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Raaijmakers LHA, Schermer TR, Wijnen M, van Bommel HE, Michielsen L, Boone F, Vercoulen JH, Bischoff EWMA. Development of a Person-Centred Integrated Care Approach for Chronic Disease Management in Dutch Primary Care: A Mixed-Method Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3824. [PMID: 36900842 PMCID: PMC10001916 DOI: 10.3390/ijerph20053824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Revised: 02/09/2023] [Accepted: 02/14/2023] [Indexed: 06/18/2023]
Abstract
To reduce the burden of chronic diseases on society and individuals, European countries implemented chronic Disease Management Programs (DMPs) that focus on the management of a single chronic disease. However, due to the fact that the scientific evidence that DMPs reduce the burden of chronic diseases is not convincing, patients with multimorbidity may receive overlapping or conflicting treatment advice, and a single disease approach may be conflicting with the core competencies of primary care. In addition, in the Netherlands, care is shifting from DMPs to person-centred integrated care (PC-IC) approaches. This paper describes a mixed-method development of a PC-IC approach for the management of patients with one or more chronic diseases in Dutch primary care, executed from March 2019 to July 2020. In Phase 1, we conducted a scoping review and document analysis to identify key elements to construct a conceptual model for delivering PC-IC care. In Phase 2, national experts on Diabetes Mellitus type 2, cardiovascular diseases, and chronic obstructive pulmonary disease and local healthcare providers (HCP) commented on the conceptual model using online qualitative surveys. In Phase 3, patients with chronic conditions commented on the conceptual model in individual interviews, and in Phase 4 the conceptual model was presented to the local primary care cooperatives and finalized after processing their comments. Based on the scientific literature, current practice guidelines, and input from a variety of stakeholders, we developed a holistic, person-centred, integrated approach for the management of patients with (multiple) chronic diseases in primary care. Future evaluation of the PC-IC approach will show if this approach leads to more favourable outcomes and should replace the current single-disease approach in the management of chronic conditions and multimorbidity in Dutch primary care.
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Affiliation(s)
- Lena H. A. Raaijmakers
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Tjard R. Schermer
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Science Support Office, Gelre Hospitals, P.O. Box 9014, 7300 DS Apeldoorn, The Netherlands
| | - Mandy Wijnen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Hester E. van Bommel
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Pharos, Dutch Centre of Expertise on Health Disparities, P.O. Box 13318, 3507 LH Utrecht, The Netherlands
| | - Leslie Michielsen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Research Group Innovation of Care and Services, HAN University of Applied Sciences, Kapittelweg 33, 6525 EN Nijmegen, The Netherlands
| | - Floris Boone
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Jan H. Vercoulen
- Department of Medical Psychology, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Erik W. M. A. Bischoff
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Center, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Jakobs K, Lautan L, Lucassen P, Janzing J, van Lieshout J, Biermans MCJ, Bischoff EWMA. Cardiovascular risk management in patients with severe mental illness or taking antipsychotics: A qualitative study on barriers and facilitators among dutch general practitioners. Eur J Gen Pract 2022; 28:191-199. [PMID: 35796600 PMCID: PMC9272927 DOI: 10.1080/13814788.2022.2092093] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND Patients with severe mental illness (SMI) or receiving treatment with antipsychotics (APs) have an increased risk of cardiovascular disease. Cardiovascular risk management (CVRM) increasingly depends on general practitioners (GPs) because of the shift of mental healthcare from secondary to primary care and the surge of off-label AP prescriptions. Nevertheless, the uptake of patients with SMI/APs in CVRM programmes in Dutch primary care is low. OBJECTIVES To explore which barriers and facilitators GPs foresee when including and treating patients with SMI or using APs in an existing CVRM programme. METHODS In 2019, we conducted a qualitative study among 13 Dutch GPs. During individual in-depth, semi-structured interviews a computer-generated list of eligible patients who lacked annual cardiovascular risk (CVR) screening guided the interview. Data was analysed thematically. RESULTS The main barriers identified were: (i) underestimation of patient CVR and ambivalence to apply risk-lowering strategies such as smoking cessation, (ii) disproportionate burden on GPs in deprived areas, (iii) poor information exchange between GPs and psychiatrists, and (iv) scepticism about patient compliance, especially those with more complex conditions. The main facilitators included: (i) support of GPs through a computer-generated list of eligible patients and (ii) involvement of family or carers. CONCLUSION This study displays a range of barriers and facilitators anticipated by GPs. These indicate the preconditions required to remove barriers and facilitate GPs, namely adequate recommendations in practice guidelines, improved consultation opportunities with psychiatrists, practical advice to support patient adherence and incentives for practices in deprived areas.
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Affiliation(s)
- Kirsti Jakobs
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Latoya Lautan
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Peter Lucassen
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Joost Janzing
- Department of Psychiatry, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Jan van Lieshout
- Department IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Marion C J Biermans
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Erik W M A Bischoff
- Department of Primary and Community Care, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
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Bergaoui J, Latiri I, Ben Saad H. Deficiency, incapacity and social disadvantage of patients with chronic hepatitis B: a case-control study. LA TUNISIE MEDICALE 2022; 99:682-692. [PMID: 35260999 PMCID: PMC8796680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
INTRODUCTION Studies examining impairment, disability and social disadvantage of patients with chronic viral hepatitis B (CHB) are scarce and present conflicting conclusions. AIM To assess the deficiency, incapacity, and social disadvantage of patients with CHB. METHODS This is a project of a case-control study with two age-matched groups. Cases (n=27) will be untreated patients with a CHB. Controls (n=27) will be healthy participants. The following data will be collected: deficiency [anthropometric, biochemical (renal and hepatic functions, lipid balance, and inflammatory markers), haematological, virological, handgrip-strength, and spirometric data], incapacity [6-min walk distance, number of stops, oxy-haemoglobin saturation, dyspnoea (visual analogue scale), heart-rate, and blood-pressure] and social disadvantage ["chronic liver disease" and physical-activity questionnaires]. Each spirometric data < lower-limit-of-normal will be considered abnormal. A handgrip-strength <26 kg (male) or <16 kg (female) will be considered low. The signs of walking intolerance will be: stop during the walk, 6-min walk distance ≤ lower-limit-of-normal, dyspnoea at the end of the walk> 5/10, drop in oxy-haemoglobin saturation >5 points, heart-rate at the end of the walk ≤60%. A total physical-activity score <9.42 will classify the participant as sedentary. EXPECTED RESULTS Compared with controls, cases will have a marked alteration of submaximal aerobic data. These alterations will worsen quality-of-life and may be related to muscle and/or spirometric abnormalities, and supported by systemic inflammation and high viral load.
