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Shaker NALA, Majumdar A, Straiton N, Bird J, Ashby S, Sharma R, Waller S, Hughes JG. Autogenic training for chronic health conditions: A service evaluation. J Eval Clin Pract 2024. [PMID: 38873764 DOI: 10.1111/jep.14014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 04/06/2024] [Accepted: 05/07/2024] [Indexed: 06/15/2024]
Abstract
BACKGROUND Autogenic training (AT) is a structured meditative-style practice, consisting of a sequence of simple mental exercises intended to induce a relaxed state in patients. There is some emerging evidence to suggest that AT can be effective in treating certain chronic conditions, however, further evidence is required. A service evaluation of AT services at the Royal London Hospital for Integrated Medicine was conducted to evaluate the impact of AT on patients with chronic conditions. METHODS The service evaluation consisted of the completion of validated quantitative outcome measures pre and posttreatment to explore the impact of AT. AT patients were asked to complete the Measure Yourself Medical Outcomes Profile (MYMOP) and Perceived Stress Scale (PSS) at their first hospital appointment (baseline) and then again 8 weeks later following completion of their AT sessions. Pre- and posttreatment scores for each outcome measure were analysed in SPSS using the Wilcoxon signed-rank test. RESULTS One hundred ninety-nine patients completed both initial and follow-up MYMOP forms and were included in the evaluation. The most common presenting complaints for MYMOP symptom 1 were prolonged anxiety/stress and depression (n = 70, 35.2%), chronic pain and migraine headache (n = 44, 22.1%), chronic insomnia and sleep problems (n = 42, 21.1%) and, long-term exhaustion and fatigue (n = 18, 9%). The change in median score pre- and posttreatment for all MYMOP categories (symptoms, activity and well-being) were statistically highly significant p < 0.001. Anxiety, stress, depression, pain and insomnia were the symptoms that had the largest statistically significant difference between the median score pre- and posttreatment. Fifty-five patients completed the PSS questionnaire at two time points (pre- and posttreatment). It showed a highly statistically significant change in PSS median score in patients experiencing stress (p < 0.001). DISCUSSION The findings of the evaluation indicate that 8 weeks of AT appears to be effective in improving symptoms of concern to patients and enhancing patients' overall well-being. In particular, AT was found to be beneficial for patients with symptoms of anxiety, stress, depression, pain and insomnia.
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Affiliation(s)
| | - Anne Majumdar
- Department of Health Studies, Royal Holloway University of London, Egham, United Kingdom
| | - Nicholas Straiton
- Department of Musculoskeletal Medicine, Royal London Hospital for Integrated Medicine, UCLH NHS Foundation Trust, London, UK
| | - Jane Bird
- Department of Musculoskeletal Medicine, Royal London Hospital for Integrated Medicine, UCLH NHS Foundation Trust, London, UK
| | - Stephen Ashby
- Department of Musculoskeletal Medicine, Royal London Hospital for Integrated Medicine, UCLH NHS Foundation Trust, London, UK
| | - Raj Sharma
- Department of Psychological Therapies, Royal London Hospital for Integrated Medicine, UCLH NHS Foundation Trust and University of West London, London, UK
| | - Sherquita Waller
- Research Department, Royal London Hospital for Integrated Medicine, UCLH NHS Foundation Trust, London, UK
| | - John Gareth Hughes
- Research Department, Royal London Hospital for Integrated Medicine, UCLH NHS Foundation Trust and School of Medicine and Biosciences, University of West London, London, UK
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Mata R, Bankole AO, Barnhill J, Roth I. A descriptive exploration of younger and older adults' experiences of Integrative Medical Group Visits for Long COVID. AGING AND HEALTH RESEARCH 2023; 3:100137. [PMID: 37799164 PMCID: PMC10554753 DOI: 10.1016/j.ahr.2023.100137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023] Open
Abstract
Introduction Long COVID disproportionately affects older adults. Individuals with Long COVID (LC) often experience symptoms that severely impact quality of life, and treatment approaches are still evolving. The Integrative Medical Group Visit (IMGV) model is an evidence-based approach that may be useful to treat patients with LC; however, there is limited evidence describing the experience and/or feasibility of using IMGV for LC treatment, especially among the older adult population. The purpose of this study is to describe older and younger adults' experiences of both having LC and participating in a virtually delivered IMGV for LC. Methods This is a secondary analysis of qualitative data from a parent study examining the experiences of participants in a virtually delivered IMGV for patients with LC. Patients participated in semi-structured interviews before and after 8 weekly IMGV sessions. Thematic analysis was used to analyze interview data. Results Overall, 21 pre-interviews and 17 post-interviews were collected. Thematic analysis of patient interviews by age group resulted in three themes that each contained similarities and differences between the younger and older adult participants. These themes included: (1) experiences of LC (2) feelings about the future (3) experiences of the pilot IMGV on LC. Conclusion This study provides critical context for clinicians who treat older adults with LC. Results support virtually delivered IMGVs as a potentially feasible option for both older and younger adults who want to apply an integrative approach to their LC treatment. Findings from this study will inform future research on IMGV for LC treatment.
