individuals with SCI differ on the prevalence of anxiety/depressive disorders compared to non-overweight/obese individuals with SCI. DESIGN Retrospective cohort study. PARTICIPANTS Individuals ≥16 years old who had patient encounters between January 1, 2011, and February 28, 2018. In total, 761 598 individuals were included, of which 3136 had SCI. MAIN OUTCOME MEASURES Individuals were identified as diagnosed with SCI, anxiety and/or depressive disorders, and overweight/obesity using the International Classification of Diseases. RESULTS Age-adjusted odds ratios (ORs) were calculated using logistic regression. In contrast to non-SCI individuals, those with SCI had increased odds of anxiety disorders (OR: 3.58, 95% CI [3.29-3.90]), depressive disorders (OR: 4.33, 95% CI [3.95-4.74]), and overweight/obesity (OR: 3.08, 95% CI [2.80-3.38]). Pertaining to multimorbidity, individuals with SCI had increased odds of having overweight/obesity alongside anxiety disorders (OR: 4.30, 95% CI [3.71-4.98]) and overweight/obesity alongside depressive disorders (OR: 4.69, 95% CI [4.01-5.47]) compared to those without SCI. Individuals with SCI who were diagnosed as overweight/obese had increased odds of having anxiety disorders (OR: 2.54, 95% CI [2.06-3.13]), and depressive disorders (OR: 2.70, 95% CI [2.18-3.36]), relative to non-overweight/obese individuals with SCI. CONCLUSIONS This work is among the first to find evidence that individuals with SCI are at heightened odds of overweight/obesity alongside anxiety and/or depressive disorders. This early work holds clinical implications for treating these interrelated comorbidities in SCI.
Collapse
Affiliation(s)
- Scott Graupensperger
- Department of Kinesiology, Pennsylvania State University, State College, Pennsylvania, USA
| | - Shane N. Sweet
- Department of Kinesiology & Physical Education, McGill University, Montreal, Quebec, Canada
| | - M. Blair Evans
- Department of Kinesiology, Pennsylvania State University, State College, Pennsylvania, USA
| |
Collapse
|
140
|
Paukkonen L, Oikarinen A, Kähkönen O, Kyngäs H. Adherence to self-management in patients with multimorbidity and associated factors: A cross-sectional study in primary health care. J Clin Nurs 2021; 31:2805-2820. [PMID: 34704303 DOI: 10.1111/jocn.16099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 08/03/2021] [Accepted: 10/11/2021] [Indexed: 11/29/2022]
Abstract
AIM The aim of the study was to explore the adherence to self-management of patients with multimorbidity, identify associated factors, and determine explanatory factors of their adherence to self-management in terms of the Theory of Adherence of People with Chronic Disease. BACKGROUND Adherence to self-management is essential for successful care of multimorbid patients, but multimorbidity poses challenges for both patients and practitioners due to its care complexity and broad impact on patients' lives. DESIGN A cross-sectional, descriptive exploratory design with the STROBE reporting checklist was applied. METHODS Adult multimorbid patients who attended primary healthcare consultations in Finland were surveyed using self-administered questionnaires with several instruments including the Adherence of People with Chronic Disease Instrument, Kasari's FIT Index, and Alcohol Use Disorders Identification test. Responses of 124 patients were analysed using descriptive statistics, Spearman correlations, binary logistic regression analysis, and Chi-squared, or corresponding, tests. RESULTS Most patients' responses indicated good or adequate adherence to care regimens and medications. However, adherence to self-management for a healthy lifestyle was more frequently inadequate. Adherence was significantly associated with several patient-related factors, including demographic and health-related factors, perceived adequacy of loved ones, and patient activation. Significant explanatory factors for adherence included energy and willpower, motivation, results of care, sense of normality, fear of complications and additional diseases, and support from nurses, from physicians, and from family and friends. Various factors were relevant for specific aspects of self-management. CONCLUSIONS Multimorbid patients' adherence to self-management is not an 'all or none phenomenon, but a multifaceted process with numerous associated and explanatory factors. RELEVANCE TO CLINICAL PRACTICE The findings highlight needs for an individualised whole-person approach in multimorbid patients' care to provide the required support for good adherence to self-management. Healthcare professionals, especially nurses working in primary health care, are well-positioned to meet this need.