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Affiliation(s)
- Jihene Bergaoui
- 1. Reasearch laboratory “Heart failure, LR12SP09”, Hospital Farhat HACHEDSousseTunisie
| | - Imed Latiri
- 1. Reasearch laboratory “Heart failure, LR12SP09”, Hospital Farhat HACHEDSousseTunisie
- 2. Université de Sousse, Faculté de Médecine de Sousse, Laboratoire de PhysiologieTunisie
| | - Helmi Ben Saad
- 1. Reasearch laboratory “Heart failure, LR12SP09”, Hospital Farhat HACHEDSousseTunisie
- 2. Université de Sousse, Faculté de Médecine de Sousse, Laboratoire de PhysiologieTunisie
- 3. Université de Sousse, Hôpital Farhat HACHED, Service de Physiologie et Explorations FonctionnellesSousse, Tunisie
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Abassi H, Huguet H, Picot MC, Vincenti M, Guillaumont S, Auer A, Werner O, De La Villeon G, Lavastre K, Gavotto A, Auquier P, Amedro P. Health-related quality of life in children with congenital heart disease aged 5 to 7 years: a multicentre controlled cross-sectional study. Health Qual Life Outcomes 2020; 18:366. [PMID: 33183312 PMCID: PMC7659069 DOI: 10.1186/s12955-020-01615-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/30/2020] [Indexed: 12/20/2022] Open
Abstract
Background In the context of tremendous progress in congenital cardiology, more attention has been given to patient-related outcomes, especially in assessing health-related quality of life (HRQoL) of patients with congenital heart diseases (CHD). However, most studies have mainly focused on teenagers or adults and currently, few HRQoL controlled data is available in young children. This study aimed to evaluate HRQoL of children with CHD aged 5 to 7 y.o., in comparison with contemporary peers recruited in school, as well as the factors associated with HRQoL in this population. Methods This multicentre controlled prospective cross-sectional study included 124 children with a CHD (mean age = 6.0 ± 0.8 y, 45% female) during their outpatient visit and 125 controls (mean age = 6.2 ± 0.8 y, 54% female) recruited at school. A generic paediatric HRQoL instrument was used (PedsQL 4.0). Results Self-reported HRQoL in children with CHD was similar to controls, overall (73.5 ± 1.2 vs. 72.8 ± 1.2, P = 0.7, respectively), and for each dimension. Parents-reported HRQoL was significantly lower in the CHD group than in controls. HRQoL was predicted by the disease severity and by repeated invasive cardiac procedures (surgery or catheterization). Conclusion HRQoL in young children with CHD aged 5 to 7 years old was good and similar to controls. This study contributed to the growing body of knowledge on HRQoL in congenital cardiology and emphasized the need for child and family support in the most complex CHD. Trial registration This study was approved by the institutional review board of Montpellier University Hospital (2019_IRB-MTP_02-19) on 22 February 2019 and was registered on ClinicalTrials.gov (NCT03931096) on 30 April 2019, https://clinicaltrials.gov/ct2/show/NCT03931096.
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Affiliation(s)
- Hamouda Abassi
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,Centre for Studies and Research On Health Services and Quality of Life, Public Health and Chronic Diseases Laboratory, Aix Marseille University, Marseille, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Helena Huguet
- Epidemiology Department, University Hospital, Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Marie-Christine Picot
- Epidemiology Department, University Hospital, Clinical Investigation Centre, INSERM-CIC 1411, University of Montpellier, Montpellier, France
| | - Marie Vincenti
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Sophie Guillaumont
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Annie Auer
- Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Oscar Werner
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Gregoire De La Villeon
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,Paediatric Cardiology and Rehabilitation Unit, St-Pierre Institute, Palavas-Les-Flots, France
| | - Kathleen Lavastre
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France
| | - Arthur Gavotto
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France.,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France
| | - Pascal Auquier
- Centre for Studies and Research On Health Services and Quality of Life, Public Health and Chronic Diseases Laboratory, Aix Marseille University, Marseille, France
| | - Pascal Amedro
- Paediatric and Congenital Cardiology Department, Arnaud De Villeneuve University Hospital, 371 Avenue du Doyen Giraud, 34295, Montpellier, France. .,Centre for Studies and Research On Health Services and Quality of Life, Public Health and Chronic Diseases Laboratory, Aix Marseille University, Marseille, France. .,PhyMedExp, CNRS, INSERM, University of Montpellier, Montpellier, France.