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Affiliation(s)
- Raveena Mata
- The Ohio State University, College of Medicine, USA
- University of North Carolina, Chapel Hill, USA
| | | | | | - Isabel Roth
- University of North Carolina, Chapel Hill, USA
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Functional Status among Polymedicated Geriatric Inpatients at Discharge: A Population-Based Hospital Register Analysis. Geriatrics (Basel) 2021; 6:geriatrics6030086. [PMID: 34562987 PMCID: PMC8482227 DOI: 10.3390/geriatrics6030086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 08/27/2021] [Accepted: 08/30/2021] [Indexed: 12/22/2022] Open
Abstract
This study explored and compared the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge. We used a cross-sectional registry of geriatric patients' hospital records from a multi-site public hospital center in Switzerland. The analysis included all inpatients aged 65 years old or more admitted between 1 January 2015 and 31 December 2017 (n = 53,690), of whom 67.5% were polymedicated at hospital discharge, 52.1% were women (n = 18,909), and 42.7% were 75-84 years old (n = 15,485). On average, the polymedicated patients' hospital lengths of stay were six days longer, they presented with more than three comorbidities, and they were prescribed more than nine medications at hospital discharge (p < 0.001). They showed more frequent general mobility decline (43.2% vs. 41.9%), gait disorders (46.2% vs. 43%), fatigue (48.6% vs. 43.4%) and dependence on lower-body care (49.7% vs. 47.6%), and presented a higher malnutrition risk (OR = 1.411; 95%CI 1.263-1.577; p < 0.001). However, the non-polymedicated inpatients had proportionally more physical and cognitive impairments. The comparison of the functional status of polymedicated and non-polymedicated geriatric inpatients at hospital discharge is important for clinicians trying to identify and monitor those who are most vulnerable to functional decline, and to design targeted strategies for the prevention of functional impairment and related adverse health outcomes.
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Pati S, Swain S, Knottnerus JA, Metsemakers JFM, van den Akker M. Magnitude and determinants of multimorbidity and health care utilization among patients attending public versus private primary care: a cross-sectional study from Odisha, India. Int J Equity Health 2020; 19:57. [PMID: 32349770 PMCID: PMC7191801 DOI: 10.1186/s12939-020-01170-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 04/07/2020] [Indexed: 12/21/2022] Open
Abstract
Background Multimorbidity in primary care is a challenge not only for developing countries but also for low and medium income countries (LMIC). Health services in LMIC countries are being provided by both public and private health care providers. However, a critical knowledge gap exists on understanding the true extent of multimorbidity in both types of primary care settings. Methods We undertook a study to identify multimorbidity prevalence and healthcare utilization among both public and private primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire collecting information on 22 chronic diseases, medication use, number of hospitalization and number of outpatient visits. Result The overall prevalence of multimorbidity was 28.3% and nearly one third of patients of public facilities and one fourth from private facilities had multimorbidity. Leading diseases among patients visiting public facilities included acid peptic diseases, arthritis and chronic back pain. No significant difference in reporting of hypertension and diabetes across the facilities was seen. Besides age, predictors of multimorbidity among patients attending public facilities were, females [AOR: 1.6; 95% CI 1.1–1.3] and non-aboriginal groups [AOR: 1.6; 95%CI 1.1–2.3] whereas, in private females [AOR: 1.6; 95%CI 1.1–2.4], better socioeconomic conditions [AOR 1.4; 95% CI 1.0–2.1] and higher educational status [primary school completed [AOR 2.6; 95%CI 1.6–4.2] and secondary schooling and above [AOR 2.0; 95%CI 1.1–3.6] with reference to no education were seen to be the determinants of multimorbidity. Increased number of hospital visits to public facilities were higher among lower educational status patients [IRR: 1.57; 95% CI 1.13–2.18] whereas, among private patients, the mean number of hospital visits was 1.70 times more in higher educational status [IRR: 1.70; 95%CI 1.01–3.69]. The mean number of medicines taken per day was higher among patients attending private hospitals. Conclusion Our findings suggest that, multimorbidity is being more reported in public primary care facilities. The pattern and health care utilization in both types of settings are different. A comprehensive care approach must be designed for private care providers.