Collapse
Affiliation(s)
- Leila Paukkonen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
| |
Collapse
|
141
|
Faruqui SHA, Alaeddini A, Wang J, Jaramillo CA, Pugh MJ. A Functional Model for Structure Learning and Parameter Estimation in Continuous Time Bayesian Network: An Application in Identifying Patterns of Multiple Chronic Conditions. IEEE ACCESS : PRACTICAL INNOVATIONS, OPEN SOLUTIONS 2021; 9:148076-148089. [PMID: 35371895 PMCID: PMC8975131 DOI: 10.1109/access.2021.3122912] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Bayesian networks are powerful statistical models to study the probabilistic relationships among sets of random variables with significant applications in disease modeling and prediction. Here, we propose a continuous time Bayesian network with conditional dependencies represented as regularized Poisson regressions to model the impact of exogenous variables on the conditional intensities of the network. We also propose an adaptive group regularization method with an intuitive early stopping feature based on Gaussian mixture model clustering for efficient learning of the structure and parameters of the proposed network. Using a dataset of patients with multiple chronic conditions extracted from electronic health records of the Department of Veterans Affairs, we compare the performance of the proposed network with some of the existing methods in the literature for both short-term (one-year ahead) and long-term (multi-year ahead) predictions. The proposed model provides a sparse intuitive representation of the complex functional relationships between multiple chronic conditions. It also provides the capability of analyzing multiple disease trajectories over time, given any combination of preexisting conditions.
Collapse
Affiliation(s)
- Syed Hasib Akhter Faruqui
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Adel Alaeddini
- Department of Mechanical Engineering, The University of Texas at San Antonio, San Antonio, TX 78249, USA
| | - Jing Wang
- College of Nursing, Florida State University, Tallahassee, FL 32306, USA
| | | | - Mary Jo Pugh
- VA Salt Lake City Health Care System, Salt Lake City, UT 84148, USA
| |
Collapse
|
142
|
Barr PJ, Haslett W, Dannenberg MD, Oh L, Elwyn G, Hassanpour S, Bonasia KL, Finora JC, Schoonmaker JA, Onsando WM, Ryan J, Bruce ML, Das AK, Arend R, Piper S, Ganoe CH. An Audio Personal Health Library of Clinic Visit Recordings for Patients and Their Caregivers (HealthPAL): User-Centered Design Approach. J Med Internet Res 2021; 23:e25512. [PMID: 34677131 PMCID: PMC8727051 DOI: 10.2196/25512] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Revised: 03/01/2021] [Accepted: 04/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background Providing digital recordings of clinic visits to patients has emerged as a strategy to promote patient and family engagement in care. With advances in natural language processing, an opportunity exists to maximize the value of visit recordings for patients by automatically tagging key visit information (eg, medications, tests, and imaging) and linkages to trustworthy web-based resources curated in an audio-based personal health library. Objective This study aims to report on the user-centered development of HealthPAL, an audio personal health library. Methods Our user-centered design and usability evaluation approach incorporated iterative rounds of video-recorded sessions from 2016 to 2019. We recruited participants from a range of community settings to represent older patient and caregiver perspectives. In the first round, we used paper prototypes and focused on feature envisionment. We moved to low-fidelity and high-fidelity versions of the HealthPAL in later rounds, which focused on functionality and use; all sessions included a debriefing interview. Participants listened to a deidentified, standardized primary care visit recording before completing a series of tasks (eg, finding where a medication was discussed in the recording). In the final round, we recorded the patients’ primary care clinic visits for use in the session. Findings from each round informed the agile software development process. Task completion and critical incidents were recorded in each round, and the System Usability Scale was completed by participants using the digital prototype in later rounds. Results We completed 5 rounds of usability sessions with 40 participants, of whom 25 (63%) were women with a median age of 68 years (range 23-89). Feedback from sessions resulted in color-coding and highlighting of information tags, a more prominent play button, clearer structure to move between one’s own recordings and others’ recordings, the ability to filter recording content by the topic discussed and descriptions, 10-second forward and rewind controls, and a help link and search bar. Perceived usability increased over the rounds, with a median System Usability Scale of 78.2 (range 20-100) in the final round. Participants were overwhelmingly positive about the concept of accessing a curated audio recording of a clinic visit. Some participants reported concerns about privacy and the computer-based skills necessary to access recordings. Conclusions To our knowledge, HealthPAL is the first patient-centered app designed to allow patients and their caregivers to access easy-to-navigate recordings of clinic visits, with key concepts tagged and hyperlinks to further information provided. The HealthPAL user interface has been rigorously co-designed with older adult patients and their caregivers and is now ready for further field testing. The successful development and use of HealthPAL may help improve the ability of patients to manage their own care, especially older adult patients who have to navigate complex treatment plans.
