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Lee CT, Harty S, Adegoke A, Palacios J, Gillan CM, Richards D. The Effectiveness of Low-Intensity Psychological Interventions for Comorbid Depression and Anxiety in Patients with Long-Term Conditions: A Real-World Naturalistic Observational Study in IAPT Integrated Care. Int J Behav Med 2024; 31:730-740. [PMID: 37697142 PMCID: PMC11452547 DOI: 10.1007/s12529-023-10215-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2023] [Indexed: 09/13/2023]
Abstract
BACKGROUND Low-intensity psychological interventions may be a cost-effective, accessible solution for treating depression and anxiety in patients with long-term conditions, but evidence from real-world service settings is lacking. This study examined the effectiveness of low-intensity psychological interventions provided in the Improving Access to Psychological Therapies programme in England for patients with and without long-term conditions. METHODS A retrospective analysis was conducted on patients (total N = 21,051, long-term conditions n = 4024) enrolled in three low-intensity psychological interventions, i.e. Internet-delivered cognitive behavioural therapy (iCBT), guided self-help (GSH), and psychoeducational group therapy (PGT) within a Talking Therapies service from 2016 to 2020. Primary outcomes included pre-post-treatment changes in depression (Patient Health Questionnaire-9) and anxiety (Generalised Anxiety Disorder-7). RESULTS Overall, both cohorts significantly improved on all outcomes post-treatment, with large effect sizes. Patients with long-term conditions experienced a greater reduction in depression while those without experienced a greater reduction in anxiety, but these differences were marginal (< 1 score difference on both measures). No difference between the cohorts was shown when comparing the differential effectiveness across interventions, but those engaging in iCBT showed greater reduction in depression and anxiety than those in GSH and PGT, while those in GSH improved more than PGT. CONCLUSIONS Low-intensity psychological interventions, particularly iCBT, were effective in treating depression and anxiety in patients with long-term conditions in a real-world service setting. Our large-scale study supports the continued and increased implementation of low-intensity psychological interventions for this subpopulation via integrated care.
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Affiliation(s)
- Chi Tak Lee
- School of Psychology, Trinity College Dublin, Dublin, Ireland.
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland.
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland.
| | - Siobhan Harty
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Adedeji Adegoke
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Jorge Palacios
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
| | - Claire M Gillan
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- Trinity College Institute of Neuroscience, Trinity College Dublin, Dublin, Ireland
- Global Brain Health Institute, Trinity College Dublin, Dublin, Ireland
| | - Derek Richards
- School of Psychology, Trinity College Dublin, Dublin, Ireland
- SilverCloud Science, SilverCloud Health, Dublin, Ireland
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Kruse J, Kampling H, Bouami SF, Grobe TG, Hartmann M, Jedamzik J, Marschall U, Szecsenyi J, Werner S, Wild B, Zara S, Heuft G, Friederich HC. Outpatient Psychotherapy in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2024; 121:315-322. [PMID: 38544323 DOI: 10.3238/arztebl.m2024.0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 02/20/2024] [Accepted: 02/20/2024] [Indexed: 07/09/2024]
Abstract
BACKGROUND A structural reform of the German psychotherapy guideline in 2017 was intended to facilitate access to outpatient guideline psychotherapy. In the present study, we evaluate the effects of this reform in particular for patients with a comorbidity of mental disorders and chronic physical conditions (cMP). METHODS Pre-post analyses of the two primary endpoints "percentage of mentally ill persons who have made an initial contact with a psychotherapist" and "waiting time for guideline psychotherapy" were carried out employing population-based and weighted routine statutory health insurance data from the German BARMER. The secondary endpoints included evaluations from the patients' perspective, based on a representative survey of patients in psychotherapy, and an overview of the health care situation based on data from the National Association of Statutory Health Insurance Physicians (Kassenärztliche Bundesvereinigung, KBV) (study registration number: DRKS00020344). RESULTS From 2015 to 2018, the percentage of mentally ill persons who had made an initial contact with a psychotherapist rose moderately, from 3.7% (95% confidence interval, [3.6; 3.7]) to 3.9% [3.8; 3.9] among persons with cMP and from 7.3% [7.2; 7.4] to 7.6% [7.5; 7.7] among those with mental disorders but without any chronic physical condition (MnoP). The new structural elements were integrated into patient care. The interval of time between the initial contact and the beginning of guideline psychotherapy became longer in both groups, from a mean of 80.6 [79.4; 81.8] to 114.8 [113.4; 116.2] days among persons with complex disease and from 80.2 [79.2; 81.3] to 109.6 [108.4; 111.0] days among persons with non-complex disease; most patients considered the waiting time. Approximately 8% of the patients who sought psychotherapy reported that they had not obtained access to a psychotherapist. CONCLUSION Neither in general nor for patients with cMP did the introduction of the structural reform appreciably lower the access barriers to psychotherapy. Further steps are needed so that outpatient care can meet the needs of all patients and particularly those with cMP.
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Affiliation(s)
- Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany; Department for Psychosomatic Medicine and Psychotherapy, Medical Center of the Philipps University Marburg, Marburg, Germany; aQua - Institute for Applied Quality Improvement and Research in Health Care GmbH, Göttingen, Germany; Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, University Hospital Münster, Münster, Germany; Department of Medicine and Health Services Research, BARMER Institute for Health System Research, Wuppertal, Germany; Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
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Cicek M, Greenfield G, Nicholls D, Majeed A, Hayhoe B. Predictors of unplanned emergency hospital admissions among patients aged 65+ with multimorbidity and depression in Northwest London during and after the Covid-19 lockdown in England. PLoS One 2024; 19:e0294639. [PMID: 38394234 PMCID: PMC10890757 DOI: 10.1371/journal.pone.0294639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 11/07/2023] [Indexed: 02/25/2024] Open
Abstract
INTRODUCTION Individuals with multimorbidity have an increased likelihood of using unplanned secondary care including emergency department visits and emergency hospitalisations. Those with mental health comorbidities are affected to a greater extent. The Covid-19 pandemic has negatively impacted on psychosocial wellbeing and multimorbidity care, especially among vulnerable older individuals. AIM To examine the risk of unplanned hospital admissions among patients aged 65+ with multimorbidity and depression in Northwest London, England, during- and post-Covid-19 lockdown. METHODS Retrospective cross-sectional data analysis with the Discover-NOW database for Northwest London was conducted. The overall sample consisted of 20,165 registered patients aged 65+ with depression. Two time periods were compared to observe the impact of the Covid-19 lockdown on emergency hospital admissions between 23rd March 2020 to 21st June 2021 (period 1) and equivalent-length post-lockdown period from 22nd June 2021 to 19th September 2022 (period 2). Multivariate logistic regression was conducted on having at least one emergency hospital admission in each period against sociodemographic and multimorbidity-related characteristics. RESULTS The odds of having an emergency hospitalisation were greater in men than women (OR = 1.19 (lockdown); OR = 1.29 (post-lockdown)), and significantly increased with age, higher deprivation, and greater number of comorbidities in both periods across the majority of categories. There was an inconclusive pattern with ethnicity; with a statistically significant protective effect among Asian (OR = 0.66) and Black ethnicities (OR = 0.67) compared to White patients during post-lockdown period only. CONCLUSION The likelihood of unplanned hospitalisation was higher in men than women, and significantly increased with age, higher deprivation, and comorbidities. Despite modest increases in magnitude of risk between lockdown and post-lockdown periods, there is evidence to support proactive case-review by multi-disciplinary teams to avoid unplanned admissions, particularly men with multimorbidity and comorbid depression, patients with higher number of comorbidities and greater deprivation. Further work is needed to determine admission reasons, multimorbidity patterns, and other clinical and lifestyle predictors.
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Affiliation(s)
- Meryem Cicek
- Applied Research Collaboration Northwest London (ARC NWL), Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Geva Greenfield
- Applied Research Collaboration Northwest London (ARC NWL), Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Dasha Nicholls
- Applied Research Collaboration Northwest London (ARC NWL), Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
- Division of Psychiatry, Department of Brain Sciences, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Azeem Majeed
- Applied Research Collaboration Northwest London (ARC NWL), Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Benedict Hayhoe
- Applied Research Collaboration Northwest London (ARC NWL), Department of Primary Care and Public Health, School of Public Health, Faculty of Medicine, Imperial College London, London, United Kingdom
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Launders N, Hayes JF, Price G, Marston L, Osborn DPJ. The incidence rate of planned and emergency physical health hospital admissions in people diagnosed with severe mental illness: a cohort study. Psychol Med 2023; 53:5603-5614. [PMID: 36069188 PMCID: PMC10482715 DOI: 10.1017/s0033291722002811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 08/10/2022] [Accepted: 08/13/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND People with severe mental illness (SMI) have more physical health conditions than the general population, resulting in higher rates of hospitalisations and mortality. In this study, we aimed to determine the rate of emergency and planned physical health hospitalisations in those with SMI, compared to matched comparators, and to investigate how these rates differ by SMI diagnosis. METHODS We used Clinical Practice Research DataLink Gold and Aurum databases to identify 20,668 patients in England diagnosed with SMI between January 2000 and March 2016, with linked hospital records in Hospital Episode Statistics. Patients were matched with up to four patients without SMI. Primary outcomes were emergency and planned physical health admissions. Avoidable (ambulatory care sensitive) admissions and emergency admissions for accidents, injuries and substance misuse were secondary outcomes. We performed negative binomial regression, adjusted for clinical and demographic variables, stratified by SMI diagnosis. RESULTS Emergency physical health (aIRR:2.33; 95% CI 2.22-2.46) and avoidable (aIRR:2.88; 95% CI 2.60-3.19) admissions were higher in patients with SMI than comparators. Emergency admission rates did not differ by SMI diagnosis. Planned physical health admissions were lower in schizophrenia (aIRR:0.80; 95% CI 0.72-0.90) and higher in bipolar disorder (aIRR:1.33; 95% CI 1.24-1.43). Accident, injury and substance misuse emergency admissions were particularly high in the year after SMI diagnosis (aIRR: 6.18; 95% CI 5.46-6.98). CONCLUSION We found twice the incidence of emergency physical health admissions in patients with SMI compared to those without SMI. Avoidable admissions were particularly elevated, suggesting interventions in community settings could reduce hospitalisations. Importantly, we found underutilisation of planned inpatient care in patients with schizophrenia. Interventions are required to ensure appropriate healthcare use, and optimal diagnosis and treatment of physical health conditions in people with SMI, to reduce the mortality gap due to physical illness.