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Affiliation(s)
- Sanghamitra Pati
- Indian Council of Medical Research, Department of Health Research, ICMR Regional Medical Research Centre, Bhubaneswar, Chandrasekharpur, Bhubaneswar, Odisha, 751023, India.
| | - Subhashisa Swain
- School of Medicine, Clinical Sciences Building, City Hospital, University of Nottingham, Nottingham, NG5 1PB, UK
| | - J André Knottnerus
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands
| | - Job F M Metsemakers
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands
| | - Marjan van den Akker
- Department of Family Medicine, School Caphri, Maastricht University, Maastricht, The Netherlands.,Academic Centre of General Practice / Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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Varanasi R, Nayak D. Homoeopathy in the management of infectious diseases: Different facets of its use and implications for the future. INDIAN JOURNAL OF RESEARCH IN HOMOEOPATHY 2020. [DOI: 10.4103/ijrh.ijrh_40_20] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Comorbidity and healthcare utilization in osteoarthritis; a primary care survey from Odisha, India. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2019. [DOI: 10.1016/j.cegh.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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Polypharmacy prevalence among older adults based on the survey of health, ageing and retirement in Europe. Arch Gerontol Geriatr 2018; 78:213-220. [PMID: 30015057 DOI: 10.1016/j.archger.2018.06.018] [Citation(s) in RCA: 184] [Impact Index Per Article: 30.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/28/2018] [Accepted: 06/28/2018] [Indexed: 01/10/2023]
Abstract
Polypharmacy, a common condition among the elderly, is associated with adverse outcomes, including increased healthcare costs, due to higher mortality, falls and hospitalizations rates, adverse drug reactions, drug-drug reactions and medication nonadherence. This study aims to evaluate the prevalence and factors related to polypharmacy in older adults across 17 European countries, plus Israel. In this cross-sectional analysis, we used data from participants aged 65 or more years from Wave 6 of the Survey of Health, Ageing, and Retirement in Europe (SHARE) database. Polypharmacy was defined as the concurrent use of five or more medications. Age, gender, education, physical inactivity, number of limitations with activities of daily living, network satisfaction, quality of life, depression, number of chronic diseases and difficulty taking medication variables were found to be associated with polypharmacy. Our results showed a prevalence of polypharmacy ranging from 26.3 to 39.9%. Switzerland, Croatia and Slovenia were the countries with the lowest prevalence, whereas Portugal, Israel and the Czech Republic were the countries where the prevalence of polypharmacy was the highest. Age, gender, number of limitations with activities of daily living, number of chronic diseases, quality of life, depression, physical inactivity, network satisfaction, difficulty in taking medications, years of education and shortage of money were significant variables associated with polypharmacy. Polypharmacy is a highly prevalent condition in the elderly population. Identification of variables associated with polypharmacy, such as those identified in this study, is important to identify and monitor elderly groups, which are most vulnerable to polypharmacy.