Collapse
Affiliation(s)
- Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - William Haslett
- The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Lisa Oh
- Department of Computer Science, Dartmouth College, Hanover, NH, United States
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - Saeed Hassanpour
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, United States.,Department of Epidemiology, Dartmouth College, Hanover, NH, United States
| | - Kyra L Bonasia
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - James C Finora
- Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Jesse A Schoonmaker
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - W Moraa Onsando
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States.,The Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, United States
| | - James Ryan
- Ryan Family Practice, Ludington, MI, United States
| | - Martha L Bruce
- Department of Psychiatry, Geisel School of Medicine, Dartmouth College, Hanover, NH, United States
| | - Amar K Das
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, United States
| | | | | | - Craig H Ganoe
- Department of Biomedical Data Science, Dartmouth College, Hanover, NH, United States
| |
Collapse
|
143
|
Smith SM, Wallace E, Clyne B, Boland F, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community setting: a systematic review. Syst Rev 2021; 10:271. [PMID: 34666828 PMCID: PMC8527775 DOI: 10.1186/s13643-021-01817-z] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 09/16/2021] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Multimorbidity, defined as the co-existence of two or more chronic conditions, presents significant challenges to patients, healthcare providers and health systems. Despite this, there is ongoing uncertainty about the most effective ways to manage patients with multimorbidity. This review updated and narrowed the focus of a previous Cochrane review and aimed to determine the effectiveness of interventions designed to improve outcomes in people with multimorbidity in primary care and community settings, compared to usual care. METHODS We searched eight databases and two trials registers up to 9 September 2019. Two review authors independently screened potentially eligible titles and selected studies, extracted data, evaluated study quality and judged the certainty of the evidence (GRADE). Interventions were grouped by their predominant focus into care-coordination/self-management support, self-management support and medicines management. Main outcomes were health-related quality of life (HRQoL) and mental health. Meta-analyses were conducted, where possible, but the synthesis was predominantly narrative. RESULTS We included 16 RCTs with 4753 participants, the majority being older adults with at least three conditions. There were eight care-coordination/self-management support studies, four self-management support studies and four medicines management studies. There was little or no evidence of an effect on primary outcomes of HRQoL (MD 0.03, 95% CI -0.01 to 0.07, I2 = 39%) and mental health or on secondary outcomes with a small number of studies reporting that care coordination may improve patient experience of care and self-management support may improve patient health behaviours. Overall, the certainty of the evidence was graded as low due to significant variation in study participants and interventions. CONCLUSIONS There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity, despite the growing number of RCTs conducted in this area. Our findings suggest that future research should consider patient experience of care, optimising medicines management and targeted patient health behaviours such as exercise.
