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Self-care of long-term conditions: patients' perspectives and their (limited) use of community pharmacies. Int J Clin Pharm 2017; 39:433-442. [PMID: 28120168 PMCID: PMC5371633 DOI: 10.1007/s11096-016-0418-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2016] [Accepted: 12/21/2016] [Indexed: 11/01/2022]
Abstract
Background Self-care support is an 'inseparable' component of quality healthcare for long-term conditions (LTCs). Evidence of how patients view and use community pharmacy (CP) to engage in self-care of LTCs is limited. Objective To explore patients' perspectives of engaging in self-care and use of CP for self-care support. Setting England and Scotland. Method Qualitative design employing semi-structured interviews. LTCs patients were recruited via general practitioners (GPs) and CPs. Interviews were conducted between May 2013 and June 2014; they were audio-recorded, transcribed verbatim and analysed thematically. Results Twenty-four participants were interviewed. Three main themes emerged: engaging in self-care, resources for self-care support and (limited) use of community pharmacy. Participants' LTC 'lived experience' showed that self-care was integral to daily living from being diagnosed to long-term maintenance of health/wellbeing; self-care engagement was very personal and diverse and was based on beliefs and experiences. Healthcare professionals were viewed as providing information which was considered passive and insufficient in helping behavioural change. Non-healthcare sources (family, carers, friends, internet) were important in filling active support gaps, particularly lifestyle management. Participants' use of, and identified need for, community pharmacy as a resource for self-care support of LTCs was limited and primarily focussed on medicines supply. There was low awareness and visibility of CPs' potential roles and capability. Conclusion CP needs to reflect on patients' low awareness of its expertise and services to contribute to self-care support of LTCs. Rethinking how interventions are designed and 'marketed'; incorporation of patients' perspectives and collaboration with others, particularly GPs, could prove beneficial.
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152
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van Hooft SM, Been-Dahmen JM, Ista E, van Staa A, Boeije HR. A realist review: what do nurse-led self-management interventions achieve for outpatients with a chronic condition? J Adv Nurs 2016; 73:1255-1271. [DOI: 10.1111/jan.13189] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Susanne M. van Hooft
- Research Centre Innovations in Care; Rotterdam University of Applied Sciences; The Netherlands
- Department of Health Policy and Management; Erasmus University Rotterdam; The Netherlands
| | - Janet M.J. Been-Dahmen
- Research Centre Innovations in Care; Rotterdam University of Applied Sciences; The Netherlands
- Erasmus Medical Centre; Rheumatology Department; Rotterdam The Netherlands
| | - Erwin Ista
- Erasmus Medical Centre-Sophia Children's Hospital; Intensive Care Unit; Rotterdam The Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care; Rotterdam University of Applied Sciences; The Netherlands
- Department of Health Policy and Management; Erasmus University Rotterdam; The Netherlands
| | - Hennie R. Boeije
- NIVEL; Netherlands Institute for Health Services Research; Utrecht The Netherlands
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153
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Nakken N, Janssen DJ, van den Bogaart EH, van Vliet M, de Vries GJ, Bootsma GP, Gronenschild MH, Delbressine JM, Muris JW, Wouters EF, Spruit MA. Patient versus proxy-reported problematic activities of daily life in patients with COPD. Respirology 2016; 22:307-314. [DOI: 10.1111/resp.12915] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 07/23/2016] [Accepted: 07/26/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Nienke Nakken