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Voorhaar M, Bischoff EWMA, Asijee G, Muris J, van Schayck OCP, Slok A, Visser A. Validation of the Dutch version of the primary care resources and support for self-management tool: A tool to assess the quality of self-management support. PLoS One 2020; 15:e0229771. [PMID: 32155180 PMCID: PMC7064186 DOI: 10.1371/journal.pone.0229771] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 02/14/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction Enhancing the self-management activities of patients improves the quality of care and is an integrated element of current healthcare provision. However, self-management support (SMS) is not yet common in healthcare. The Primary Care Resources and Support for Self-Management (PCRS) is a tool for healthcare professionals to assess the quality of SMS. In this study, we assessed the validity and reliability of the Dutch version of the PCRS. Method The validation of the PCRS was performed in Dutch healthcare centres. Correlations between the PCRS scores and the Assessment of Chronic Illness Care (ACIC) and Clinician Support for Patient Activation Measure (CS-PAM) scores were calculated to assess the convergent and discriminant validity. A confirmatory factor analysis (CFA) was performed to test the factor structure. Lastly, the internal consistency and face validity were assessed. Results The convergent and discriminant validity were good, with respective correlations of 0.730 (p < 0.001) and 0.030 (p > 0.050) between the PCRS and the ACIC SMS subscale and the PCRS and the CS-PAM. Although 49% of the variance of the PCRS was explained by one factor, the CFA could not confirm a fit between a one-factor model and the data. The reliability was excellent (Cronbach’s α = 0.921). Conclusion The PCRS showed good validity and excellent internal consistency. However, the evidence for its validity was inconclusive. We therefore suggest rephrasing specific items.
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Affiliation(s)
- Maarten Voorhaar
- Maastricht University, CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht, the Netherlands
- * E-mail:
| | - Erik WMA Bischoff
- Radboud University Medical Centre, Department of Primary and Community Care, Nijmegen, the Netherlands
| | - Guus Asijee
- Maastricht University, CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht, the Netherlands
| | - Jean Muris
- Maastricht University, CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht, the Netherlands
| | - Onno CP van Schayck
- Maastricht University, CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht, the Netherlands
| | - Annerika Slok
- Maastricht University, CAPHRI Care and Public Health Research Institute, Department of Family Medicine, Maastricht, the Netherlands
| | - Anja Visser
- University of Groningen, Theology and Religious Studies,Groningen, the Netherlands
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Chao DY, Lin TM, Ma WY. Enhanced Self-Efficacy and Behavioral Changes Among Patients With Diabetes: Cloud-Based Mobile Health Platform and Mobile App Service. JMIR Diabetes 2019; 4:e11017. [PMID: 31094324 PMCID: PMC6534048 DOI: 10.2196/11017] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Revised: 08/04/2018] [Accepted: 04/02/2019] [Indexed: 01/19/2023] Open
Abstract
Background The prevalence of chronic disease is increasing rapidly. Health promotion models have shifted toward patient-centered care and self-efficacy. Devices and mobile app in the Internet of Things (IoT) have become critical self-management tools for collecting and analyzing personal data to improve individual health outcomes. However, the precise effects of Web-based interventions on self-efficacy and the related motivation factors behind individuals’ behavioral changes have not been determined. Objective The objective of this study was to gain insight into patients' self-efficacy with newly diagnosed diabetes (type 2 diabetes mellitus) and analyze the association of patient-centered health promotion behavior and to examine the implications of the results for IoT and mobile health mobile app features. Methods The study used data from the electronic health database (n=3128). An experimental design (n=121) and randomized controlled trials were employed to determine patient preferences in the health promotion program (n=62) and mobile self-management education (n=28). The transtheoretical model was used as a framework for observing self-management behavior for the improvement of individual health, and the theory of planned behavior was used to evaluate personal goals, execution, outcome, and personal preferences. A mobile app was used to determine individualized health promotion interventions and to apply these interventions to improve patients’ self-management and self-efficacy. Results Mobile questionnaires were administered for pre- and postintervention assessment through mobile app. A dynamic questionnaire allocation method was used to follow up and monitor patient behavioral changes in the subsequent 6 to 18 months. Participants at a high risk of problems related to blood pressure (systolic blood pressure ≥120 mm Hg) and body mass index (≥23 kg/m2) indicated high motivation to change and to achieve high scores in the self-care knowledge assessment (n=49, 95% CI −0.26% to −0.24%, P=.052). The associated clinical outcomes in the case group with the mobile-based intervention were slightly better than in the control group (glycated hemoglobin mean −1.25%, 95% CI 6.36 to 7.47, P=.002). In addition, 86% (42/49) of the participants improved their health knowledge through the mobile-based app and information and communications technology. The behavior-change compliance rate was higher among the women than among the men. In addition, the personal characteristics of steadiness and dominance corresponded with a higher compliance rate in the dietary and wellness intervention (83%, 81/98). Most participants (71%, 70/98) also increased their attention to healthy eating, being active, and monitoring their condition (30% 21/70, 21% 15/70, and 20% 14/70, respectively). Conclusions The overall compliance rate was discovered to be higher after the mobile app–based health intervention. Various intervention strategies based on patient characteristics, health care–related word-of-mouth communication, and social media may be used to increase self-efficacy and improve clinical outcomes. Additional research should be conducted to determine the most influential factors and the most effective adherence management techniques.