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Affiliation(s)
- Naomi Launders
- Division of Psychiatry, UCL. 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Joseph F. Hayes
- Division of Psychiatry, UCL. 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
| | - Gabriele Price
- Department of Health and Social Care, Office for Health Improvement and Disparities, Wellington House, 133-155 Waterloo Road, London SE1 8UG, UK
| | - Louise Marston
- Department of Primary Care and Population Health, UCL, Rowland Hill Street, NW3 2PF, London, UK
| | - David P. J. Osborn
- Division of Psychiatry, UCL. 6th Floor Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
- Camden and Islington NHS Foundation Trust, St Pancras Hospital, 4 St Pancras Way, London, NW1 0PE, UK
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Liberman JN, Pesa J, Rui P, Teeple A, Lakey S, Wiggins E, Ahmedani B. Predicting Poor Outcomes Among Individuals Seeking Care for Major Depressive Disorder. PSYCHIATRIC RESEARCH AND CLINICAL PRACTICE 2022; 4:102-112. [PMID: 36545504 PMCID: PMC9757499 DOI: 10.1176/appi.prcp.20220011] [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: 05/18/2022] [Revised: 11/03/2022] [Accepted: 11/06/2022] [Indexed: 12/15/2022] Open
Abstract
Objective To develop and validate algorithms to identify individuals with major depressive disorder (MDD) at elevated risk for suicidality or for an acute care event. Methods We conducted a retrospective cohort analysis among adults with MDD diagnosed between January 1, 2018 and February 28, 2019. Generalized estimating equation models were developed to predict emergency department (ED) visit, inpatient hospitalization, acute care visit (ED or inpatient), partial-day hospitalization, and suicidality in the year following diagnosis. Outcomes (per 1000 patients per month, PkPPM) were categorized as all-cause, psychiatric, or MDD-specific and combined into composite measures. Predictors included demographics, medical and pharmacy utilization, social determinants of health, and comorbid diagnoses as well as features indicative of clinically relevant changes in psychiatric health. Models were trained on data from 1.7M individuals, with sensitivity, positive predictive value, and area-under-the-curve (AUC) derived from a validation dataset of 0.7M. Results Event rates were 124.0 PkPPM (any outcome), 21.2 PkPPM (psychiatric utilization), and 7.6 PkPPM (suicidality). Among the composite models, the model predicting suicidality had the highest AUC (0.916) followed by any psychiatric acute care visit (0.891) and all-cause ED visit (0.790). Event-specific models all achieved an AUC >0.87, with the highest AUC noted for partial-day hospitalization (AUC = 0.938). Select predictors of all three outcomes included younger age, Medicaid insurance, past psychiatric ED visits, past suicidal ideation, and alcohol use disorder diagnoses, among others. Conclusions Analytical models derived from clinically-relevant features identify individuals with MDD at risk for poor outcomes and can be a practical tool for health care organizations to divert high-risk populations into comprehensive care models.
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Affiliation(s)
| | | | - Pinyao Rui
- Health Analytics, LLCClarksvilleMarylandUSA
| | | | - Susan Lakey
- Janssen Scientific AffairsTitusvilleNew Jersey
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Mao AL, Tian YK, Li YN. Can community health centers improve the self-rated health of migrants? Evidence from China. Front Public Health 2022; 10:986201. [PMID: 36211663 PMCID: PMC9541740 DOI: 10.3389/fpubh.2022.986201] [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: 07/04/2022] [Accepted: 08/31/2022] [Indexed: 01/26/2023] Open
Abstract
Background Due to the "epidemiological paradox," migrants face the risk of health attrition during their migration. Meanwhile, institutional constraints cause a health gap between migrants and non-migrants. To narrow this gap and maintain equity, scholars have studied the role and impact mechanism of medical insurance participation in improving the health of migrants. However, due to the provision of China's basic medical insurance system, the proportion of migrants participating in employee medical insurance is still relatively low, while the community health center (CHC) is a more accessible medical resource for this group. Therefore, this study attempts to explore the impact of CHCs on the self-rated health (SRH) of migrants and identify the factors and mechanisms associated with such an impact. This study addresses the hypotheses whether (a) CHCs can significantly improve the SRH of migrants in China and (b) CHCs improve the SRH of migrants by promoting both their health knowledge and health behavior. Methods Data was obtained from the 2017 China Migrants Dynamic Survey (CMDS). From the survey, 127,687 migrants were identified, and a series of logit regressions were conducted to explore the correlation between CHCs and the SRH of migrants. Propensity score matching (PSM) logit was also used for the robustness tests. Results Logit estimations revealed that CHC is positively related to the SRH of migrants (OR = 1.095, p < 0.001). Compared to others, males (OR = 1.156, p < 0.001), younger people with higher education (OR = 1.027, p < 0.001), more stable employment (OR = 1.544, p < 0.001), and people with a lower proportion of elderly (> 65 years) household family members (OR = 0.842, p < 0.001) tended to have better SRH. The results also showed that the impact of CHCs on migrants' SRH varied by gender, age, and income (p < 0.001). A possible mechanism is that CHCs can improve migrants' SRH by promoting both their health knowledge and health behaviors. Conclusion Programs that strengthen health knowledge and policies to enhance access to healthcare could be prioritized to improve the SRH of migrants in China.
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Nicklas L, Albiston M, Dunbar M, Gillies A, Hislop J, Moffat H, Thomson J. A systematic review of economic analyses of psychological interventions and therapies in health-related settings. BMC Health Serv Res 2022; 22:1131. [PMID: 36071425 PMCID: PMC9450839 DOI: 10.1186/s12913-022-08158-0] [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: 10/02/2021] [Accepted: 05/31/2022] [Indexed: 11/16/2022] Open
Abstract
Background This review aims to synthesise evidence on the economic impact of psychological interventions and therapies when applied to a broad range of physical health conditions. Methods The following bibliographic databases were searched for relevant articles: MEDLINE (Ovid), EMBASE (Ovid) and PsycINFO (Ebsco). As this review was intended to update an earlier review, the date range for the search was restricted to between January 2012 and September 2018. Reference lists from the review articles were also searched for relevant articles. Study quality was evaluated using the Scottish Intercollegiate Network Guidelines (SIGN) appraisal checklists for both economic studies and Randomised Controlled Trials (RCTs). When the economic analyses did not provide sufficient detail for quality evaluation, the original RCT papers were sought and these were also evaluated. Half of the papers were quality rated by a second author. Initial agreement was high and all disagreements were resolved by discussion. Results This yielded 1408 unique articles, reduced to 134 following screening of the title and abstract. The full texts of the remaining articles were reviewed by at least one team member and all exclusions were discussed and agreed by the team. This left 46 original research articles, alongside five systematic reviews. Fifty-seven per cent of the articles were deemed to be of high quality, with the remainder of acceptable quality. Fifteen different medical conditions were covered, with chronic pain (10 articles) and cancer (9 articles) being the two most investigated health conditions. Three quarters of the papers reviewed showed evidence for the cost-effectiveness of psychological interventions in physical health, with the clearest evidence being in the field of chronic pain and cancer. Conclusions This paper provides a comprehensive integration of the research on the cost-effectiveness of psychological therapies in physical health. Whilst the evidence for cost-effectiveness in chronic pain and cancer is encouraging, some health conditions require further study. Clearly, as the primary research is international, and was therefore conducted across varying health care systems, caution must be exercised when applying the results to counties outside of those covered. Despite this, the results are of potential relevance to service providers and funders. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08158-0.
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Affiliation(s)
- Leeanne Nicklas
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK.
| | - Mairi Albiston
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | - Martin Dunbar
- Stobhill Hospital, NHS Greater Glasgow and Clyde, Glasgow, Scotland, UK
| | - Alan Gillies
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
| | | | - Helen Moffat
- NHS Grampian, Aberdeen Royal Infirmary, Aberdeen, Scotland, UK
| | - Judy Thomson
- NHS Education for Scotland, 2 Central Quay, Glasgow, Scotland, UK
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Kampling H, Kruse J, Friederich HC, Heuft G, Christoffer A, Grobe TG, Marschall U, Szecsenyi J, Wild B, Hartmann M. Evaluating effects of the structural reform of outpatient psychotherapy for patients with mental disorders in Germany: comparing patients with and without comorbid chronic physical condition - rationale and study protocol of the ES-RiP project. BMJ Open 2022; 12:e057298. [PMID: 36691158 PMCID: PMC9442475 DOI: 10.1136/bmjopen-2021-057298] [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] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 08/12/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION In 2017, in Germany, a structural reform of the outpatient psychotherapy guideline took place, aiming to reduce waiting times, to facilitate flexible low-threshold access (eg, general reachability by phone) and to lower access barriers for specific patient groups. The reform included new service elements, such as the implementation of additional psychotherapeutic consultations, acute short-term psychotherapeutic interventions and relapse prophylaxis as well as the promotion of group therapies, the facilitation of psychotherapists' availability, and the installation of appointment service centres. The ES-RiP project aims to thoroughly evaluate the effects of the reform with a special focus on patients with a comorbidity of mental disorders and chronic physical conditions (cMPs) compared with patients with a mental disorder but no long-term physical condition (MnoP). The project aims to evaluate (a) the extent to which the reform goals were achieved in the large group of patients with cMPs compared with MnoP, (b) the barriers that might hinder the implementation of the new guideline and (c) the procedures required for further developing and improving outpatient psychotherapy. METHODS AND ANALYSIS A mixed-methods design (quantitative, qualitative) along with a multilevel approach (patients, service providers, payers) triangulating several data sources (primary and secondary data) will be applied to evaluate the reform from different perspectives. ETHICS AND DISSEMINATION Ethical approval was obtained from the coordinating committee as well as one local ethics committee, Justus Liebig University Giessen and Marburg - Faculty of Medicine (approval number: AZ 107/20) and Heidelberg (approval number: S-466/2020). The results of this study will be disseminated through expert panels, conference presentations and publications in peer-reviewed journals. TRIAL REGISTRATION NUMBER DRKS00020344.