- Department of Research and Education; CIRO; Horn The Netherlands
| | - Daisy J.A. Janssen
- Department of Research and Education; CIRO; Horn The Netherlands
- Centre of Expertise for Palliative Care; Maastricht University Medical Centre+ (MUMC+); Maastricht The Netherlands
| | | | - Monique van Vliet
- Department of Respiratory Medicine; Zuyderland; Heerlen The Netherlands
| | - Geeuwke J. de Vries
- Department of Respiratory Medicine; Zuyderland; Sittard-Geleen The Netherlands
| | - Gerben P. Bootsma
- Department of Respiratory Medicine; Zuyderland; Heerlen The Netherlands
| | | | | | - Jean W.M. Muris
- Department of Family Medicine, CAPHRI School of Public Health and Primary Care; Maastricht University; Maastricht The Netherlands
| | - Emiel F.M. Wouters
- Department of Research and Education; CIRO; Horn The Netherlands
- Department of Respiratory Medicine; Maastricht University Medical Centre+ (MUMC+); Maastricht The Netherlands
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154
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Fu Y, McNichol E, Marczewski K, Closs SJ. Exploring the Influence of Patient-Professional Partnerships on the Self-Management of Chronic Back Pain: A Qualitative Study. Pain Manag Nurs 2016; 17:339-49. [DOI: 10.1016/j.pmn.2016.05.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/06/2016] [Accepted: 05/18/2016] [Indexed: 10/21/2022]
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155
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van Gaalen JL, van Bodegom-Vos L, Bakker MJ, Snoeck-Stroband JB, Sont JK. Internet-based self-management support for adults with asthma: a qualitative study among patients, general practitioners and practice nurses on barriers to implementation. BMJ Open 2016; 6:e010809. [PMID: 27566627 PMCID: PMC5013403 DOI: 10.1136/bmjopen-2015-010809] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES The aim of this study was to explore barriers among patients, general practitioners (GPs) and practice nurses to implement internet-based self-management support as provided by PatientCoach for asthma in primary care. SETTING Primary care within South Holland, the Netherlands. PARTICIPANTS Twenty-two patients (12 women, mean age 38 years), 21 GPs (6 women, mean age 52 years) and 13 practice nurses (all women, mean age 41 years). DESIGN A qualitative study using focus groups and interviews. OUTCOMES Barriers as perceived by patients, GPs and practice nurses to implementation of PatientCoach. METHODS 10 focus groups and 12 interviews were held to collect data: 4 patient focus groups, 4 GP focus groups, 2 practice nurse focus group, 2 patient interviews, 5 GP interviews and 5 practice nurse interviews. A prototype of PatientCoach that included modules for coaching, personalised information, asthma self-monitoring, medication treatment plan, feedback, e-consultations and a forum was demonstrated. A semistructured topic guide was used. Directed content analysis was used to analyse data. Reported barriers were classified according to a framework by Grol and Wensing. RESULTS A variety of barriers emerged among all participant groups. Barriers identified among patients include a lack of a patient-professional partnership in using PatientCoach and a lack of perceived benefit in improving asthma symptoms. Barriers identified among GPs include a low sense of urgency towards asthma care and current work routines. Practice nurses identified a low level of structured asthma care and a lack of support by colleagues as barriers. Among all participant groups, insufficient ease of use of PatientCoach, lack of financial arrangements and patient characteristics such as a lack of asthma symptoms were reported as barriers. CONCLUSIONS We identified a variety of barriers to implementation of PatientCoach. An effective implementation strategy for internet-based self-management support in asthma care should focus on these barriers.