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Affiliation(s)
- Dyna Yp Chao
- Healthcare Solution Center, Health Inventor of Taipei, Taipei City, Taiwan
| | - Tom My Lin
- Graduate Institute of Management, National Taiwan University of Science and Technology, Taipei City, Taiwan
| | - Wen-Ya Ma
- Department of Metabolism, Cardinal Tien Hospital, New Taipei City, Taiwan
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Nieboer AP, Cramm JM. Enabling and disabling behaviors in the social environment are associated with physical Activity of older people in the Netherlands. BMC Public Health 2019; 19:361. [PMID: 30935379 PMCID: PMC6444431 DOI: 10.1186/s12889-019-6670-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Accepted: 03/18/2019] [Indexed: 11/10/2022] Open
Abstract
Background Although research clearly shows that physical activity has significant health benefits and contributes to the prevention of chronic disease onset, the vast majority of the world’s population is insufficiently physically active, and the prevalence of insufficient physical activity is greatest in the population of older adults. The social environment may play an important role in shaping health behaviors, we however, lack knowledge regarding the exact influence of the social environment on older persons’ physical activity levels. This research therefore aims to identify the relationships of physical activity to enabling and disabling behaviors in the social environment among older people in the Netherlands. Methods Participants were randomly sampled from the Rotterdam municipality register and stratified by age group (70–74, 75–79, 80–84, and ≥ 85 years) and neighborhood (district). Of 2798 respondents, 1280 (46%) returned filled-in questionnaires. The Perceived Social Influence on Health Behavior (PSI-HB) instrument was used to assess the degree to which individuals’ health behavior is influenced by those around them. Respondents were additionally asked about enabling and disabling behaviors in their social environments and how many days per week they were physically active. Physical activity scores ranged from 0 (not being physically active for 30 min a day at all during the week) to 7 (being physically active every day of the week). Respondents with a score of ≥5 were considered to be physically active and those with a score of < 5 as physically inactive. Results Results revealed that increasing age significantly contributed to physical inactivity within this older population. Lower educational level significantly decreased the odds of physical activity. After controlling for background characteristics results show enabling behaviors and utilitarian social influence significantly increased the odds of physical activity while disabling behaviour of the social environment contributed to physical inactivity. No significant associations were found with perceived social influence aspects value-expressive influence and informational influence. Conclusion Actual enabling and disabling behaviors of actors in older people’s social environments seem relevant for their physical activity levels, in positive and negative ways. In promoting active aging, consideration of the role of the social environment and ensuring that it is supportive of older people’s physical activity are important. Electronic supplementary material The online version of this article (10.1186/s12889-019-6670-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anna P Nieboer
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands.
| | - Jane M Cramm
- Department of Social Medical Sciences, Erasmus School of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, 3000, DR, Rotterdam, The Netherlands
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Yi YH, Kim YJ, Lee SY, Cho BM, Cho YH, Lee JG. Health behaviors of Korean adults with hepatitis B: Findings of the 2016 Korean National Health and Nutrition Examination Survey. World J Gastroenterol 2018; 24:3163-3170. [PMID: 30065562 PMCID: PMC6064957 DOI: 10.3748/wjg.v24.i28.3163] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Revised: 06/20/2018] [Accepted: 06/28/2018] [Indexed: 02/06/2023] Open
Abstract
AIM To assess the frequencies of five health-related behaviors (smoking, alcohol consumption, body weight, sleep duration, and physical activity) in Korean adults with chronic hepatitis B.
METHODS Data were obtained from the 2016 Korean National Health and Nutrition Examination Survey. In total, 5887 subjects (2568 males, 3319 females) over 19 years old were enrolled in this study. Interviews were performed to obtain information on demographic characteristics and medical conditions. A selfadministered questionnaire and medical examination were used to assess the smoking history, alcohol use, physical activity, sleep duration, and body weight of the subjects. Chronic hepatitis B was diagnosed based on detection of hepatitis B surface antigen (HBsAg). The subjects were categorized into HBsAg positive and negative groups, and a complex sampling analysis was conducted to compare the health behaviors between these groups.
RESULTS Among males, the current smoking rate in the HBsAg positive group was higher than that in the negative group (45.5% vs 38.5%). In the positive group, the rates of monthly and high-risk alcohol use were 70.4% and 17.6% in males and 45.9% and 3.8% in females, respectively. The rate of alcohol use was similar between the two groups [P = 0.455 (males) and P = 0.476 (females)]. In the HBsAg positive group, 32.3% and 49.9% of males and 26.5% and 49.6% of females were overweight and physically inactive, respectively. High-risk alcohol consumption and physical inactivity were significantly associated with self-perceived health status.
CONCLUSION Our data demonstrate that a large proportion of Korean adults with chronic hepatitis B have poor health behaviors. Further studies are needed to confirm our results.