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Affiliation(s)
- Hanna Kampling
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Johannes Kruse
- Department of Psychosomatic Medicine and Psychotherapy, Justus Liebig University Giessen, Giessen, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Gereon Heuft
- Section of Psychosomatic Medicine and Psychotherapy, Clinic for Mental Health, University Hospital Munster, Munster, Germany
| | - Andrea Christoffer
- Section of Psychosomatic Medicine and Psychotherapy, Clinic for Mental Health, University Hospital Munster, Munster, Germany
| | - Thomas G Grobe
- aQua - Institute for Applied Quality Improvement and Research in Health Care GmbH, Gottingen, Germany
| | - Ursula Marschall
- Department of Medicine and Health Services Research, BARMER Institute for Health System Research, Wuppertal, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, University Hospital Heidelberg, Heidelberg, Germany
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Depression and unplanned secondary healthcare use in patients with multimorbidity: A systematic review. PLoS One 2022; 17:e0266605. [PMID: 35390086 PMCID: PMC8989325 DOI: 10.1371/journal.pone.0266605] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 03/23/2022] [Indexed: 11/19/2022] Open
Abstract
Background
Growing numbers of people with multimorbidity have a co-occurring mental health condition such as depression. Co-occurring depression is associated with poor patient outcomes and increased healthcare costs including unplanned use of secondary healthcare which may be avoidable.
Aim
To summarise the current evidence on the association between depression and unplanned secondary healthcare use among patients with multimorbidity.
Methods
We conducted a systematic review by searching MEDLINE, EMBASE, PsychINFO, Web of Science, CINAHL, and Cochrane Library from January 2000 to March 2021. We included studies on adults with depression and at least one other physical long-term condition that examined risk of emergency hospital admissions as a primary outcome, alongside emergency department visits or emergency readmissions. Studies were assessed for risk of bias using The National Institute of Health National Heart, Lung, and Blood Institute quality assessment tool. Relevant data were extracted from studies and a narrative synthesis of findings produced.
Results
Twenty observational studies were included in the review. Depression was significantly associated with different outcomes of unplanned secondary healthcare use, across various comorbidities. Among the studies examining these outcomes, depression predicted emergency department visits in 7 out of 9 studies; emergency hospital admissions in 19 out of 20 studies; and emergency readmissions in 4 out of 4 studies. This effect increased with greater severity of depression. Other predictors of unplanned secondary care reported include increased age, being female, and presence of greater numbers of comorbidities.
Conclusion
Depression predicted increased risk of unplanned secondary healthcare use in individuals with multimorbidity. The literature indicates a research gap in identifying and understanding the impact of complex multimorbidity combinations, and other patient characteristics on unplanned care in patients with depression. Findings indicate the need to improve planned care for patients with moderate-to-severe depression. We suggest regular reviews of care plans, depression severity monitoring and assessment of hospital admission risk in primary care settings.
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Coventry PA, Brown J, Pervin J, Brabyn S, Pateman R, Breedvelt J, Gilbody S, Stancliffe R, McEachan R, White P. Nature-based outdoor activities for mental and physical health: Systematic review and meta-analysis. SSM Popul Health 2021; 16:100934. [PMID: 34646931 PMCID: PMC8498096 DOI: 10.1016/j.ssmph.2021.100934] [Citation(s) in RCA: 84] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/15/2021] [Accepted: 09/27/2021] [Indexed: 12/17/2022] Open
Abstract
Mental health problems are associated with lower quality of life, increased unscheduled care, high economic and social cost, and increased mortality. Nature-based interventions (NBIs) that support people to engage with nature in a structured way are asset-based solutions to improve mental health for community based adults. However, it is unclear which NBIs are most effective, or what format and dose is most efficacious. We systematically reviewed the controlled and uncontrolled evidence for outdoor NBIs. The protocol was registered at PROSPERO (CRD42020163103). Studies that included adults (aged ≥18 years) in community-based settings with or without mental and/or physical health problems were eligible for inclusion. Eligible interventions were structured outdoor activities in green and/or blue space for health and wellbeing. We searched ASSIA, CENTRAL, Embase, Greenfile, MEDLINE, PsycINFO, and Web of Science in October 2019; the search was updated in September 2020. We screened 14,321 records and included 50 studies. Sixteen studies were randomised controlled trials (RCTs); 18 were controlled studies; and 16 were uncontrolled before and after studies. Risk of bias for RCTs was low to moderate; and moderate to high for controlled and uncontrolled studies. Random effects meta-analysis of RCTs showed that NBIs were effective for improving depressive mood -0.64 (95% CI: 1.05 to -0.23), reducing anxiety -0.94 (95% CI: 0.94 to -0.01), improving positive affect 0.95 (95% CI: 0.59 to 1.31), and reducing negative affect -0.52 (95% CI: 0.77 to -0.26). Results from controlled and uncontrolled studies largely reflected findings from RCTs. There was less evidence that NBIs improved physical health. The most effective interventions were offered for between 8 and 12 weeks, and the optimal dose ranged from 20 to 90 min. NBIs, specifically gardening, green exercise and nature-based therapy, are effective for improving mental health outcomes in adults, including those with pre-existing mental health problems.
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Affiliation(s)
- Peter A. Coventry
- Department of Health Sciences, University of York, York, YO10 5DD, UK
- York Environmental Sustainability Institute, University of York, York, YO10 5NG, UK
| | | | - Jodi Pervin
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Sally Brabyn
- Department of Health Sciences, University of York, York, YO10 5DD, UK
| | - Rachel Pateman
- Stockholm Environment Institute, Department of Environment and Geography, University of York, York, YO10 5NG, UK
| | | | - Simon Gilbody
- Department of Health Sciences, University of York, York, YO10 5DD, UK
- Hull York Medical School, University of York, York, YO10 5DD, UK
| | | | | | - PiranC.L. White
- York Environmental Sustainability Institute, University of York, York, YO10 5NG, UK
- Department of Environment and Geography, University of York, York, YO10 5NG, UK
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11
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Schäfer I, Menzel A, Oltrogge JH, Slagman A, Möckel M, Lühmann D, Scherer M. Is subjectively perceived treatment urgency of patients in emergency departments associated with self-reported health literacy and the willingness to use the GP as coordinator of treatment? Results from the multicentre, cross-sectional, observational study PiNo Bund. BMJ Open 2021; 11:e053110. [PMID: 34819288 PMCID: PMC8614139 DOI: 10.1136/bmjopen-2021-053110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Aim of this study was to analyse if subjectively perceived treatment urgency of patients in emergency departments is associated with self-reported health literacy and the willingness to use the general practitioner (GP) as coordinator of treatment. DESIGN A multicentre, cross-sectional, observational study. SETTING Emergency departments in five hospitals. Each hospital was visited 14 times representing two 8-hour shifts on each day of the week. Calendar dates were randomly assigned. PARTICIPANTS All patients of legal age registered at the emergency department or hospital reception desk. Exclusion criteria included immediate or very urgent need of treatment, high level of symptom burden and severe functional impairments in terms of hearing, vision and speech. We conducted standardised personal interviews. Additionally, clinical data were extracted from patient records. PRIMARY AND SECONDARY OUTCOME MEASURES Our target variable was subjectively perceived treatment urgency. Predictor variables included age, sex, education, health-related quality of life (EuroQol Five-Dimension Scale, value set UK), anxiety and depression (Hospital Anxiety and Depression Scale), somatic symptoms (Patient Health Questionnaire, 15 items version), self-reported health literacy (European Health Literacy Questionnaire, 16 questions version) and the commitment to the GP (Fragebogen zur Intensität der Hausarztbindung, 'F-HaBi'). Data were analysed by multilevel, multivariable linear regression adjusted for random effects at the hospital level. RESULTS Our sample comprised 276 patients with a mean age of 50.1 years and 51.8% women. A low treatment urgency (defined as 0-5 points on a Numerical Rating Scale) was reported by 111 patients (40.2%). In the final model, lower subjective treatment urgency was associated with male sex (β=0.84; 95% CI 0.11/1.57, p=0.024), higher health-related quality of life (-2.27 to -3.39/-1.15, p<0.001), lower somatic symptoms score (0.09, 0.004/0.17, p=0.040), higher anxiety score (-0.13 to -0.24/-0.01, p=0.027) and lower commitment to the GP (0.08, 0.01/0.14, p=0.029). CONCLUSIONS A lower level of subjectively perceived treatment urgency was predicted by a lower willingness to use the GP as coordinator of treatment. Self-reported health literacy did not predict the patients' urgency rating.
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Affiliation(s)
- Ingmar Schäfer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Agata Menzel
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jan Hendrik Oltrogge
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anna Slagman
- Department of Emergency and Acute Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Martin Möckel
- Department of Emergency and Acute Medicine, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Dagmar Lühmann
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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12
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Patient Activation, Depressive Symptoms, and Self-Rated Health: Care Management Intervention Effects among High-Need, Medically Complex Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18115690. [PMID: 34073277 PMCID: PMC8198245 DOI: 10.3390/ijerph18115690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 05/20/2021] [Accepted: 05/23/2021] [Indexed: 11/17/2022]
Abstract
The purpose of this randomized controlled trial (n = 268) at a Federally Qualified Health Center was to evaluate the outcomes of a care management intervention versus an attention control telephone intervention on changes in patient activation, depressive symptoms and self-rated health among a population of high-need, medically complex adults. Both groups had similar, statistically significant improvements in patient activation and self-rated health. Both groups had significant reductions in depressive symptoms over time; however, the group who received the care management intervention had greater reductions in depressive symptoms. Participants in both study groups who had more depressive symptoms had lower activation at baseline and throughout the 12 month study. Findings suggest that patients in the high-need, medically complex population can realize improvements in patient activation, depressive symptoms, and health status perceptions even with a brief telephone intervention. The importance of treating depressive symptoms in patients with complex health conditions is highlighted.
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13
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Soley-Bori M, Ashworth M, Bisquera A, Dodhia H, Lynch R, Wang Y, Fox-Rushby J. Impact of multimorbidity on healthcare costs and utilisation: a systematic review of the UK literature. Br J Gen Pract 2021; 71:e39-e46. [PMID: 33257463 PMCID: PMC7716874 DOI: 10.3399/bjgp20x713897] [Citation(s) in RCA: 109] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 06/15/2020] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Managing multimorbidity is complex for both patients and healthcare systems. Patients with multimorbidity often use a variety of primary and secondary care services. Country-specific research exploring the healthcare utilisation and cost consequences of multimorbidity may inform future interventions and payment schemes in the UK. AIM To assess the relationship between multimorbidity, healthcare costs, and healthcare utilisation; and to determine how this relationship varies by disease combinations and healthcare components. DESIGN AND SETTING A systematic review. METHOD This systematic review followed the bidirectional citation searching to completion method. MEDLINE and grey literature were searched for UK studies since 2004. An iterative review of references and citations was completed. Authors from all articles selected were contacted and asked to check for completeness of UK evidence. The National Institutes of Health National Heart, Lung, and Blood Institute quality assessment tool was used to assess risk of bias. Data were extracted, findings synthesised, and study heterogeneity assessed; meta-analysis was conducted when possible. RESULTS Seventeen studies were identified: seven predicting healthcare costs and 10 healthcare utilisation. Multimorbidity was found to be associated with increased total costs, hospital costs, care transition costs, primary care use, dental care use, emergency department use, and hospitalisations. Several studies demonstrated the high cost of depression and of hospitalisation associated with multimorbidity. CONCLUSION In the UK, multimorbidity increases healthcare utilisation and costs of primary, secondary, and dental care. Future research is needed to examine whether integrated care schemes offer efficiencies in healthcare provision for multimorbidity.