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Affiliation(s)
- Johanna L van Gaalen
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Leti van Bodegom-Vos
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Moira J Bakker
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jiska B Snoeck-Stroband
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
| | - Jacob K Sont
- Department of Medical Decision Making, Leiden University Medical Centre, Leiden, The Netherlands
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156
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Nøst TH, Steinsbekk A, Bratås O, Grønning K. Expectations, effect and experiences of an easily accessible self-management intervention for people with chronic pain: study protocol for a randomised controlled trial with embedded qualitative study. Trials 2016; 17:325. [PMID: 27430319 PMCID: PMC4950079 DOI: 10.1186/s13063-016-1462-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2016] [Revised: 06/29/2016] [Accepted: 07/01/2016] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND People struggling with chronic pain may benefit from different types of non-pharmacological interventions such as self-management courses. Self-management courses aim to increase participants' skills and knowledge in managing chronic conditions. Community health-care services in Norway have increasingly established Healthy Life Centres (HLCs) to offer easily accessible interventions to people in need of support to better handle a life with chronic illness. The aim of this trial is to investigate the expectations, effect and experience of an easily accessible, group-based self-management course delivered at a HLC for people with chronic pain. METHODS/DESIGN This is an open pragmatic two-armed randomised controlled trial with an embedded qualitative study. The intervention is a self-management course comprising education, discussions, exchange of experiences between the participants, and physical movement exercises. The control group is offered a drop-in outdoor physical activity. The intervention period is 6 weeks. The primary outcome is patient activation measured by the patient activation measure (PAM). The secondary outcomes include measures of self-efficacy, pain and quality of life. Data will be collected at baseline, and after 3, 6 and 12 months. Using a mixed linear model, the number needed in each arm to achieve a power of 80 % becomes 55. To allow for dropout, the aim is to include 120 participants. Analysis will be done using mixed linear models. In the embedded qualitative study, we will perform semi-structured face-to-face interviews with a sample from both trial arms before randomisation and after 3 and 12 months. The topics elaborated will be motivation for participation and experiences with the activity related to possible changes in managing and coping with chronic pain. DISCUSSION There is need for more knowledge on interventions delivering self-care support in an easily accessible way that aim to reach those in need of this kind of health service. This trial will produce important knowledge on the effect and the experiences of participants in such an easily accessible self-management course delivered in Norwegian public primary care. TRIAL REGISTRATION ClinicalTrials.gov: NCT02531282 . Registered on 21 August 2015.
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Affiliation(s)
- Torunn Hatlen Nøst
- />Centre for Health Promotion Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Nursing Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Aslak Steinsbekk
- />Department of Public Health and General Practice, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Ola Bratås
- />Centre for Health Promotion Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Nursing Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
| | - Kjersti Grønning
- />Centre for Health Promotion Research, Norwegian University of Science and Technology, 7491 Trondheim, Norway
- />Department of Nursing Science, Norwegian University of Science and Technology, 7491 Trondheim, Norway
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157
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Ter Maten-Speksnijder AJ, Dwarswaard J, Meurs PL, van Staa A. Rhetoric or reality? What nurse practitioners do to provide self-management support in outpatient clinics: an ethnographic study. J Clin Nurs 2016; 25:3219-3228. [PMID: 27411952 DOI: 10.1111/jocn.13345] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2016] [Indexed: 11/26/2022]
Abstract
AIMS AND OBJECTIVES To describe how nurse practitioners enact their role in outpatient consultations, and how this compares to their perception of their responsibility for patients with chronic conditions. BACKGROUND Nurse practitioners working with patients with chronic conditions seek to support them in self-managing their diseases. DESIGN An ethnographic study. METHODS Episodic participant observations (in total 48 hours) were carried out combined with formal interviews. The study population consisted of a purposive sample of nurse practitioners working in five outpatient clinics related to chronic care in one university medical centre in the Netherlands. Two different types of clinics were selected, namely (1) for patients with episodic flare-ups and (2) for patients with diseases requiring life-saving procedures. RESULTS The nurse practitioners perceived the monitoring of patients' treatment as their main professional responsibility. Four monitoring strategies could be distinguished: 'assessing health conditions', 'connecting with patients', 'prioritising treatment in daily living' and 'educating patients'. CONCLUSION While nurse practitioners considered building a relationship with their patients of utmost importance, their consultations were mostly based on a conventional medical model of medical history taking. Little attention was paid to the social, psychological and behavioural dimensions of illness. Nurse practitioners in this study seemed quite successful in their extension into medical territory, but moving patients' illness perceptions to the background was not conducive to self-management support. RELEVANCE TO CLINICAL PRACTICE By their medical subspecialty expertise, nurse practitioners have a major role in the longitudinal process of the management of chronic diseases' treatment. Supporting patients to reduce the impact of the disease and its complications requires nurse practitioners to develop new coaching strategies designed to meet patients' individual needs.