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Affiliation(s)
- Yu-Hyeon Yi
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan-si 50612, South Korea
- Medical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
- Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, South Korea
| | - Yun-Jin Kim
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan-si 50612, South Korea
- Medical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
| | - Sang-Yeoup Lee
- Department of Medical Education, Pusan National University School of Medicine, Yangsan-si 50612, South Korea
- Family Medicine Clinic, Pusan National University Yangsan Hospital, Yangsan-si 50612, South Korea
| | - Byung-Mann Cho
- Medical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
- Department of Preventive Medicine and Occupational Medicine, Pusan National University School of Medicine, Yangsan-si 50612, South Korea
| | - Young-Hye Cho
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan-si 50612, South Korea
- Family Medicine Clinic, Pusan National University Yangsan Hospital, Yangsan-si 50612, South Korea
| | - Jeong-Gyu Lee
- Department of Family Medicine, Pusan National University School of Medicine, Yangsan-si 50612, South Korea
- Medical Research Institute, Pusan National University Hospital, Busan 49241, South Korea
- Busan Tobacco Control Center, Pusan National University Hospital, Busan 49241, South Korea
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Aarts J. Samantha Adams Festschrift: Coming of Age-Samantha Adam's Career at Erasmus University Rotterdam. Appl Clin Inform 2018; 9:493-495. [PMID: 29969790 DOI: 10.1055/s-0038-1656523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Jos Aarts
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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10
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DeMuro PR, Novak LL, Petersen C. Samantha Adams Festschrift: Adamsian Discourse-The Patient, and Everything Else. Appl Clin Inform 2018; 9:500-502. [PMID: 29969792 DOI: 10.1055/s-0038-1654701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022] Open
Affiliation(s)
- Paul R DeMuro
- Broad and Cassel LLP, Fort Lauderdale, Florida, United States
| | - Laurie L Novak
- Department of Biomedical Informatics, Vanderbilt University Medical Center, Vanderbilt University, Nashville, Tennessee, United States
| | - Carolyn Petersen
- Global Business Solutions, Mayo Clinic, Rochester, Minnesota, United States
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Sá A, Peleteiro B. The effect of chronic disease family history on the adoption of healthier lifestyles. Int J Health Plann Manage 2018; 33:e906-e917. [PMID: 29968422 DOI: 10.1002/hpm.2561] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 05/24/2018] [Indexed: 12/27/2022] Open
Abstract
AIM To determine the influence of family history (FH) and personal history (PH) of chronic disease (CD) in the adoption of healthy lifestyles. METHODS This cross-sectional study was based on the EPIPorto cohort (n = 1588). Participants were grouped taking into account FH and PH of CD, such as diabetes, myocardial infarction, stroke, asthma, and cancer, and if at least one of the first-degree relatives had died from the CD. Age-, sex-, and education-adjusted odds ratios and corresponding 95% confidence intervals were computed using multinomial logistic regression. RESULTS Subjects with PH and FH of CD were more likely to follow recommendations regarding salt intake but less likely regarding obesity measures. Overall, similar results were observed when repeating the analyses according to the type of CD, particularly in those with diabetes. CONCLUSIONS Recommendations towards healthier lifestyles are not followed by individuals with history of CD, at least in what concerns obesity measures. Our study suggests reducing obesity as a major target for interventions in these groups of individuals.
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Affiliation(s)
- Alexandre Sá
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal
| | - Bárbara Peleteiro
- ISPUP-EPIUnit, Universidade do Porto, Porto, Portugal.,Departamento de Ciências da Saúde Pública e Forenses, e Educação Médica, Faculdade de Medicina Universidade do Porto, Porto, Portugal
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12
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Tuyen LTT, Gunawan J. Behavior management in the field of nursing: A concept analysis. Nurs Forum 2018; 53:481-488. [PMID: 29943834 DOI: 10.1111/nuf.12275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
AIM This concept analysis is to clarify what behavior management in the field of nursing means, what attributes signify it, and what its antecedents and consequences are. BACKGROUND A variety of definitions of behavior management were identified in literature. This has resulted in a degree of confusion in the way behavior management is described. METHODS The Walker and Avant concept analysis approach was applied. Literature searches were conducted using CINAHL, Academic Search Complete, Business Source Complete, Communication and Mass Media Complete, Education Research Complete, PubMed Medline, Google Scholar and many online dictionaries, with timeline from January 2000 to November 2017. FINDINGS The analysis demonstrates that the concept of behavior management in nursing field has two core attributes: (a) conscious actions to maintain and promote positive activities, and (b) training and assisting from the person who has knowledge and experience. Antecedents include poor general knowledge, lack of ability to control, and personality. Consequences include an improvement of quality and productivity and quality of life, reduction of mortality rate of diseases, and development of pro-social skills for the youth. CONCLUSION The analysis helps nurses to understand the concept and its application into clinical practice as well as to develop appropriate intervention plans for patients.
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Affiliation(s)
- Le Thi Thanh Tuyen
- Faculty of Nursing, Da Nang University of Medical Technology and Pharmacy, Da Nang, Viet Nam
| | - Joko Gunawan
- Academy of Nursing of Belitung, Akademi Keperawatan Pemerintah Kabupaten Belitung, Indonesia
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Cramm JM, Nieboer AP. Is "disease management" the answer to our problems? No! Population health management and (disease) prevention require "management of overall well-being". BMC Health Serv Res 2016; 16:500. [PMID: 27655044 PMCID: PMC5031273 DOI: 10.1186/s12913-016-1765-z] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 09/16/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Disease management programs based on the chronic care model have achieved successful and long-term improvement in the quality of chronic care delivery and patients' health behaviors and physical quality of life. However, such programs have not been able to maintain or improve broader self-management abilities or social well-being, which decline over time in chronically ill patients. Disease management efforts, population health management initiatives and innovative primary care solutions are still mainly focused on clinical and functional outcomes and health behaviors (e.g., smoking cessation, exercise, and diet) failing to address individuals' overall quality of life and well-being. Individuals' ability to achieve well-being can be assessed with great specificity through the application of social production function (SPF) theory. This theory asserts that people produce their own well-being by trying to optimize the achievement of instrumental goals (stimulation, comfort, status, behavioral confirmation, affection) that provide the means to achieve the larger, universal goals of physical and social well-being. DISCUSSION A shift in focus from the management of physical function, disease limitations, and lifestyle behaviors alone to an approach that fosters self-management abilities such as self-efficacy and resource investment as well as overall quality of life, is urgently needed. Disease management interventions should be aimed at adequately addressing all difficulties chronically ill patients face in life, such as the effects of pain and fatigue on the ability to maintain a job and social life and to participate in activities promoting physical and social well-being. Patients' ability to maintain engagement in stimulating work and social activities with the people who are important to them may be even more important than aspects of disease self-management such as blood pressure or glycemic control. Interventions should aim to make chronically ill patients capable of managing their own well-being and adequately addressing their needs in a broader sense. So, is disease management the answer to our problems in the time of aging populations and increased prevalence of unhealthy lifestyles, chronic illnesses, and comorbidity? No! Effective (disease) prevention, disease management, patient-centered care, and high-quality chronic care and/or population health management calls for management of overall well-being.