Collapse
Affiliation(s)
- Susan M. Smith
- Department of General Practice and HRB Centre for Primary Care Research, Royal College of Surgeons, 123 St Stephens Green, Dublin 2, Ireland
| | - Emma Wallace
- Department of General Practice and HRB Centre for Primary Care Research, Royal College of Surgeons, 123 St Stephens Green, Dublin 2, Ireland
| | - Barbara Clyne
- Department of General Practice and HRB Centre for Primary Care Research, Royal College of Surgeons, 123 St Stephens Green, Dublin 2, Ireland
| | - Fiona Boland
- Data Science Centre and HRB Centre for Primary Care Research, Royal College of Surgeons, 123 St Stephens Green, Dublin 2, Ireland
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Quebec, Canada
| |
Collapse
|
144
|
Cheng S, Siddiqui TG, Gossop M, Wyller TB, Kristoffersen ES, Lundqvist C. The patterns and burden of multimorbidity in geriatric patients with prolonged use of addictive medications. Aging Clin Exp Res 2021; 33:2857-2864. [PMID: 33599959 PMCID: PMC8531043 DOI: 10.1007/s40520-021-01791-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2020] [Accepted: 01/11/2021] [Indexed: 01/12/2023]
Abstract
Background Multimorbidity and prolonged use of addictive medications are prevalent among older patients, and known to increase the risk of adverse drug events. Yet, the relationship between these two entities has remained understudied. Aims This study explored the association between multimorbidity burden and prolonged use of addictive medications in geriatric patients, adjusted for clinically important covariates. Furthermore, we identified comorbidity patterns in prolonged users. Methods We conducted a cross-sectional study on a consecutive sample of 246 patients, aged 65–90 years, admitted to a large public university hospital in Norway. We defined prolonged use of addictive medications as using benzodiazepines, opioids and/or z-hypnotics beyond the duration recommended by clinical guidelines (≥ 4 weeks). Multimorbidity was assessed with the Cumulative Illness Rating Scale for Geriatrics (CIRS-G), based on diagnoses made by independent physicians. Results Compared to non-prolonged use, prolonged use was significantly more common among patients who had psychiatric (19/27, 70%), liver (19/22, 86%), upper gastrointestinal tract (21/32, 66%), musculoskeletal (52/96, 54%), or nervous system disorders (46/92, 50%). Patients with prolonged use had a higher multimorbidity burden than those without such use (CIRS-G score, mean = 7.7, SD = 2.7 versus mean = 4.6, SD = 2.2, p < 0.001). Multivariable logistic regression indicated a significant association between multimorbidity burden and prolonged addictive medication use (OR = 1.72, 95% CI 1.42–2.08). Predictive margins postestimation showed a systematic increase in the predicted CIRS-G scores when the number of addictive drug used increases. Conclusions Multimorbidity is strongly associated with prolonged use of addictive medications. Multiple substance use may aggravate disease burden of older patients. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-021-01791-5.
Collapse
Affiliation(s)
- Socheat Cheng
- Division of Health Services Research and Psychiatry (AHUSKHP), Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1000, 1478, Lørenskog, Norway.
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway.
| | - Tahreem Ghazal Siddiqui
- Division of Health Services Research and Psychiatry (AHUSKHP), Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, PO Box 1000, 1478, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
| | - Michael Gossop
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Torgeir Bruun Wyller
- Department of Geriatric Medicine, Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Espen Saxhaug Kristoffersen
- Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| | - Christofer Lundqvist
- Health Services Research Unit (HØKH), Akershus University Hospital, Lørenskog, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Campus Ahus, Lørenskog, Norway
- Department of Neurology, Akershus University Hospital, Lørenskog, Norway
| |
Collapse
|
145
|
Lawless MT, Drioli-Phillips P, Archibald MM, Ambagtsheer RC, Kitson AL. Communicating with older adults with long-term conditions about self-management goals: A systematic review and thematic synthesis. PATIENT EDUCATION AND COUNSELING 2021; 104:2439-2452. [PMID: 33658141 DOI: 10.1016/j.pec.2021.02.035] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/17/2021] [Accepted: 02/17/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To synthesise a body of fine-grained observational research on communication between healthcare professionals (HCPs), older adults, and carers regarding self-management goals and actions. METHODS We conducted a systematic review, searching nine electronic databases and the grey literature. Two reviewers independently selected for inclusion following a two-stage process and studies and discrepancies were resolved through consultation with the review team. RESULTS 898 records were retrieved, and eight studies were included in the review. Aggregative thematic analysis resulted in 13 categories of communication practices across three decision-making domains: (1) initiating: actions occurring prior to the commitment point; (2) proposing: putting forward a course of action; and (3) committing and closing: committing (or not) to the course of action. CONCLUSIONS Despite an increasing emphasis on the importance of personalised care planning and shared decision-making (SDM) to support older people's health and wellbeing, HCPs did not consistently practice this approach and, in some cases, worked in opposition to it. PRACTICE IMPLICATIONS We encourage HCPs to prepare older adults to engage actively with SDM and the goal setting process by employing patient-centred communication resources. These could assist with identifying different types of goals that are realistic and relevant to patients in daily life.