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Affiliation(s)
| | - Mark Ashworth
- King's College London, School of Population Health Sciences, London
| | | | - Hiten Dodhia
- King's College London, School of Population Health Sciences, London
| | - Rebecca Lynch
- King's College London, School of Population Health Sciences, London
| | - Yanzhong Wang
- King's College London, School of Population Health Sciences, London
| | - Julia Fox-Rushby
- King's College London, School of Population Health Sciences, London
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14
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Sveinsdóttir H, Zoëga S, Ingadóttir B, Blöndal K. Symptoms of anxiety and depression in surgical patients at the hospital, 6 weeks and 6 months postsurgery: A questionnaire study. Nurs Open 2021; 8:210-223. [PMID: 33318829 PMCID: PMC7729539 DOI: 10.1002/nop2.620] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 07/15/2020] [Accepted: 07/27/2020] [Indexed: 11/12/2022] Open
Abstract
Aims To describe prevalence of symptoms of anxiety and depression in surgical patients at three time points: at hospital postsurgery (T1), 6 weeks (T2) and 6 months (T3) postdischarge from hospital; and detect situations and experiences that predict symptoms of anxiety and depression at T2 and T3. Design Prospective, explorative two-site follow-up study. Methods Patients having selected surgeries from January-July 2016 were invited to participate. Final participation was 390 patients. Participation involved answering questionnaires, including the Hospital Anxiety and Depression Scale (HADS). A stepwise multiple linear regression model was employed to calculate predictors of anxiety and depression. Results The proportion of patients presenting with moderate-to-severe anxiety or depression ranged from 5.4%-20.2% at different times. Major predictors of anxiety at both times were not feeling rested upon awakening and higher scores on HADS-Anxiety at T1 and T2 and at T2 also experiencing more distressing postoperative symptoms. For depression, the major predictors were at both times higher scores on HADS-Depression at T2 and T3 and also at T2 not feeling rested upon awakening and at T3 reporting delayed or very delayed recovery.The four models explained from 43.9%-55.6% of the variance in symptoms of anxiety and depression. Our findings show that patients presenting with psychological distress at the hospital are in a vulnerable position. Also, that benefits of good sleep during the recovery should be emphasized during hospital stay.
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Affiliation(s)
- Herdís Sveinsdóttir
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
| | - Sigríður Zoëga
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
| | - Brynja Ingadóttir
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
| | - Katrín Blöndal
- Faculty of NursingUniversity of IcelandReykjavíkIceland
- Surgical ServicesLandspitali University HospitalReykjavíkIceland
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15
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Multimorbidity Patterns and Unplanned Hospitalisation in a Cohort of Older Adults. J Clin Med 2020; 9:jcm9124001. [PMID: 33321977 PMCID: PMC7764652 DOI: 10.3390/jcm9124001] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/04/2020] [Accepted: 12/08/2020] [Indexed: 12/16/2022] Open
Abstract
The presence of multiple chronic conditions (i.e., multimorbidity) increases the risk of hospitalisation in older adults. We aimed to examine the association between different multimorbidity patterns and unplanned hospitalisations over 5 years. To that end, 2,250 community-dwelling individuals aged 60 years and older from the Swedish National Study on Aging and Care in Kungsholmen (SNAC-K) were studied. Participants were grouped into six multimorbidity patterns using a fuzzy c-means cluster analysis. The associations between patterns and outcomes were tested using Cox models and negative binomial models. After 5 years, 937 (41.6%) participants experienced at least one unplanned hospitalisation. Compared to participants in the unspecific multimorbidity pattern, those in the cardiovascular diseases, anaemia and dementia pattern, the psychiatric disorders pattern and the metabolic and sleep disorders pattern presented with a higher hazard of first unplanned hospitalisation (hazard ratio range: 1.49–2.05; p < 0.05 for all), number of unplanned hospitalisations (incidence rate ratio (IRR) range: 1.89–2.44; p < 0.05 for all), in-hospital days (IRR range: 1.91–3.61; p < 0.05 for all), and 30-day unplanned readmissions (IRR range: 2.94–3.65; p < 0.05 for all). Different multimorbidity patterns displayed a differential association with unplanned hospital care utilisation. These findings call for a careful primary care follow-up of older adults with complex multimorbidity patterns.
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16
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Keller S, Dy S, Wilson R, Dukhanin V, Snyder C, Wu A. Selecting Patient-Reported Outcome Measures to Contribute to Primary Care Performance Measurement: a Mixed Methods Approach. J Gen Intern Med 2020; 35:2687-2697. [PMID: 32495096 PMCID: PMC7459066 DOI: 10.1007/s11606-020-05811-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/17/2020] [Indexed: 01/11/2023]
Abstract
New models of primary care include patient-reported outcome measures (PROMs) to promote patient-centered care. PROMs provide information on patient functional status and well-being, can be used to enhance care quality, and are proposed for use in assessing performance. Our objective was to identify a short list of candidate PROMs for use in primary care practice and to serve as a basis for performance measures (PMs). We used qualitative and quantitative methods to identify relevant patient-reported outcome (PRO) domains for use in performance measurement (PRO-PM) and their associated PROMs. We collected data from key informant groups: patients (n = 13; one-on-one and group interviews; concept saturation analysis), clinical thought leaders (n = 9; group discussions; thematic analysis), primary care practices representatives (n = 37; six focus groups; thematic analysis), and primary care payer representatives (n = 10; 12-question survey; frequencies of responses). We merged the key informant group information with findings from environmental literature scans. We conducted a targeted evidence review of measurement properties for candidate PROMs. We used a scoping review and key informant groups to identify PROM evaluation criteria, which were linked to the National Quality Forum measure evaluation criteria. We developed a de novo schema to score candidate PROMs against our criteria. We identified four PRO domains and 10 candidate PROMs: 3 for depressive symptoms, 2 for physical function, 3 for self-efficacy, 2 for ability to participate. Five PROMs met ≥ 70% of the evidence criteria for three PRO domains: PHQ-9 or PROMIS Depression (depression), PF-10 or PROMIS-PF (physical functioning), and PROMIS Self-Efficacy for Managing Treatments and Medications (self-efficacy). The PROMIS Ability to Participate in Social Roles and Activities met 68% of our criteria and might be considered for inclusion. Existing evidence and key informant data identified 5 candidate PROMs to use in primary care. These instruments can be used to develop PRO-PMs.
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Affiliation(s)
- San Keller
- American Institutes for Research in the Behavioral and Social Sciences, Chapel Hill, NC, USA.
| | - Sydney Dy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Renee Wilson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vadim Dukhanin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Albert Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
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17
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Hill T, Jiang Y, Friese CR, Darbes LA, Blazes CK, Zhang X. Analysis of emergency department visits for all reasons by adults with depression in the United States. BMC Emerg Med 2020; 20:51. [PMID: 32571223 PMCID: PMC7310062 DOI: 10.1186/s12873-020-00347-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 06/16/2020] [Indexed: 12/20/2022] Open
Abstract
Background We aimed to characterize Emergency Department (ED) utilization and outcomes of patients with depression seeking emergency care for all reasons. Methods Using 2014–2016 ED data from the National Hospital Ambulatory Medical Care Survey, we investigated demographics, ED resource utilization, clinical characteristics, and disposition of patients with depression versus those without depression. Results Approximately 10,626,184 (11.4%) out of 92,899,685 annual ED visits were by patients with depression. ED patients with depression were mostly non-Hispanic White (74.0%) and were less likely to be male than patients without depression (aOR: 0.62; [95%] CI: 0.57–0.68). ED patients with depression were more likely to be admitted to the hospital (aOR: 1.50; CI: 1.38–1.63) than patients without depression. Among ED patients with depression, males were more likely than females to be seeking emergency care for psychiatric reasons (OR: 2.45; 95% CI: 2.10–2.87)) and to present with overdose/poisoning (OR: 1.46; CI: 1.03–2.05). Conclusions We described the unique demographic, socioeconomic, and clinical characteristics of ED patients with depression, using the most comprehensive, nationally representative study to date. We revealed notable gender disparities in rates and reasons for admissions. The higher hospital and ICU admission rates of ED patients with depression suggests this population requires a higher level of emergency care, for reasons that remain poorly understood.
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Affiliation(s)
- Tyler Hill
- Department of Psychology, University of Michigan College of Literature, Science, and the Arts, Ann Arbor, MI, USA.,Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Room 1177, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA
| | - Yun Jiang
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Room 1177, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA
| | - Christopher R Friese
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Room 1177, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - Christopher K Blazes
- Department of Emergency Medicine, University of Michigan School of Medicine, Ann Arbor, MI, USA.,Department of Psychiatry, University of Michigan School of Medicine, Ann Arbor, MI, USA
| | - Xingyu Zhang
- Department of Systems, Populations, and Leadership, University of Michigan School of Nursing, Room 1177, 400 North Ingalls Building, Ann Arbor, MI, 48109-5482, USA.