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Affiliation(s)
- Jane Murray Cramm
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands
| | - Anna Petra Nieboer
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands
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Tsiachristas A, Burgers L, Rutten-van Mölken MPMH. Cost-Effectiveness of Disease Management Programs for Cardiovascular Risk and COPD in The Netherlands. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:977-986. [PMID: 26686781 DOI: 10.1016/j.jval.2015.07.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2014] [Revised: 07/05/2015] [Accepted: 07/19/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Disease management programs (DMPs) for cardiovascular risk (CVR) and chronic obstructive pulmonary disease (COPD) are increasingly implemented in The Netherlands to improve care and patient's health behavior. OBJECTIVE The aim of this study was to provide evidence about the (cost-) effectiveness of Dutch DMPs as implemented in daily practice. METHODS We compared the physical activity, smoking status, quality-adjusted life-years, and yearly costs per patient between the most and the least comprehensive DMPs in four disease categories: primary CVR prevention, secondary CVR prevention, both types of CVR prevention, and COPD (N = 1034). Propensity score matching increased comparability between DMPs. A 2-year cost-utility analysis was performed from the health care and societal perspectives. Sensitivity analysis was performed to estimate the impact of DMP development and implementation costs on cost-effectiveness. RESULTS Patients in the most comprehensive DMPs increased their physical activity more (except for primary CVR prevention) and had higher smoking cessation rates. The incremental QALYs ranged from -0.032 to 0.038 across all diseases. From a societal perspective, the most comprehensive DMPs decreased costs in primary CVR prevention (certainty 57%), secondary CVR prevention (certainty 88%), and both types of CVR prevention (certainty 98%). Moreover, the implementation of comprehensive DMPs led to QALY gains in secondary CVR prevention (certainty 92%) and COPD (certainty 69%). CONCLUSIONS The most comprehensive DMPs for CVR and COPD have the potential to be cost saving, effective, or cost-effective compared with the least comprehensive DMPs. The challenge for Dutch stakeholders is to find the optimal mixture of interventions that is most suited for each target group.
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Affiliation(s)
- Apostolos Tsiachristas
- Nuffield Department of Population Health, Health Economics Research Centre, University of Oxford, Oxford, UK; Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands.
| | - Laura Burgers
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
| | - Maureen P M H Rutten-van Mölken
- Department of Health Policy and Management, Institute for Medical Technology Assessment, Erasmus University, Rotterdam, The Netherlands
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Measured outcomes of chronic care programs for older adults: a systematic review. BMC Geriatr 2015; 15:139. [PMID: 26503159 PMCID: PMC4621859 DOI: 10.1186/s12877-015-0136-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 10/19/2015] [Indexed: 11/10/2022] Open
Abstract
Background Wagner’s Chronic Care Model (CCM), as well as the expanded version (ECCM) developed by Barr and colleagues, have been widely adopted as frameworks for prevention and management of chronic disease. Given the high prevalence of chronic illness in older persons, these frameworks can play a valuable role in reorienting the health care system to better serve the needs of seniors. We aimed to identify and assess the measured goals of E/CCM interventions in older populations. In particular, our objective was to determine the extent to which published E/CCM initiatives were evaluated based on population, community, system and individual-level outcomes (including clinical, functional and quality of life measures). Methods We conducted a systematic search of the Science Citation Index Web of Knowledge search tool to gather articles published between January 2003 and July 2014. We included published CCM interventions that cited at least one of the fundamental papers that introduced and described the CCM and ECCM. Studies retained for review reported evaluations of senior-focused E/CCM initiatives in community-based settings, with the topic of “older adults” OR senior* OR elder* OR geriatric OR aged. The resulting 619 published articles were independently reviewed for inclusion by two researchers. We excluded the following: systematic reviews, meta-analyses, descriptions of proposed programs, and studies whose populations did not focus on seniors. Results We identified 14 articles that met inclusion criteria. Studies used a wide range of measures, with little consensus between studies. All of the included studies used the original CCM. While a range of system-level and individual patient outcomes have been used to evaluate CCM interventions, no studies employed measures of population or community health outcomes. Conclusions Future efforts to test E/CCM interventions with seniors would be aided by more consistent outcome measures, greater attention to outcomes for the caregivers of older persons with chronic illness, and a greater focus on population and community impacts.
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Cramm JM, Nieboer AP. Chronically ill patients' self-management abilities to maintain overall well-being: what is needed to take the next step in the primary care setting? BMC FAMILY PRACTICE 2015; 16:123. [PMID: 26374206 PMCID: PMC4571068 DOI: 10.1186/s12875-015-0340-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2015] [Accepted: 09/10/2015] [Indexed: 12/30/2022]
Abstract
BACKGROUND Although widespread problems in patient-professional interaction and insufficient support of patients' self-management abilities have been recognized, research investigating the relationships among care quality, productive interaction, and self-management abilities to maintain overall well-being is lacking. Furthermore, studies have revealed differences in these characteristics among certain groups (e.g., less-educated and older patients). This longitudinal study thus aimed to identify relationships among background characteristics, quality of care, productivity of patient-professional interaction, and self-management abilities to maintain overall well-being in chronically ill patients participating in 18 Dutch disease management programs. METHODS This longitudinal study included patients participating in 18 Dutch disease management programs. Surveys were administered in 2011 (T1; n = 2191 (out of 4693), 47 % response rate) and 2012 (T2: n = 1722 (out of 4350), 40 % response rate). A total of 1279 patients completed questionnaires at both timepoints (T1 and T2) (27 % response rate). Self-management abilities to maintain well-being were measured using the short (18-item) version of the Self-Management Ability Scale (SMAS-S), patients' perceptions of the productivity of interactions with health care professionals were assessed with the relational coordination instrument and the short (11-item) version of the Patient Assessment of Chronic Illness Care (PACIC-S) was used to assess patients' perceptions of the quality of chronic care delivery. RESULTS Perceived and objective quality of care and the productivity of patient-professional interaction were found to be related to patients' self-management abilities to maintain overall well-being. These abilities were related negatively to and significantly predicted by low educational level, single status, and older age, despite the mediating role of productive interaction in their relationship with patients' perceptions of care quality. CONCLUSIONS These findings suggest that patient-professional interaction is not yet sufficiently productive to successfully protect against the deterioration of self-management abilities in some groups of chronically ill patients, although such interaction and high-quality care are important factors in such protection. Improvement of the quality of chronic care delivery should thus always be accompanied by investment in high-quality communication and patient-professional relationships.