Collapse
Affiliation(s)
- Michael T Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia.
| | | | - Mandy M Archibald
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia; College of Nursing Helen Glass Centre for Nursing, 99 Curry Place University of Manitoba, Winnipeg, Canada.
| | - Rachel C Ambagtsheer
- National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia; Torrens University Australia, 88 Wakefield Street, Adelaide, SA, 5000, Australia.
| | - Alison L Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Bedford Park, SA, 5042, Australia; National Health and Medical Research Council Transdisciplinary Centre of Research Excellence in Frailty Research to Achieve Healthy Ageing, Adelaide, SA, Australia.
| |
Collapse
|
146
|
Ly VT, Coleman BC, Coulis CM, Lisi AJ. Exploring the application of the Charlson Comorbidity Index to assess the patient population seen in a Veterans Affairs chiropractic residency program. THE JOURNAL OF CHIROPRACTIC EDUCATION 2021; 35:199-204. [PMID: 33428733 PMCID: PMC8528440 DOI: 10.7899/jce-20-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 01/17/2020] [Accepted: 07/27/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE Chiropractic trainees require exposure to a diverse patient base, including patients with multiple medical conditions. The Veterans Affairs (VA) Chiropractic Residency Program aims for its doctor of chiropractic (DC) residents to gain experience managing a range of multimorbid cases, yet to our knowledge there are no published data on the comorbidity characteristics of patients seen by VA DC residents. We tested 2 approaches to obtaining Charlson Comorbidity Index (CCI) scores and compared CCI scores of resident patients with those of staff DCs at 1 VA medical center. METHODS Two processes of data collection to calculate CCI scores were developed. Time differences and agreement between methods were assessed. Comparison of CCI distribution between resident DC and staff DCs was done using 100 Monte Carlo simulation iterations of Fisher's exact test. RESULTS Both methods were able to calculate CCI scores (n = 22). The automated method was faster than the manual (13 vs 78 seconds per patient). CCI scores agreement between methods was good (κ = 0.67). We failed to find a significant difference in the distribution of resident DC and staff DC patients (mean p = .377; 95% CI, .375-.379). CONCLUSION CCI scores of a VA chiropractic resident's patients are measurable with both manual and automated methods, although automated may be preferred for its time efficiency. At the facility studied, the resident and staff DCs did not see patients with significantly different distributions of CCI scores. Applying CCI may give better insight into the characteristics of DC trainee patient populations.
Collapse
|
147
|
Sturmberg JP, Getz LO, Stange KC, Upshur REG, Mercer SW. Beyond multimorbidity: What can we learn from complexity science? J Eval Clin Pract 2021; 27:1187-1193. [PMID: 33588522 DOI: 10.1111/jep.13521] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 11/12/2020] [Indexed: 12/18/2022]
Abstract
Multimorbidity - the occurrence of two or more long-term conditions in an individual - is a major global concern, placing a huge burden on healthcare systems, physicians, and patients. It challenges the current biomedical paradigm, in particular conventional evidence-based medicine's dominant focus on single-conditions. Patients' heterogeneous range of clinical presentations tend to escape characterization by traditional means of classification, and optimal management cannot be deduced from clinical practice guidelines. In this article, we argue that person-focused care based in complexity science may be a transformational lens through which to view multimorbidity, to complement the specialism focus on each particular disease. The approach offers an integrated and coherent perspective on the person's living environment, relationships, somatic, emotional and cognitive experiences and physiological function. The underlying principles include non-linearity, tipping points, emergence, importance of initial conditions, contextual factors and co-evolution, and the presence of patterned outcomes. From a clinical perspective, complexity science has important implications at the theoretical, practice and policy levels. Three essential questions emerge: (1) What matters to patients? (2) How can we integrate, personalize and prioritize care for whole people, given the constraints of their socio-ecological circumstances? (3) What needs to change at the practice and policy levels to deliver what matters to patients? These questions have no simple answers, but complexity science principles suggest a way to integrate understanding of biological, biographical and contextual factors, to guide an integrated approach to the care of people with multimorbidity.