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18
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Bowen ME, Gaynor B, Phillips LJ, Orsega-Smith E, Lavery A, Mitchell AB, Basehore HK. Factors Associated With Health Service Use Among Older Adults in a Mobile Veterans Program. J Gerontol Nurs 2020; 46:15-22. [PMID: 32324891 DOI: 10.3928/00989134-20200313-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 12/03/2019] [Indexed: 11/20/2022]
Abstract
The current retrospective, longitudinal study applied Andersen's Behavioral Model of Health Services Use to examine how demographic characteristics (age), available resources (e.g., a caregiver, the Mobile Veterans Program [MVP]) and health needs (e.g., cognitive and physical functioning, depressive symptoms) affect hospitalization and institutionalization outcomes among older adults using the MVP. Fifty-four Veterans (age 55 to 95) participating in the MVP for up to 2 years were examined using hierarchical linear modeling (HLM) and growth curve model. In the final HLM model, each 1-point increase in depressive symptoms was associated with 76% (p ≤ 0.05) greater risk of institutionalization and 40% (p ≤ 0.01) greater risk of hospitalization. Each 1-point increase in cognitive functioning was associated with 24% (p ≤ 0.05) lower risk of institutionalization. The relationship between caregiver burden and hospitalization was attenuated by frequency of MVP visits. Services focused on reducing depressive symptoms may influence health service use and reduce caregiver burden in this population. [Journal of Gerontological Nursing, 46(5), 15-22.].
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19
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Blakemore A, Dickens C, Chew-Graham CA, Afzal CW, Tomenson B, Coventry PA, Guthrie E. Depression predicts emergency care use in people with chronic obstructive pulmonary disease: a large cohort study in primary care. Int J Chron Obstruct Pulmon Dis 2019; 14:1343-1353. [PMID: 31388297 PMCID: PMC6607976 DOI: 10.2147/copd.s179109] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/18/2019] [Indexed: 11/24/2022] Open
Abstract
Background: Depression is common in people with chronic obstructive pulmonary disease (COPD) and has been associated with a variety of poor outcomes. A large proportion of health care costs in the UK are spent on emergency care. This study examined the prospective relationship between depression and use of emergency care in patients with COPD managed in primary care. Methods: This was a twelve-month, prospective longitudinal study of 355 patients with COPD in six primary care practices in the UK. Baseline measures included demographic characteristics, depression and anxiety, severity of COPD, presence or absence of other chronic diseases, and prior use of emergency care. Outcome measures were (a) number of emergency department (ED) visits; or (b) an emergency hospital admission in the follow-up year. Results: Older age, number of comorbid physical health conditions, severity of COPD, prior use of emergency care, and depression were all independently associated with both ED attendance and an emergency hospital admission in the follow-up year. Subthreshold depression (HADS depression score 4–7) was associated with a 2.8 times increased odds of emergency hospital admission, and HADS depression >8 was associated with 4.8 times increased odds. Conclusion: Depression is a predictor of emergency care in COPD, independent of severity of disease or physical comorbidity. Even mild (subthreshold) symptoms of depression more than double the risk of using emergency care, suggesting there is a strong case to develop and deploy integrated preventive strategies in primary care that can promote mental health in people with COPD.
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Affiliation(s)
- A Blakemore
- Division of Nursing, Social Work and Midwifery, School of Health Sciences, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - C Dickens
- University of Exeter Medical School, Exeter, St Luke's Campus , Exeter, UK
| | - C A Chew-Graham
- Research Institute, Primary Care and Health Sciences, West Midlands CLAHRC, Keele, University, Newcastle, UK
| | - C W Afzal
- Health Innovation Manchester, Greater Manchester's Academic Health Science Network, Manchester Academic Health Science Centre, Manchester, UK
| | - B Tomenson
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - P A Coventry
- Department of Health Sciences, University of York, York, UK
| | - E Guthrie
- Leeds Institute of Health Sciences, Faculty of Medicine and Health, University of Leeds, Leeds, UK
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20
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Larsen M, Strumse Y, Borge C, Osborne R, Andersen M, Wahl A. Health literacy: a new piece of the puzzle in psoriasis care? A cross‐sectional study. Br J Dermatol 2019; 180:1506-1516. [DOI: 10.1111/bjd.17595] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2018] [Indexed: 12/26/2022]
Affiliation(s)
- M.H. Larsen
- Department of Health Sciences Institute of Health and Society Faculty of Medicine University of Oslo OsloNorway
| | - Y.A.S. Strumse
- Section for Climate Therapy Oslo University Hospital Oslo Norway
| | - C.R. Borge
- Department of Health Sciences Institute of Health and Society Faculty of Medicine University of Oslo OsloNorway
- Department of Patient Safety and Research at Lovisenberg Diaconal Hospital OsloNorway
| | - R. Osborne
- Deakin University Faculty of Health School of Health and Social Development Geelong VICAustralia
| | - M.H. Andersen
- Department of Health Sciences Institute of Health and Society Faculty of Medicine University of Oslo OsloNorway
- Department of Transplantation Medicine Oslo University Hospital Oslo Norway
| | - A.K. Wahl
- Department of Health Sciences Institute of Health and Society Faculty of Medicine University of Oslo OsloNorway
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21
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Long H, Howells K, Peters S, Blakemore A. Does health coaching improve health-related quality of life and reduce hospital admissions in people with chronic obstructive pulmonary disease? A systematic review and meta-analysis. Br J Health Psychol 2019; 24:515-546. [PMID: 31033121 PMCID: PMC6767143 DOI: 10.1111/bjhp.12366] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2018] [Revised: 03/04/2019] [Indexed: 11/29/2022]
Abstract
Purpose To systematically review the evidence for health coaching as an intervention to improve health‐related quality of life (HRQoL) and reduce hospital admissions in people with chronic obstructive pulmonary disease (COPD). Methods We systematically searched MEDLINE, EMBASE, PsycINFO, and CINAHL from database inception to August 2018 to identify all randomized controlled trials (RCTs) of health coaching for people with COPD. Eligible health coaching interventions had to include three components: goal setting, motivational interviewing, and COPD‐related health education. Data were extracted on study characteristics and the effects of the intervention on HRQoL, hospital admissions, physical activity, self‐care behaviour, and mood. Study quality was appraised by two authors using the Cochrane tool for assessing the risk of bias in RCTs. Effect sizes (standardized mean differences [SMD] or odds ratios [OR]) with 95% confidence intervals (CIs) were calculated and pooled using random effects meta‐analyses. Results Of 1578 articles, 10 RCTs were included. Meta‐analysis showed that health coaching has a significant positive effect on HRQoL (SMD = −0.69, 95% CI: −1.28, −0.09, p = .02, from k = 4) and leads to a significant reduction in COPD‐related hospital admissions (OR = 0.46, 95% CI: 0.31, 0.69, p = .0001, from k = 5), but not in all‐cause hospital admissions (OR = 0.70, 95% CI: 0.41–1.12, p = .20, from k = 3). Three of four studies reported significant improvements to self‐care behaviours such as medication adherence and exercise compliance. Conclusions This is the first systematic review to show that health coaching may be a candidate intervention to improve HRQoL and reduce costly hospital admissions in people with COPD. Statement of contribution What is already known on this subject? COPD is a leading cause of death worldwide and considerably reduces HRQoL. In turn, HRQoL is associated with a range of adverse health outcomes in COPD. Health coaching is a self‐management intervention for people with long‐term conditions such as COPD. Studies have examined whether health coaching improves HRQOL and other health outcomes in people with COPD, but no systematic review has been conducted.
What does this study add? The first systematic review and meta‐analysis of RCTs of health coaching for people with COPD. Health coaching may be a candidate intervention for improving HRQoL and reducing COPD‐related hospital admissions in people with COPD. The need to establish the most effective health coaching components, delivery modality, and economic impact.
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Affiliation(s)
- Hannah Long
- Manchester Centre of Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Kelly Howells
- National Institute for Health Research, School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, UK
| | - Sarah Peters
- Manchester Centre of Health Psychology, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, UK
| | - Amy Blakemore
- Division of Nursing, Social Work and Midwifery, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester and Manchester Academic Health Science Centre, UK
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22
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Rancans E, Trapencieris M, Ivanovs R, Vrublevska J. Validity of the PHQ-9 and PHQ-2 to screen for depression in nationwide primary care population in Latvia. Ann Gen Psychiatry 2018; 17:33. [PMID: 30083220 PMCID: PMC6071402 DOI: 10.1186/s12991-018-0203-5] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 07/27/2018] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Depression is highly underdiagnosed in primary care settings in Latvia. Screening for depression in primary care is potentially an efficient way to find undetected case s and improve diagnostics. We aimed to validate both a nine-item and two-item Patient Health Questionnaire (PHQ-9 and PHQ-2) in the Latvian and Russian languages in primary care settings using a representative sample in Latvia. MATERIALS AND METHODS The study was carried out within the framework of the National Research Program BIOMEDICINE to assess the prevalence of mental disorders at 24 primary care facilities. During a 1-week period, all consecutive adult patients were invited to complete the PHQ-9 and PHQ-2. Criterion validity was assessed against the Mini International Neuropsychiatric Interview (MINI). RESULTS There were 1467 patients who completed the PHQ-9 and the MINI. Overall, the PHQ-9 items showed good internal reliability (Cronbach's alpha 0.81 for Latvian version and 0.79 for Russian version of the PHQ-9). A cut-off score of 8 or greater was established for the PHQ-9 (sensitivity 0.75 and 0.79, specificity 0.84 and 0.80 for Latvian and Russian languages, respectively). For the PHQ-2, a score of 2 or higher (sensitivity 0.79 and 0.79, specificity 0.65 and 0.67 for Latvian and Russian languages) detected more cases of depression than a score of 3 or higher. CONCLUSIONS We suggest GPs ask patients to respond to the first 2 questions of the PHQ-9. If their score is positive, the patients should then complete the PHQ-9.