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Affiliation(s)
- Jane Murray Cramm
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands.
| | - Anna Petra Nieboer
- Institute of Health Policy & Management (iBMG), Erasmus University, Rotterdam, The Netherlands.
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Cramm JM, Jolani S, van Buuren S, Nieboer AP. Better experiences with quality of care predict well-being of patients with chronic obstructive pulmonary disease in the Netherlands. Int J Integr Care 2015; 15:e028. [PMID: 26150766 PMCID: PMC4491321 DOI: 10.5334/ijic.1587] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 05/15/2015] [Accepted: 05/20/2015] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE This study was conducted to (1) identify improvements in care quality and well-being of patients with chronic obstructive pulmonary disease in the Netherlands and (2) investigate the longitudinal relationship between these factors. METHODS This longitudinal study was conducted among patients diagnosed with chronic obstructive pulmonary disease enrolled in the Kennemer Lucht care programme in the Netherlands. Biomarker data (lung capacity) were collected at patients' health care practices in 2012. Complete case analysis was conducted, and the multiple imputation technique allowed us to report pooled results from imputed datasets. RESULTS Surveys were filled out by 548/1303 (42%) patients at T0 (2012) and 569/996 (57%) remaining participants at T1. Quality of care improved significantly (p < 0.05). Analyses adjusted for well-being at T0, age, educational level, marital status, gender, lung function and health behaviours showed that patients' assessments of the quality of chronic care delivery at T0 (p < 0.01) and changes therein (p < 0.001) predicted patients' well-being at T1. CONCLUSION These results clearly show that the quality of care and changes therein are important for the well-being of patients with chronic obstructive pulmonary disease in the primary care setting. PRACTICE IMPLICATIONS To improve quality of care for chronically ill patients, multicomponent interventions may be needed.
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Affiliation(s)
- Jane Murray Cramm
- Department of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Shahab Jolani
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Stef van Buuren
- Department of Methodology and Statistics, Utrecht University, Utrecht, The Netherlands
| | - Anna Petra Nieboer
- Department of Health Policy and Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Cramm JM, Nieboer AP. Disease Management: The Need for a Focus on Broader Self-Management Abilities and Quality of Life. Popul Health Manag 2015; 18:246-55. [PMID: 25607246 DOI: 10.1089/pop.2014.0120] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The study objective was to investigate long-term effects of disease management programs (DMPs) on (1) health behaviors (smoking, physical exercise); (2) self-management abilities (self-efficacy, investment behavior, initiative taking); and (3) physical and mental quality of life among chronically ill patients. The study also examined whether (changes in) health behaviors and self-management abilities predicted quality of life. Questionnaires were sent to all 5076 patients participating in 18 Dutch DMPs in 2010 (T0; 2676 [53%] respondents). Two years later (T1), questionnaires were sent to 4350 patients still participating in DMPs (1722 [40%] respondents). Structured interviews were held with the 18 DMP project leaders. DMP implementation improved patients' health behavior and physical quality of life, but mental quality of life and self-management abilities declined over time. Changes in patients' investment behavior predicted physical quality of life at T1 (P<.001); physical activity, investment behavior (both P<.05), and self-efficacy (P<.01) at T0, and changes in self-efficacy and investment behavior (both P<.001) predicted patients' mental quality of life at T1. The long-term benefits of these DMPs include successful improvement of chronically ill patients' health behaviors and physical quality of life. However, these programs were not able to improve or maintain broader self-management abilities or mental quality of life, highlighting the need to focus on these abilities and overall quality of life. As coproducers of care, patients should be stimulated and enabled to manage their health and quality of life.
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Affiliation(s)
- Jane Murray Cramm
- Institute of Health Policy and Management, Erasmus University , Rotterdam, the Netherlands
| | - Anna Petra Nieboer
- Institute of Health Policy and Management, Erasmus University , Rotterdam, the Netherlands
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Cramm JM, Nieboer AP. A longitudinal study to identify the influence of quality of chronic care delivery on productive interactions between patients and (teams of) healthcare professionals within disease management programmes. BMJ Open 2014; 4:e005914. [PMID: 25239294 PMCID: PMC4170203 DOI: 10.1136/bmjopen-2014-005914] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The chronic care model is an increasingly used approach to improve the quality of care through system changes in care delivery. While theoretically these system changes are expected to increase productive patient-professional interaction empirical evidence is lacking. This study aims to identify the influence of quality of care on productive patient-professional interaction. SETTING Longitudinal study in 18 Dutch regions. PARTICIPANTS Questionnaires were sent to all 5076 patients participating in 18 Disease Management Programmes (DMPs) in 2010 (2676 (53%) respondents). One year later (T1), 4693 patients still participating in the DMPs received a questionnaire (2191 (47%) respondents) and 2 years later (in 2012; T2) 1722 patients responded (out of 4350; 40% response). INTERVENTIONS DMPs PRIMARY OUTCOME MEASURE Patients' perceptions of the productivity of interactions (measured as relational coordination/coproduction of care) with professionals. Patients were asked about communication dimensions (frequent, accurate, and problem-solving communication) and relationship dimensions (shared goals and mutual respect). FINDINGS After controlling for background characteristics these results clearly show that quality of chronic care (T0), first-year changes in quality of chronic care (T1-T0) and second-year changes in quality of chronic care (T2-T1) predicted productive interactions between patients and professionals at T2 (all at p≤0.001). Furthermore, we found a negative relationship between lower educational level and productive interactions between patients and professionals 2 years later. CONCLUSIONS We can conclude that successfully dealing with the consequences of chronic illnesses requires proactive patients who are able to make productive decisions together with their healthcare providers. Since patients and professionals share responsibility for management of the chronic illness, they must also share control of interactions and decisions. The importance of patient-centeredness is growing and this study reports a first example of how quality of chronic care stimulates productive interactions between patients and professionals.