Collapse
Affiliation(s)
- Joachim P Sturmberg
- School of Medicine and Public Health, Faculty of Health and Medicine, University of Newcastle, Newcastle, New South Wales, Australia.,Foundation President, International Society for Systems and Complexity Sciences for Health, Waitsfield, Vermont
| | - Linn O Getz
- General Practice Research Unit, Department of Public Health and Nursing, Norwegian University of Science and Technology, Trondheim, Norway
| | - Kurt C Stange
- Department of Family Medicine & Community Health, Epidemiology & Biostatistics, Oncology and Sociology, Center for Community Health Integration, Case Western Reserve University, Cleveland, Ohio, USA
| | - Ross E G Upshur
- Department of Family and Community Medicine, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Stewart W Mercer
- Department of Primary Care and Multimorbidity, Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| |
Collapse
|
148
|
Hu XJ, Wang HHX, Li YT, Wu XY, Wang Y, Chen JH, Wang JJ, Wong SYS, Mercer SW. Healthcare needs, experiences and treatment burden in primary care patients with multimorbidity: An evaluation of process of care from patients' perspectives. Health Expect 2021; 25:203-213. [PMID: 34585465 PMCID: PMC8849236 DOI: 10.1111/hex.13363] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 08/15/2021] [Accepted: 09/06/2021] [Indexed: 01/06/2023] Open
Abstract
Background Patients with multimorbidity often experience treatment burden as a result of fragmented, specialist‐driven healthcare. The ‘family doctor team' is an emerging service model in China to address the increasing need for high‐quality routine primary care. Objective This study aimed to explore the extent to which treatment burden was associated with healthcare needs and patients' experiences. Methods Multisite surveys were conducted in primary care facilities in Guangdong province, southern China. Interviewer‐administered questionnaires were used to collect data from patients (N = 2160) who had ≥2 clinically diagnosed long‐term conditions (multimorbidity) and had ≥1 clinical encounter in the past 12 months since enrolment registration with the family doctor team. Patients' experiences and treatment burden were measured using a previously validated Chinese version of the Primary Care Assessment Tool (PCAT) and the Treatment Burden Questionnaire, respectively. Results The mean age of the patients was 61.4 years, and slightly over half were females. Patients who had a family doctor team as the primary source of care reported significantly higher PCAT scores (mean difference 7.2 points, p < .001) and lower treatment burden scores (mean difference −6.4 points, p < .001) when compared to those who often bypassed primary care. Greater healthcare needs were significantly correlated with increased treatment burden (β‐coefficient 1.965, p < .001), whilst better patients' experiences were associated with lower treatment burden (β‐coefficient −0.252, p < .001) after adjusting for confounders. Conclusion The inverse association between patients' experiences and treatment burden supports the importance of primary care in managing patients with multimorbidity. Patient Contribution Primary care service users were involved in the instrument development and data collection.
Collapse
Affiliation(s)
- Xiu-Jing Hu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China.,JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Yu-Ting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, China
| | - Xiao-Ya Wu
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Yi Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jia-Heng Chen
- School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Jia-Ji Wang
- Guangdong-provincial Primary Healthcare Association, Guangdong, China.,School of Public Health, Guangzhou Medical University, Guangzhou, China
| | - Samuel Y S Wong
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Stewart W Mercer
- Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Scotland, UK
| |
Collapse
|
149
|
Doherty A, Moriarty F, Boland F, Clyne B, Fahey T, Kennelly S, Wallace E. Prescribing cascades in community-dwelling adults: protocol for a systematic review. HRB Open Res 2021; 4:72. [PMID: 34738069 PMCID: PMC8529400 DOI: 10.12688/hrbopenres.13345.2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/08/2021] [Indexed: 01/04/2023] Open
Abstract
Introduction: Internationally, health systems face the challenge of managing a growing ageing population living with multimorbidity and polypharmacy. Potentially inappropriate prescribing is common among patients with polypharmacy, increasing the risk for adverse drug reactions (ADRs). Several prescribing indicator sets exist to improve prescribing and reduce potentially inappropriate prescribing, but do not address prescribing cascades. Prescribing cascades occur when a medication is prescribed to treat an ADR to another prescribed medication, whether intentionally or unintentionally, and constitute an important area to consider when characterising problematic polypharmacy. This is a protocol for a systematic review examining prescribing cascades in community-dwelling adults. Methods: The review will be reported adhering to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A systematic search of Medline (Ovid), EMBASE, PsycINFO, CINAHL and the Cochrane Library will be conducted from inception to March 2021, using a predetermined strategy. Grey literature will be searched using Open Grey, MedNar, Dart Europe, and the Turning Research Into Practice (TRIP) databases. No restrictions will be placed on language or publication year. Inclusion criteria are: population - community-dwelling adults (≥18 years); risk - prescription medication with the potential to cause side effects; outcomes - initiation of a new medicine to 'treat' or reduce the risk of experiencing an ADR. Prospective and retrospective cohort studies, case control and case series studies will be included. Two reviewers will independently screen titles and abstracts; studies meeting inclusion criteria will undergo independent full-text screening by two reviewers. A narrative synthesis will be conducted. Study quality will be independently assessed using the relevant Joanna Briggs Institute Critical Appraisal Checklist. Discussion: This systematic review will identify examples of prescribing cascades for community-dwelling adults and contribute to developing an evidence base regarding such cascades. Registration: PROSPERO [ CRD42021243163, 31/03/2021].