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Affiliation(s)
- Elmars Rancans
- Department of Psychiatry and Narcology, Riga Stradins University, Tvaika Street 2, Riga, 1005 Latvia
| | - Marcis Trapencieris
- Institute of Philosophy and Sociology, University of Latvia, Kalpaka bulv. 4, Riga, Latvia
| | - Rolands Ivanovs
- Department of Psychiatry and Narcology, Riga Stradins University, Tvaika Street 2, Riga, 1005 Latvia
| | - Jelena Vrublevska
- Department of Psychiatry and Narcology, Riga Stradins University, Tvaika Street 2, Riga, 1005 Latvia
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Depression and Associated Factors among Adult Inpatients at Public Hospitals of Harari Regional State, Eastern Ethiopia. PSYCHIATRY JOURNAL 2018; 2018:6743520. [PMID: 29805969 PMCID: PMC5899879 DOI: 10.1155/2018/6743520] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 02/15/2018] [Indexed: 11/24/2022]
Abstract
Introduction Globally, depression is one of the three leading causes of disease and it will be the second leading cause of world disability by 2030. The prevalence of depression in Sub-Saharan Africa ranges from 15 to 30%. In Ethiopia, depression was found to be the seventh leading cause of disease burden and its prevalence has been increased in hospital compared to community setting because hospital environment itself is stressful. Yet, no study was done in Eastern Ethiopia, where substance use like Khat is very rampant. Objective To assess depression and associated factors among adult inpatients at public hospitals of Harari Regional State, Eastern Ethiopia, from February 01 to 28, 2017. Methodology Hospital based cross-sectional study design was employed on 492 admitted adult patients in Harari region hospitals. Consecutive sampling method was used to include study population. The data were collected by interviewee and analyzed by SPSS version 20.0. Bivariate and multivariate logistic regression analyses were employed. p value of 0.05 or less was considered to be statistically significant. Result A total of 489 patients were interviewed with response rate of 99.4%. Having duration of 1-2 weeks in the hospital [AOR = 2.02, 95% CI: (1.28, 3.19)], being diagnosed with chronic morbidity [AOR = 4.06, 95% CI: (2.23, 7.40)], being users of psychoactive drugs [AOR = 2.24, 95% CI: (1.18, 4.24)], and having been admitted to surgical ward [AOR = 0.50, 95% CI: (0.31, 0.81)] were significantly associated with depression. Conclusion and Recommendation Prevalence of depression among admitted inpatients was high. Therefore, increasing the awareness of benefits of early diagnosis of patients to prevent major form of depression and strengthening the clinical set-up and establishing good referral linkage with mental health institutions was considered to be cost-effective method to reduce its prevalence.
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Costa-Font J, Jimenez-Martin S, Vilaplana C. Does long-term care subsidization reduce hospital admissions and utilization? JOURNAL OF HEALTH ECONOMICS 2018; 58:43-66. [PMID: 29408154 DOI: 10.1016/j.jhealeco.2018.01.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2017] [Revised: 10/19/2017] [Accepted: 01/13/2018] [Indexed: 05/25/2023]
Abstract
We use quasi-experimental evidence on the expansion of the public subsidization of long-term care to examine the causal effect of a change in caregiving affordability on the delivery of hospital care. More specifically, we examine a reform that both introduced a new caregiving allowance and expanded the availability of publicly funded home care services, on both hospital admissions (both on the internal and external margin) and length of stay. We find robust evidence of a reduction in both hospital admissions and utilization among both those receiving a caregiving allowance and, albeit less intensely, among beneficiaries of publicly funded home care, which amounts to 11% of total healthcare costs. These effects were stronger when regions had an operative regional health and social care coordination plan in place. Consistently, a subsequent reduction in the subsidy, five years after its implementation, is found to significantly attenuate such effects. We investigate a number of potential mechanisms, and show a number of falsification and robustness checks.
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Affiliation(s)
- Joan Costa-Font
- London School of Economics and Political Science (LSE) & CESifo & IZA, United Kingdom.
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25
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Ricketts T, Wood E, Soady J, Saxon D, Hulin J, Ohlsen S, Mitchell C. The effect of comorbid depression on the use of unscheduled hospital care by people with a long term condition: A retrospective observational study. J Affect Disord 2018; 227:366-371. [PMID: 29149754 DOI: 10.1016/j.jad.2017.10.029] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 10/04/2017] [Accepted: 10/18/2017] [Indexed: 11/18/2022]
Abstract
BACKGROUND The prevalence of long-term conditions (LTCs) and multiple-morbidity is increasing. Depression prevalence increases with the number of LTCs. Self-management of LTCs improves outcomes, but depression impacts on self-management. Unscheduled hospital care may be a proxy for failure of planned care to support successful self-management. METHODS Retrospective observational study based on routine NHS datasets covering 19 LTCs. Prevalence of LTCs and depression was identified in all primary care registered adults in one English city (n = 469,368). Chi squared was used for hypothesis testing, and logistic regression to determine the influence of depression and LTC(s) on the use of unscheduled hospital care. RESULTS At least one LTC was identified in 220,010 (46.9%) adults; 75,107 (16.0%) had depression; and 38,232 (8.1%) had LTC plus comorbid depression. A significantly greater proportion of individuals with LTC and comorbid depression had ≥ 1 unscheduled event over 12 months (31.5%) compared to individuals with LTC(s) only (24.0%), X2(1) = 883.860, p < .001. The logistic regression model explained 4.4% of the variation in unscheduled care use. Individuals with depression plus ≥ 1 LTC were 1.59 times more likely to use unscheduled hospital care than individuals with LTC only (p < .001), after controlling for deprivation, age and number of LTCs. LIMITATIONS Cross-sectional data precluded identification of the direction of influence between LTCs and depression. Only 19 major LTCs were studied, so overall LTC prevalence will be under-represented, and other significant predictors may be omitted. CONCLUSION In people with a LTC, comorbidity with depression increases use of unscheduled hospital care.
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Affiliation(s)
| | | | | | | | - Joe Hulin
- University of Sheffield, United Kingdom
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26
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Panagioti M, Skevington SM, Hann M, Howells K, Blakemore A, Reeves D, Bower P. Effect of health literacy on the quality of life of older patients with long-term conditions: a large cohort study in UK general practice. Qual Life Res 2018; 27:1257-1268. [PMID: 29322478 PMCID: PMC5891567 DOI: 10.1007/s11136-017-1775-2] [Citation(s) in RCA: 44] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2017] [Indexed: 12/21/2022]
Abstract
Purpose The levels of health literacy in patients with long-term conditions (LTCs) are critical for better disease management and quality of life (QoL). However, the impact of health literacy on QoL in older adults with LTCs is unclear. This study examined the association between health literacy and domains of QoL in older people with LTCs, investigating key socio-demographic and clinical variables, as confounders. Methods A prospective cohort study was conducted on older adults (n = 4278; aged 65 years and over) with at least one LTC, registered in general practices in Salford, UK. Participants completed measures of health literacy, QoL, multi-morbidity, depression, social support, and socio-demographic characteristics. Multivariate linear regressions were performed to examine the effects of health literacy on four QoL domains at baseline, and then changes in QoL over 12 months. Results At baseline, poor health literacy was associated with lower scores in all four QoL domains (physical, psychological, social relationships and environment), after adjusting for the effects of multi-morbidity, depression, social support and socio-demographic factors. At 12-month follow-up, low health literacy significantly predicted declines in the physical, psychological and environment domains of QoL, but not in social relationships QoL. Conclusions This is the largest, most complete assessment of the effects of health literacy on QoL in older adults with LTCs. Low health literacy is an independent indicator of poor QoL older patients with LTCs. Interventions to improve health literacy in older people with LTCs are encouraged by these findings.
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Affiliation(s)
- Maria Panagioti
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Suzanne M. Skevington
- Division of Psychological Sciences and Mental Health, Manchester Centre for Health Psychology and International Hub for Quality of Life Research, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Mark Hann
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Kelly Howells
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Amy Blakemore
- Division of Nursing, Social Work and Midwifery, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - David Reeves
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
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27
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Liu Q, Li YX, Hu ZH, Jiang XY, Li SJ, Wang XF. Reduced estimated glomerular filtration rate is associated with depressive symptoms in elder Chinese: A population-based cross-sectional study. Neurosci Lett 2017; 666:127-132. [PMID: 29269122 DOI: 10.1016/j.neulet.2017.12.029] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 12/12/2017] [Accepted: 12/13/2017] [Indexed: 01/26/2023]
Abstract
Depression has been associated with chronic kidney disease (CKD). However, few studies have examined whether such association exist in average older individuals with mild to moderate reduced kidney function. This study investigated the association between reduced estimated glomerular filtration rate (eGFR) and depressive symptoms in Chinese older population. Data was obtained from the Rugao Longevity and Ageing Study conducted in Jiangsu, China. Cockcroft-Gault (CG) equation was used to calculate eGFR. Depressive symptoms were defined by using Chinese version of 15-item Geriatric Depression Scale (GDS-15). The prevalence of depressive symptoms was 9.9% among 1749 elderly participants aged 70-84 years. Many elderly had a mild to moderate reduced renal function (84.3%, 57.1% in stage2 CKD and 27.2% in stage3 CKD, respectively). The overall GDS-15 score showed an upward trend with decreasing of eGFR (p < 0.05). Furthermore, a moderate decline of eGFR (in stage3 CKD) was significantly associated with increased risk of depressive symptoms even after adjusting for confounders (OR = 1.71, 95%CI 1.05-2.77, P = 0.03). Elder had no depressive symptoms if their eGFR was normal or mildly reduced. Our results suggest that a moderate decrease of eGFR (stage3 CKD) was independently associated with depressive symptoms in general Chinese elderly.
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Affiliation(s)
- Qian Liu
- Department of Neurology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China
| | - Yan-Xun Li
- Department of Neurology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China
| | - Zhi-Hao Hu
- Department of Neurology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China
| | - Xiao-Yan Jiang
- Department of Pathology and Pathophysiology, School of Medicine, Tongji University, Shanghai 200092, China
| | - Shu-Juan Li
- Department of Neurology, Beijing Chao-yang Hospital, Capital Medical University, Beijing 100020, China.
| | - Xiao-Feng Wang
- College of Life Sciences, Fudan University, Shanghai 200433, China.
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Rogal SS, Udawatta V, Akpan I, Moghe A, Chidi A, Shetty A, Szigethy E, Bielefeldt K, DiMartini A. Risk factors for hospitalizations among patients with cirrhosis: A prospective cohort study. PLoS One 2017; 12:e0187176. [PMID: 29149171 PMCID: PMC5693413 DOI: 10.1371/journal.pone.0187176] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 10/14/2017] [Indexed: 12/13/2022] Open
Abstract
This study was designed to assess unique baseline factors associated with subsequent hospitalizations in a cohort of outpatients with cirrhosis. A cohort of 193 patients with cirrhosis was recruited from an outpatient liver disease clinic at a single, tertiary medical center. Comorbidities, prescription medications, liver disease symptoms and severity, and psychiatric and pain symptoms were assessed at baseline using validated instruments. Inflammatory markers were measured using standardized Luminex assays. Subsequent hospitalizations and the primary admission diagnoses were collected via chart review. Multivariable models were used to evaluate which baseline factors were associated with time to hospitalization and number of hospitalizations. The cohort consisted of 193 outpatients, with an average age of 58±9 and model for end-stage liver disease (MELD) score of 12±5. Over follow-up, 57 (30%) were admitted to the hospital. The factors associated with time to hospitalization included the severity of liver disease (HR/MELD point:1.10, 95% CI:1.04,1.16), ascites (HR: 1.90, 95% CI: 1.01, 3.58), baseline symptoms of depression (HR:2.34, 95% CI:1.28,4.25), sleep medications (HR:1.81, 95% CI:1.01, 3.22) and IL-6 (HR:1.43, 95% CI: 1.10, 1.84). Similarly the number admissions was significantly associated with MELD (IIR: 1.08, CI: 1.07,1.09), ascites (IIR: 4.15, CI:3.89, 4.43), depressive symptoms (IIR:1.54, CI:1.44,1.64), IL-6 (IIR:1.26, CI:1.23,1.30), sleep medications (IIR:2.74, CI:2.57, 2.93), and widespread pain (IIR: 1.61, CI: 1.50, 1.73). In conclusion, consistent with prior studies, MELD and ascites were associated with subsequent hospitalization. However, this study also identified other factors associated with hospitalization including inflammation, depressive symptoms, sleep medication use, and pain.