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Patients' experience of Chinese Medicine Primary Care Services: Implications on Improving Coordination and Continuity of Care. Sci Rep 2015; 5:18853. [PMID: 26686267 PMCID: PMC4685421 DOI: 10.1038/srep18853] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/16/2015] [Indexed: 11/30/2022] Open
Abstract
Chinese medicine (CM) is major form of traditional and complementary medicine used by Chinese populations. Evaluation on patients’ experience on CM service is essential for improving service quality. This cross sectional study aims (i) to assess how CM clinics with different administrative model differ in terms of quality from patients’ perspective; and (ii) to investigate how quality varies with patients’ demographic and health characteristics. Five hundred and sixteen patients were sampled from charity and semi-public CM clinics in Hong Kong, and were invited to assess their experience using the Primary Care Assessment Tool (PCAT). Results indicated that overall mean PCAT scoring is satisfactory, achieving 70.7% (91.26/129) of total score. Ratings were lower in areas of “coordination of patient information”, “continuity of care”, and “range of service provided”. Impact of administrative models, including involvement of tax-funded healthcare system and outreach delivery, were minimal after adjusting for patient characteristics. Demographic and health characteristics of patients did not contribute to substantial variations in scoring. To improve patient experience, policy makers should consider strengthening care coordination, continuity and comprehensiveness in CM primary care services. Sharing of electronic records and establishing referral system are potential solutions for linking CM and conventional healthcare services.
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Kenning C, Protheroe J, Gray N, Ashcroft D, Bower P. The potential for using a Universal Medication Schedule (UMS) to improve adherence in patients taking multiple medications in the UK: a qualitative evaluation. BMC Health Serv Res 2015; 15:94. [PMID: 25888725 PMCID: PMC4359545 DOI: 10.1186/s12913-015-0749-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 02/17/2015] [Indexed: 12/04/2022] Open
Abstract
Background Poor adherence to prescribed medication has major consequences. Managing multiple long-term conditions often involves polypharmacy, potentially increasing complexity and the possibility of poor adherence. As a result of the globally recognised problems in supporting adherence to medication, some researchers have proposed the use of reminder charts. The main aim of the research was to explore the need for and perceptions around the ‘Universal Medication Schedule’ (UMS). Looking at ways in which pharmacists and General Practitioners (GPs) could use the UMS in NHS settings. Methods Semi-structured interviews were carried out with 10 GPs, 10 community pharmacists and 15 patients. Patients were aged 65 years and over, had multiple long-term conditions and were prescribed at least 5 medications. Interviews were recorded and transcribed and thematic analysis was conducted, using a framework approach to manage the data. Results Attitudes towards the UMS were mixed with stakeholders seeing benefits and limitations to the chart. Practitioners proposed a number of existing services where they thought the UMS could easily be integrated but there was evidence of role conflict with GPs feeling it may be best placed with pharmacists and vice versa. The potential for the UMS to be used as a tool to aid communication between the different services involved in a patient’s care was a key theme. Conclusions The UMS chart provides consolidated medicines information that might help to improve patients’ knowledge and health literacy, which may or may not improve adherence but could help patients in making informed decisions about their treatment. One of the key benefits of using the UMS in practice is that it could be introduced across services. In this way it may aid in medicines reconciliation between healthcare settings to ensure continuity of message, improve patient experience and create more joined up working between services. Further research is needed to test implementation in different services and to assess outcomes on patient understanding and adherence. Electronic supplementary material The online version of this article (doi:10.1186/s12913-015-0749-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Cassandra Kenning
- NIHR School for Primary Care Research, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor, Williamson Building, Oxford Road, M13 9PL, Manchester, UK.
| | - Joanne Protheroe
- Institute of Primary Care and Health Sciences, Keele University, Keele, UK.
| | - Nicola Gray
- Independent Pharmacist Researcher and Director- Green Line Consulting Ltd, Manchester, UK.
| | - Darren Ashcroft
- Centre for Pharmacoepidemiology and Drug Safety Research, Manchester Pharmacy School, NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, University of Manchester, Manchester, UK.
| | - Peter Bower
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, UK.
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