Collapse
Affiliation(s)
- Ann Doherty
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Frank Moriarty
- School of Pharmacy and Biomolecular Sciences, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Fiona Boland
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
- Data Science Centre, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| | - Seán Kennelly
- Department of Medical Gerontology, Trinity College Dublin, Dublin 2, Ireland
- Department of Age-related Healthcare, Tallaght University Hospital, Dublin 24, Ireland
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, Ireland
| |
Collapse
|
150
|
Ganoe CH, Wu W, Barr PJ, Haslett W, Dannenberg MD, Bonasia KL, Finora JC, Schoonmaker JA, Onsando WM, Ryan J, Elwyn G, Bruce ML, Das AK, Hassanpour S. Natural language processing for automated annotation of medication mentions in primary care visit conversations. JAMIA Open 2021; 4:ooab071. [PMID: 34423262 PMCID: PMC8374372 DOI: 10.1093/jamiaopen/ooab071] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/27/2021] [Accepted: 08/04/2021] [Indexed: 01/13/2023] Open
Abstract
OBJECTIVES The objective of this study is to build and evaluate a natural language processing approach to identify medication mentions in primary care visit conversations between patients and physicians. MATERIALS AND METHODS Eight clinicians contributed to a data set of 85 clinic visit transcripts, and 10 transcripts were randomly selected from this data set as a development set. Our approach utilizes Apache cTAKES and Unified Medical Language System controlled vocabulary to generate a list of medication candidates in the transcribed text and then performs multiple customized filters to exclude common false positives from this list while including some additional common mentions of the supplements and immunizations. RESULTS Sixty-five transcripts with 1121 medication mentions were randomly selected as an evaluation set. Our proposed method achieved an F-score of 85.0% for identifying the medication mentions in the test set, significantly outperforming existing medication information extraction systems for medical records with F-scores ranging from 42.9% to 68.9% on the same test set. DISCUSSION Our medication information extraction approach for primary care visit conversations showed promising results, extracting about 27% more medication mentions from our evaluation set while eliminating many false positives in comparison to existing baseline systems. We made our approach publicly available on the web as an open-source software. CONCLUSION Integration of our annotation system with clinical recording applications has the potential to improve patients' understanding and recall of key information from their clinic visits, and, in turn, to positively impact health outcomes.
Collapse
Affiliation(s)
- Craig H Ganoe
- Biomedical Data Science Department, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Weiyi Wu
- Biomedical Data Science Department, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Paul J Barr
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - William Haslett
- Biomedical Data Science Department, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Michelle D Dannenberg
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Kyra L Bonasia
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - James C Finora
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Jesse A Schoonmaker
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Wambui M Onsando
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - James Ryan
- Ryan Family Practice, Ludington, Michigan, USA
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Martha L Bruce
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Amar K Das
- The Dartmouth Institute for Health Policy & Clinical Practice, Geisel School of Medicine, Dartmouth College, Lebanon, New Hampshire, USA
| | - Saeed Hassanpour
- Corresponding Author: Saeed Hassanpour, PhD, One Medical Center Drive, HB 7261, Lebanon, NH 03756, USA ()
| |
Collapse
|