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Affiliation(s)
| | - Jolanda Dwarswaard
- Erasmus University Rotterdam and Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
| | - Pauline L Meurs
- iBMG, Erasmus University Rotterdam, Rotterdam, the Netherlands
| | - AnneLoes van Staa
- Erasmus University Rotterdam and Rotterdam University of Applied Sciences, Rotterdam, the Netherlands
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158
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Fu Y, Yu G, McNichol E, Marczewski K, José Closs S. The effects of patient–professional partnerships on the self-management and health outcomes for patients with chronic back pain: A quasi-experimental study. Int J Nurs Stud 2016; 59:197-207. [DOI: 10.1016/j.ijnurstu.2016.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/14/2016] [Accepted: 04/17/2016] [Indexed: 10/21/2022]
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159
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Pumar-Méndez MJ, Mujika A, Regaira E, Vassilev I, Portillo MC, Foss C, Todorova E, Roukova P, Ruud Knutsen IA, Serrano M, Lionis C, Wensing M, Rogers A. Stakeholders in support systems for self-care for chronic illness: the gap between expectations and reality regarding their identity, roles and relationships. Health Expect 2016; 20:434-447. [PMID: 27231025 PMCID: PMC5433542 DOI: 10.1111/hex.12471] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/18/2016] [Indexed: 11/30/2022] Open
Abstract
Background and objective The spread of self‐care holds the promise of containing chronic illness burden. Falling within the framework of a FP7 collaborative research project, this paper reports the views of key informants from six countries regarding who the main stakeholders are at different levels in the support system for self‐care for patients with chronic illness (SSSC) and how they accomplish their role and collaborate. Methods 90 Interviews with purposefully selected key informants from Bulgaria, Greece, the Netherlands, Norway, Spain and United Kingdom were conducted. Interviews involved government and local authorities, politicians, academics, health professionals and private sector representatives. Interviewers followed an expert opinion‐based guide. Analysis involved a cross‐country examination with thematic analysis and framework method techniques. Results Key informants described the ideal SSSC as inclusive, interdependent and patient‐centred. The following main stakeholders in SSSC were identified: patients, governments, health‐care professionals, associations, private companies and the media. In the current SSSCs, collaboration among stakeholders within and across different levels was said to be lacking. Patients were seen as playing a passive subordinate role based on the following: their own attitudes; the paternalistic and medicalized attitudes of the health‐care professionals; their misrepresentation by patient associations; and their exposure to the damaging influences of media and industries. Conclusions Making SSSC patient‐centred constitutes the greatest challenge for European authorities. Strategies must be revised for promoting patient participation. They should undergo changes so as to promote industry and media social responsibility and patient association advocacy capacity.
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Affiliation(s)
| | | | - Elena Regaira
- Quality Department, Clínica Universidad de Navarra, Navarra, Spain
| | - Ivaylo Vassilev
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK
| | - Mari Carmen Portillo
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK
| | - Christina Foss
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Elka Todorova
- Department of Economic Sociology, University of National and World Economy, Sofia, Bulgaria
| | - Poli Roukova
- Department of Economic and Social Geography, NIGGG, Bulgarian Academy of Sciences, Sofia, Bulgaria
| | | | | | - Christos Lionis
- Clinic of Social and Family Medicine, Department of Social Medicine, University of Crete, Heraklion, Greece
| | - Michel Wensing
- Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Anne Rogers
- Faculty of Health Sciences, NIHR Wessex CLAHRC, University of Southampton, Hampshire, UK
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160
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Duprez V, Van Hooft SM, Dwarswaard J, van Staa A, Van Hecke A, Strating MM. The development and psychometric validation of the self-efficacy and performance in self-management support (SEPSS) Instrument. J Adv Nurs 2016; 72:1381-95. [DOI: 10.1111/jan.12918] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Veerle Duprez
- University Centre for Nursing and Midwifery; Department of Public Health; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Susanne M. Van Hooft