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Affiliation(s)
- Jane Murray Cramm
- Department of Health Policy & Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anna Petra Nieboer
- Department of Health Policy & Management (iBMG), Erasmus University Rotterdam, Rotterdam, The Netherlands
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Tsiachristas A, Cramm JM, Nieboer AP, Rutten-van Mölken MPMH. Changes in costs and effects after the implementation of disease management programs in the Netherlands: variability and determinants. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2014; 12:17. [PMID: 25089122 PMCID: PMC4118650 DOI: 10.1186/1478-7547-12-17] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2014] [Accepted: 07/22/2014] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES The aim of the study was to investigate the changes in costs and outcomes after the implementation of various disease management programs (DMPs), to identify their potential determinants, and to compare the costs and outcomes of different DMPs. METHODS We investigated the 1-year changes in costs and effects of 1,322 patients in 16 DMPs for cardiovascular risk (CVR), chronic obstructive pulmonary disease (COPD), and diabetes mellitus (DMII) in the Netherlands. We also explored the within-DMP predictors of these changes. Finally, a cost-utility analysis was performed from the healthcare and societal perspective comparing the most and the least effective DMP within each disease category. RESULTS This study showed wide variation in development and implementation costs between DMPs (range:€16;€1,709) and highlighted the importance of economies of scale. Changes in health care utilization costs were not statistically significant. DMPs were associated with improvements in integration of CVR care (0.10 PACIC units), physical activity (+0.34 week-days) and smoking cessation (8% less smokers) in all diseases. Since an increase in physical activity and in self-efficacy were predictive of an improvement in quality-of-life, DMPs that aim to improve these are more likely to be effective. When comparing the most with the least effective DMP in a disease category, the vast majority of bootstrap replications (range:73%;97) pointed to cost savings, except for COPD (21%). QALY gains were small (range:0.003;+0.013) and surrounded by great uncertainty. CONCLUSIONS After one year we have found indications of improvements in level of integrated care for CVR patients and lifestyle indicators for all diseases, but in none of the diseases we have found indications of cost savings due to DMPs. However, it is likely that it takes more time before the improvements in care lead to reductions in complications and hospitalizations.
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Affiliation(s)
- Apostolos Tsiachristas
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands
| | - Jane Murray Cramm
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands
| | - Anna P Nieboer
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands
| | - Maureen PMH Rutten-van Mölken
- Institute for Medical Technology Assessment, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands
- Department of Health Policy and Management, Erasmus University Rotterdam, P.O. Box 1738, Rotterdam, 3000 DR, The Netherlands
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Cramm JM, Strating MMH, Nieboer AP. The role of team climate in improving the quality of chronic care delivery: a longitudinal study among professionals working with chronically ill adolescents in transitional care programmes. BMJ Open 2014; 4:e005369. [PMID: 24852302 PMCID: PMC4039831 DOI: 10.1136/bmjopen-2014-005369] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES This study aimed to (1) evaluate the effectiveness of implementing transition programmes in improving the quality of chronic care delivery and (2) identify the predictive role of (changes in) team climate on the quality of chronic care delivery over time. SETTINGS This longitudinal study was undertaken with professionals working in hospitals and rehabilitation units that participated in the transition programme 'On Your Own Feet Ahead!' in the Netherlands. PARTICIPANTSS A total of 145/180 respondents (80.6%) filled in the questionnaire at the beginning of the programme (T1), and 101/173 respondents (58.4%) did so 1 year later at the end of the programme (T2). A total of 90 (52%) respondents filled in the questionnaire at both time points. Two-tailed, paired t tests were used to investigate improvements over time and multilevel analyses to investigate the predictive role of (changes in) team climate on the quality of chronic care delivery. INTERVENTIONS Transition programme. PRIMARY OUTCOME MEASURES Quality of chronic care delivery measured with the Assessment of Chronic Illness Care Short version (ACIC-S). RESULTS The overall ACIC-S score at T1 was 5.90, indicating basic or intermediate support for chronic care delivery. The mean ACIC-S score at T2 significantly improved to 6.70, indicating advanced support for chronic care. After adjusting for the quality of chronic care delivery at T1 and significant respondents' characteristics, multilevel regression analyses showed that team climate at T1 (p<0.01) and changes in team climate (p<0.001) predicted the quality of chronic care delivery at T2. CONCLUSIONS The implementation of transition programmes requires a supportive and stimulating team climate to enhance the quality of chronic care delivery to chronically ill adolescents.
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Affiliation(s)
- Jane M Cramm
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Mathilde M H Strating
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Anna P Nieboer
- Institute of Health Policy and Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
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