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Affiliation(s)
- Shari S. Rogal
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
- * E-mail:
| | - Viyan Udawatta
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Imo Akpan
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Akshata Moghe
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Alexis Chidi
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, United States of America
- Division of General Internal Medicine, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Amit Shetty
- University of Pittsburgh, School of Medicine, Pittsburgh, PA, United States of America
| | - Eva Szigethy
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Klaus Bielefeldt
- Division of Gastroenterology, Hepatology, and Nutrition, University of Pittsburgh, Pittsburgh, PA, United States of America
| | - Andrea DiMartini
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, United States of America
- Department of Psychiatry, University of Pittsburgh, Pittsburgh, PA, United States of America
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Yin H, Wu Q, Cui Y, Hao Y, Liu C, Li Y, Liang L, Wang L, Tao Y. Socioeconomic status and prevalence of chronic non-communicable diseases in Chinese women: a structural equation modelling approach. BMJ Open 2017; 7:e014402. [PMID: 28827232 PMCID: PMC5724228 DOI: 10.1136/bmjopen-2016-014402] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Revised: 03/13/2017] [Accepted: 03/29/2017] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To investigate the role of socioeconomic status (SES) in chronic non-communicable diseases (NCDs) and offer theoretical evidence for the prevention and control of NCDs. DESIGN Cross-sectional survey and structural equation modelling. SETTING Nationwide, China. PARTICIPANTS Female participants in the 2008 National Health Services Survey in China who were 15 years and older. RESULTS SES factors were associated with the increased risk of NCDs in Chinese women. Education was identified as the most important factor with a protective role (factor loading=-0.115) for NCDs. Income mainly affected NCDs directly, whereas occupation mainly affected NCDs indirectly. The effects of SES on NCDs were more significant than that of smoking. Medical insurance, smoking and self-reported health played a mediating role in the correlations between those SES factors and NCDs. CONCLUSIONS In China, socioeconomic disparities associated with the prevalence of NCDs exist among women. Educational and social interventions are needed to mitigate their negative consequences on health outcomes in Chinese women.
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Affiliation(s)
- Hui Yin
- Department of Health Education, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Qunhong Wu
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Yu Cui
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Yanhua Hao
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Chaojie Liu
- School of Psychology and Public Health, La Trobe University, Melbourne, Australia
| | - Ye Li
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Libo Liang
- Department of Social Medicine, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Limin Wang
- Department of Health Education, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
| | - Yuchun Tao
- Department of Health Education, School of Public Health, Harbin Medical University, Harbin, People’s Republic of China
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Guthrie E, Afzal C, Blakeley C, Blakemore A, Byford R, Camacho E, Chan T, Chew-Graham C, Davies L, de Lusignan S, Dickens C, Drinkwater J, Dunn G, Hunter C, Joy M, Kapur N, Langer S, Lovell K, Macklin J, Mackway-Jones K, Ntais D, Salmon P, Tomenson B, Watson J. CHOICE: Choosing Health Options In Chronic Care Emergencies. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundOver 70% of the health-care budget in England is spent on the care of people with long-term conditions (LTCs), and a major cost component is unscheduled health care. Psychological morbidity is high in people with LTCs and is associated with a range of adverse outcomes, including increased mortality, poorer physical health outcomes, increased health costs and service utilisation.ObjectivesThe aim of this programme of research was to examine the relationship between psychological morbidity and use of unscheduled care in people with LTCs, and to develop a psychosocial intervention that would have the potential to reduce unscheduled care use. We focused largely on emergency hospital admissions (EHAs) and attendances at emergency departments (EDs).DesignA three-phase mixed-methods study. Research methods included systematic reviews; a longitudinal prospective cohort study in primary care to identify people with LTCs at risk of EHA or ED admission; a replication study in primary care using routinely collected data; an exploratory and feasibility cluster randomised controlled trial in primary care; and qualitative studies to identify personal reasons for the use of unscheduled care and factors in routine consultations in primary care that may influence health-care use. People with lived experience of LTCs worked closely with the research team.SettingPrimary care. Manchester and London.ParticipantsPeople aged ≥ 18 years with at least one of four common LTCs: asthma, coronary heart disease, chronic obstructive pulmonary disease (COPD) and diabetes. Participants also included health-care staff.ResultsEvidence synthesis suggested that depression, but not anxiety, is a predictor of use of unscheduled care in patients with LTCs, and low-intensity complex interventions reduce unscheduled care use in people with asthma and COPD. The results of the prospective study were that depression, not having a partner and life stressors, in addition to prior use of unscheduled care, severity of illness and multimorbidity, were independent predictors of EHA and ED admission. Approximately half of the cost of health care for people with LTCs was accounted for by use of unscheduled care. The results of the replication study, carried out in London, broadly supported our findings for risk of ED attendances, but not EHAs. This was most likely due to low rates of detection of depression in general practitioner (GP) data sets. Qualitative work showed that patients were reluctant to use unscheduled care, deciding to do so when they perceived a serious and urgent need for care, and following previous experience that unscheduled care had successfully and unquestioningly met similar needs in the past. In general, emergency and primary care doctors did not regard unscheduled care as problematic. We found there are missed opportunities to identify and discuss psychosocial issues during routine consultations in primary care due to the ‘overmechanisation’ of routine health-care reviews. The feasibility trial examined two levels of an intervention for people with COPD: we tried to improve the way in which practices manage patients with COPD and developed a targeted psychosocial treatment for patients at risk of using unscheduled care. The former had low acceptability, whereas the latter had high acceptability. Exploratory health economic analyses suggested that the practice-level intervention would be unlikely to be cost-effective, limiting the value of detailed health economic modelling.LimitationsThe findings of this programme may not apply to all people with LTCs. It was conducted in an area of high social deprivation, which may limit the generalisability to more affluent areas. The response rate to the prospective longitudinal study was low. The feasibility trial focused solely on people with COPD.ConclusionsPrior use of unscheduled care is the most powerful predictor of unscheduled care use in people with LTCs. However, psychosocial factors, particularly depression, are important additional predictors of use of unscheduled care in patients with LTCs, independent of severity and multimorbidity. Patients and health-care practitioners are unaware that psychosocial factors influence health-care use, and such factors are rarely acknowledged or addressed in consultations or discussions about use of unscheduled care. A targeted patient intervention for people with LTCs and comorbid depression has shown high levels of acceptability when delivered in a primary care context. An intervention at the level of the GP practice showed little evidence of acceptability or cost-effectiveness.Future workThe potential benefits of case-finding for depression in patients with LTCs in primary care need to be evaluated, in addition to further evaluation of the targeted patient intervention.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.
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Affiliation(s)
- Elspeth Guthrie
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Cara Afzal
- Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK
- Greater Manchester Academic Health Science Network (GM AHSN), Manchester, UK
| | - Claire Blakeley
- Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
| | - Amy Blakemore
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Rachel Byford
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Elizabeth Camacho
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Health Economics, Institute for Population Health, University of Manchester, Manchester, UK
| | - Tom Chan
- Department of Health Care Management and Policy, University of Surrey, Guildford, UK
| | - Carolyn Chew-Graham
- Research Institute, Primary Care and Health Sciences, Keele University, Keele, UK
| | - Linda Davies
- Centre for Health Economics, Institute for Population Health, University of Manchester, Manchester, UK
| | - Simon de Lusignan
- Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Chris Dickens
- Institute of Health Research, Medical School, University of Exeter, Exeter, UK
- Peninsula Collaboration for Leadership in Health Research and Care (PenCLAHRC), University of Exeter, Exeter, UK
| | | | - Graham Dunn
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Cheryl Hunter
- Health Services Research Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Mark Joy
- Faculty of Science, Engineering and Computing, Kingston University, London, UK
| | - Navneet Kapur
- Manchester Academic Health Science Centre, Manchester, UK
- Institute of Brain, Behaviour and Mental Health, University of Manchester, Manchester, UK
| | - Susanne Langer
- Department of Psychology, Manchester Metropolitan University, Manchester, UK
| | - Karina Lovell
- Manchester Academic Health Science Centre, Manchester, UK
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | | | - Kevin Mackway-Jones
- Manchester Academic Health Science Centre, Manchester, UK
- Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - Dionysios Ntais
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Health Economics, Institute for Population Health, University of Manchester, Manchester, UK
| | - Peter Salmon
- Department of Psychological Sciences, University of Liverpool, Liverpool, UK
| | - Barbara Tomenson
- Manchester Academic Health Science Centre, Manchester, UK
- Centre for Biostatistics, Institute of Population Health, University of Manchester, Manchester, UK
| | - Jennifer Watson
- Manchester Mental Health and Social Care Trust, Manchester Royal Infirmary, Manchester, UK
- Manchester Academic Health Science Centre, Manchester, UK
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Panagioti M, Blakeman T, Hann M, Bower P. Patient-reported safety incidents in older patients with long-term conditions: a large cross-sectional study. BMJ Open 2017; 7:e013524. [PMID: 28559454 PMCID: PMC5729978 DOI: 10.1136/bmjopen-2016-013524] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Increasing evidence suggests that patient safety is a serious concern for older patients with long-term conditions. Despite this, there is a lack of research on safety incidents encountered by this patient group. In this study, we sought to examine patient reports of safety incidents and factors associated with reports of safety incidents in older patients with long-term conditions. METHODS The baseline cross-sectional data from a longitudinal cohort study were analysed. Older patients (n=3378 aged 65 years and over) with a long-term condition registered in general practices were included in the study. The main outcome was patient-reported safety incidents including availability and appropriateness of medical tests and prescription of wrong types or doses of medication. Binary univariate and multivariate logistic regression analyses were undertaken to examine factors associated with patient-reported safety incidents. RESULTS Safety incidents were reported by 11% of the patients. Four factors were significantly associated with patient-reported safety incidents in multivariate analyses. The experience of multiple long-term conditions (OR=1.09, 95% CI 1.05 to 1.13), a probable diagnosis of depression (OR=1.36, 95% CI 1.06 to 1.74) and greater relational continuity of care (OR=1.28, 95% CI 1.08 to 1.52) were associated with increased odds for patient-reported safety incidents. Perceived greater support and involvement in self-management was associated with lower odds for patient-reported safety incidents (OR=0.95, 95% CI 0.93 to 0.97). CONCLUSIONS We found that older patients with multimorbidity and depression are more likely to report experiences of patient safety incidents. Improving perceived support and involvement of patients in their care may help prevent patient-reported safety incidents.