- Research Centre Innovations in Care; Rotterdam University of Applied Sciences; the Netherlands
- Institute of Health Policy & Management; Erasmus University Rotterdam; Rotterdam the Netherlands
| | - Jolanda Dwarswaard
- Research Centre Innovations in Care; Rotterdam University of Applied Sciences; the Netherlands
- Institute of Health Policy & Management; Erasmus University Rotterdam; Rotterdam the Netherlands
| | - AnneLoes van Staa
- Research Centre Innovations in Care; Rotterdam University of Applied Sciences; the Netherlands
- Institute of Health Policy & Management; Erasmus University Rotterdam; Rotterdam the Netherlands
| | - Ann Van Hecke
- University Centre for Nursing and Midwifery; Department of Public Health; Faculty of Medicine and Health Sciences; Ghent University; Ghent Belgium
| | - Mathilde M.H. Strating
- Institute of Health Policy & Management; Erasmus University Rotterdam; Rotterdam the Netherlands
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161
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Fernandes ES, Cerqueira ARA, Soares AG, Costa SKP. Capsaicin and Its Role in Chronic Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2016; 929:91-125. [PMID: 27771922 DOI: 10.1007/978-3-319-41342-6_5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
A significant number of experimental and clinical studies published in peer-reviewed journals have demonstrated promising pharmacological properties of capsaicin in relieving signs and symptoms of non-communicable diseases (chronic diseases). This chapter provides an overview made from basic and clinical research studies of the potential therapeutic effects of capsaicin, loaded in different application forms, such as solution and cream, on chronic diseases (e.g. arthritis, chronic pain, functional gastrointestinal disorders and cancer). In addition to the anti-inflammatory and analgesic properties of capsaicin largely recognized via, mainly, interaction with the TRPV1, the effects of capsaicin on different cell signalling pathways will be further discussed here. The analgesic, anti-inflammatory or apoptotic effects of capsaicin show promising results in arthritis, neuropathic pain, gastrointestinal disorders or cancer, since evidence demonstrates that the oral or local application of capsaicin reduce inflammation and pain in rheumatoid arthritis, promotes gastric protection against ulcer and induces apoptosis of the tumour cells. Sadly, these results have been paralleled by conflicting studies, which indicate that high concentrations of capsaicin are likely to evoke deleterious effects, thus suggesting that capsaicin activates different pathways at different concentrations in both human and rodent tissues. Thus, to establish effective capsaicin doses for chronic conditions, which can be benefited from capsaicin therapeutic effects, is a real challenge that must be pursued.
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Affiliation(s)
- E S Fernandes
- Programa de Pós-Graduação, Universidade Ceuma, São Luís-MA, Brazil.,Vascular Biology Section, Cardiovascular Division, King's College London, London, UK
| | - A R A Cerqueira
- Department of Pharmacology, Institute of Biomedical Sciences (ICB), University of São Paulo (USP), Av. Prof. Lineu Prestes, 1524 - Room 326, Butantan, São Paulo, 05508-900, Sao Paulo, Brazil
| | - A G Soares
- Department of Pharmacology, Institute of Biomedical Sciences (ICB), University of São Paulo (USP), Av. Prof. Lineu Prestes, 1524 - Room 326, Butantan, São Paulo, 05508-900, Sao Paulo, Brazil
| | - Soraia K P Costa
- Department of Pharmacology, Institute of Biomedical Sciences (ICB), University of São Paulo (USP), Av. Prof. Lineu Prestes, 1524 - Room 326, Butantan, São Paulo, 05508-900, Sao Paulo, Brazil.
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Been-Dahmen JM, Dwarswaard J, Hazes JM, van Staa A, Ista E. Nurses' views on patient self-management: a qualitative study. J Adv Nurs 2015; 71:2834-45. [DOI: 10.1111/jan.12767] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/04/2015] [Indexed: 11/26/2022]
Affiliation(s)
- Janet M.J. Been-Dahmen
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
- Erasmus Medical Center; Rheumatology Department; The Netherlands
| | - Jolanda Dwarswaard
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
| | | | - AnneLoes van Staa
- Rotterdam University of Applied Sciences; Research Center Innovations in Care; The Netherlands
- Erasmus University Rotterdam; Institute of Health Policy & Management; The Netherlands
| | - Erwin Ista
- Erasmus Medical Center-Sophia Children's Hospital; Intensive Care Unit; Rotterdam The Netherlands
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