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Affiliation(s)
- Maria Panagioti
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Thomas Blakeman
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Mark Hann
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Peter Bower
- NIHR School for Primary Care Research Centre for Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre (Greater Manchester PSTRC), Manchester Academic Health Science Centre University of Manchester, Manchester, UK
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Hung MS, Chen IC, Lee CP, Huang RJ, Chen PC, Tsai YH, Yang YH. Incidence and risk factors of depression after diagnosis of lung cancer: A nationwide population-based study. Medicine (Baltimore) 2017; 96:e6864. [PMID: 28489782 PMCID: PMC5428616 DOI: 10.1097/md.0000000000006864] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
This study aimed to explore the incidence and risk factors of depression after lung cancer diagnosis. Using the Taiwan National Health Insurance Research Database (NHIRD), incidences and risk factors of depression in lung cancer and nonlung cancer cohorts were analyzed.From 1998 to 2006, a total of 22,125 patients were included in each matched cohort of lung cancer and nonlung cancer patients from NHIRD. The incidence of depression was higher in the lung cancer cohort than in the nonlung cancer cohort (1545.8 vs 1366.6 per 100,000 person-years). An increased risk of depression was observed in the lung cancer cohort [adjusted hazard ratio (aHR): 1.16, 95% confidence interval (95% CI): 1.01-1.34, P = .0377]. In lung cancer patients, age ≤50 years (aHR: 2.72, 95% CI: 2.02-3.66, P < .0001), age 50 to 69 years (aHR: 2.34, 95% CI: 1.87-2.94, P < .0001), female gender (aHR: 1.50, 95% CI: 1.26-1.80, P < .0001), coronary artery disease (CAD) (aHR: 1.40, 95% CI: 1.08-1.82, P = .0113), and operation (aHR: 1.78, 95% CI: 1.46-2.16, P < .0001) were associated with an increased risk of depression. In addition, higher incidences of emergency room (ER) visit (4.76 vs 2.82, per person-year) and admission (5.73 vs 4.33, per person-year) were observed in lung cancer patients with depression than those without depression.Our results showed that early surveillance and intervention of depression should be advocated after a diagnosis of lung cancer.
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Affiliation(s)
- Ming-Szu Hung
- Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi City
- Department of Medicine, College of Medicine, Chang Gung University, Taoyuan
- Department of Respiratory Care, Chang Gung University of Science and Technology, Chiayi Campus
| | - I-Chuan Chen
- Department of Emergency Medicine, Chang Gung Memorial Hospital, Chiayi Branch
- Department of Nursing, Chang Gung University of Science and Technology, Chiayi Campus
| | - Chuan-Pin Lee
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi
| | - Ru-Jiun Huang
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University, College of Medicine, Taipei
| | - Ying-Huang Tsai
- Division of Thoracic Oncology, Department of Pulmonary and Critical Care Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi City
- Department of Respiratory Care, College of Medicine, Chang Gung University, Taoyuan
| | - Yao-Hsu Yang
- Center of Excellence for Chang Gung Research Datalink, Chang Gung Memorial Hospital, Chiayi
- Department of Traditional Chinese Medicine, Chang Gung Memorial Hospital, Chiayi Branch, Puzi City
- School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan ROC
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Blakemore A, Hann M, Howells K, Panagioti M, Sidaway M, Reeves D, Bower P. Patient activation in older people with long-term conditions and multimorbidity: correlates and change in a cohort study in the United Kingdom. BMC Health Serv Res 2016; 16:582. [PMID: 27756341 PMCID: PMC5069882 DOI: 10.1186/s12913-016-1843-2] [Citation(s) in RCA: 76] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 10/12/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patient Activation is defined as the knowledge, skill, and confidence a patient has in managing their health. Higher levels of patient activation are associated with better self-management, better health outcomes, and lower healthcare costs. Understanding the drivers of patient activation can allow better tailoring of patient support and interventions. There are few data on patient activation in UK patients with long-term conditions. METHODS A prospective cohort design was used. Questionnaires were mailed to 12,989 patients over the age of 65 years with at least one long-term condition in Salford, UK. They completed the Patient Activation Measure and self-report measures of: depression, health literacy, social support, health-related quality of life, and impact of multimorbidity. We report descriptive data on baseline activation and change over time, and use multivariate regression to model associations with patient activation at baseline and predictors of change in Activation over 6 months. RESULTS The cohort included 4377 (33.6 %) older people, of whom 4225 were mailed a further questionnaire at 6 months; 3390 returned it complete (80.2 %). At baseline, 15 % self-reported PAM level 1, 16 % level 2, 45 % level 3, and 25 % level 4. Across all patients, depression had the strongest association with patient activation. Other important factors were: older age, being retired, poor health literacy, health-related quality of life, and social support. Total number of self-reported comorbidities and the perceived impact of comorbidities were also important for patients with more than one long-term condition. Patient activation scores were reasonably enduring over time (r = 0.43 between baseline and at six months), although nearly half changed 'levels' of activation over that time. Few variables predicted change in activation over 6 months. CONCLUSIONS This is the first large scale assessment of patient activation in the UK. Our data may be useful in identifying patients who need support with patient activation, and allow interventions (such as health coaching) to be tailored to better support older patients with long-term conditions who have symptoms of depression, poor social support and impaired health literacy. Further analyses of longitudinal studies will be necessary to better understand the causal relationships between patient activation and variables such as depression.
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Affiliation(s)
- Amy Blakemore
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Mark Hann
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Kelly Howells
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Maria Panagioti
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Mark Sidaway
- Salford Royal NHS Foundation Trust, Salford Royal Foundation Trust, Stott Lane, Salford, M6 8HD UK
| | - David Reeves
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
- NIHR Greater Manchester Primary Care Patient Safety Translational Research Centre, Manchester Academic Health Science Centre, University of Manchester, Oxford Road, Manchester, M13 9PL UK
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Abstract
Depression is the most common psychiatric illness in the general community, with 3% to 4% of depressives dying by suicide today. Studies have shown that depression has considerable morbidity and mortality. This article focuses on depressed patients and their management within the emergency department. Understanding the intricacies of the interview process and identifying which patients need immediate attention are important skills for the emergency physician.
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Affiliation(s)
- Dick C Kuo
- Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA
| | - Mina Tran
- Section of Emergency Medicine, Department of Medicine, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
| | - Asim A Shah
- Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX 77030, USA
| | - Anu Matorin
- Department of Psychiatry, Baylor College of Medicine, One Baylor Plaza - BCM350, Houston, TX 77030, USA
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Webster F, Christian J, Mansfield E, Bhattacharyya O, Hawker G, Levinson W, Naglie G, Pham TN, Rose L, Schull M, Sinha S, Stergiopoulos V, Upshur R, Wilson L. Capturing the experiences of patients across multiple complex interventions: a meta-qualitative approach. BMJ Open 2015; 5:e007664. [PMID: 26351182 PMCID: PMC4563230 DOI: 10.1136/bmjopen-2015-007664] [Citation(s) in RCA: 16] [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: 11/16/2022] Open
Abstract
OBJECTIVES The perspectives, needs and preferences of individuals with complex health and social needs can be overlooked in the design of healthcare interventions. This study was designed to provide new insights on patient perspectives drawing from the qualitative evaluation of 5 complex healthcare interventions. SETTING Patients and their caregivers were recruited from 5 interventions based in primary, hospital and community care in Ontario, Canada. PARTICIPANTS We included 62 interviews from 44 patients and 18 non-clinical caregivers. INTERVENTION Our team analysed the transcripts from 5 distinct projects. This approach to qualitative meta-evaluation identifies common issues described by a diverse group of patients, therefore providing potential insights into systems issues. OUTCOME MEASURES This study is a secondary analysis of qualitative data; therefore, no outcome measures were identified. RESULTS We identified 5 broad themes that capture the patients' experience and highlight issues that might not be adequately addressed in complex interventions. In our study, we found that: (1) the emergency department is the unavoidable point of care; (2) patients and caregivers are part of complex and variable family systems; (3) non-medical issues mediate patients' experiences of health and healthcare delivery; (4) the unanticipated consequences of complex healthcare interventions are often the most valuable; and (5) patient experiences are shaped by the healthcare discourses on medically complex patients. CONCLUSIONS Our findings suggest that key assumptions about patients that inform intervention design need to be made explicit in order to build capacity to better understand and support patients with multiple chronic diseases. Across many health systems internationally, multiple models are being implemented simultaneously that may have shared features and target similar patients, and a qualitative meta-evaluation approach, thus offers an opportunity for cumulative learning at a system level in addition to informing intervention design and modification.
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Affiliation(s)
- Fiona Webster
- Department of Family and CommunityMedicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | | | | | - Onil Bhattacharyya
- Department of Family and CommunityMedicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Gillian Hawker
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Wendy Levinson
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Gary Naglie
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Thuy-Nga Pham
- Department of Family and CommunityMedicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- South East Toronto Family Health Team, Toronto East General Hospital, Toronto, Ontario, Canada
| | - Louise Rose
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto; Provincial Centre of Weaning Excellence/Prolonged Ventilation Weaning Centre, Toronto East General Hospital, Toronto, Ontario, Canada
| | - Michael Schull
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Health System Planning & Evaluation Research Program, Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Samir Sinha
- Health System Planning & Evaluation Research Program, Institute of Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Ross Upshur
- Department of Family and CommunityMedicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
- Bridgepoint Health, Bridgepoint Collaboratory for Research and Innovation, Toronto, Ontario, Canada
| | - Lynn Wilson
- Department of Family and CommunityMedicine and the Institute of Health Policy Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
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