Factors associated with healthcare-related frustrations among adults with chronic conditions

Living with Multimorbidity through Time: A Meta-Synthesis of Qualitative Longitudinal Evidence

The growing prevalence of multimorbidity places a strain on primary healthcare globally. The current study's aim was to identify, appraise, and synthesize published qualitative longitudinal research on individuals' experiences concerning living with multimorbidity through time. The authors searched two electronic databases, MEDLINE and CINAHL, and performed an additional literature search in Google Scholar. A thematic synthesis approach was used to analyze the qualitative data across the studies. A total of 10 reports that met the inclusion and exclusion criteria were included in the synthesis. Five descriptive themes emerged from the analysis of the living experiences of individuals with multimorbidity: (1) perceiving multimorbidity, (2) managing chronic conditions, (3) emotional struggles in everyday life with multimorbidity, (4) interactions with the healthcare system and healthcare professionals, and (5) family support. This meta-synthesis provides insights into the diverse perceptions of multimorbidity and how individuals cope with their chronic conditions in their daily lives. The findings highlight the importance of establishing effective patient-centered care that acknowledges and supports the multifaceted needs of this population. It is also recommended to involve a psychological component in the care of individuals with multimorbidity, as part of a collaborative and interprofessional approach.

Performance Medicine: a novel and needed paradigm for proactive health care

Performance Medicine is an emerging clinical practice that holds immense promise for advancing preventive health. To date, however, the concept remains imprecise, disorganized, and commercialized. The purpose of this perspective article is to define characteristics, core tenets, and practice standards to help build a common framework. We define performance broadly as "one's capacity to bring energy and attention to what matters most in a given moment". Performance Medicine, therefore, is predicated on the thesis that the critical practices that enhance one's daily wellbeing simultaneously increase both lifespan and healthspan. As a clinical practice, Performance Medicine is proactive and preventive. It focuses on the immediate and actionable strategies to address one's physical, mental, and emotional capabilities every day. The practice employs a values-centered approach that begins with a discovery process to elucidate the client's deeply held beliefs about their health status, life mission and goals, vision for optimal wellbeing, and motivations for change. Subsequent diagnostics and therapies combine evidence-based practices from multiple medical specialties including internal medicine, sports medicine, obesity medicine, integrative medicine, and others. This is complemented by the most recent scientific advancements in nutrition, exercise physiology, sleep, and recovery. The Performance Medicine prescription incorporates a personalized combination of lifestyle-based behavior change practices, evidence-based diagnostics and risk reduction therapies, ongoing monitoring, and community support. Finally, the iterative and incremental process towards enhanced and sustained health is guided and supported by a trusted partnership between the client and a team of expert practitioners and coaches.

My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity

BACKGROUND

Patient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration.

OBJECTIVE

We sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity.

DESIGN

We conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery.

PARTICIPANTS

Of 23 physicians interviewed, most were female (n = 14/23, 61%), serving in hospital-affiliated outpatient clinics (n = 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience.

KEY RESULTS

Facilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care.

CONCLUSIONS

Physicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.

An integrative review of negative emotions of older adults in later life

BACKGROUND

Older adults are one of the most vulnerable populations requiring scientific, psychological, and clinical attention. Although several studies have explored psychoemotional needs in later life, one critical gap in the literature is a shortage of studies comprehensively reviewing negative emotional experiences and their antecedents associated with later life.

AIM

This integrative review aims to identify negative emotional experiences during older adult years.

METHODS

This review of articles from Medline, CINAHL, Science Direct, Web of Science, ProQuest, and Taylor and Francis synthesized negative emotional experiences during older adult years. Across these six electronic databases, we searched and identified 17 relevant articles from 2005 to 2020 containing quantitative, qualitative, and mixed-method studies.

RESULTS

Based on the review, we identified five negative emotions (sadness, anxiety, frustration, anger, and loneliness). These negative emotions were rooted in marital problems, separation from families, medical problems, physical functioning and disability, and financial limitations. Additionally, we identified common antecedents of negative emotions.

CONCLUSION

At the center of numerous interventions, older adults are reinvigorated to understand the antecedents of negative emotions. The complex array of emotions, specifically regrets and frustration in later life, is depicted by more negativity than positivity. Such array of emotions could help develop strategies to prevent the causes of regret and frustration that nurses see when working with older adults in a clinical practice setting.

Contextualizing the Chronic Care Model among Non-Hispanic Black and Hispanic Men with Chronic Conditions

Middle-aged and older men of color with chronic conditions have low utilization of preventive health services. In the context of the Chronic Care Model (CCM), the objective of this study was to identify perceptions about being informed, activated patients and having productive interactions in healthcare settings among non-Hispanic Black and Hispanic middle-aged and older men with chronic health conditions in the United States. Using an internet-based survey deployed nationally using a Qualtrics panel, data were collected from a sample of non-Hispanic Black and Hispanic men aged 40 years and older with one or more self-reported chronic conditions (n = 2028). Chi-square tests and one-way ANOVAs were used to describe this national sample by race/ethnicity and age group (40-64 years and ≥65 years). Results suggest that most health-related factors differed more on age than by race/ethnicity. Younger age groups reported less preventive care, greater barriers to self-care, mental health issues, and risky behavior. Findings from this study provide insight into the health status and healthcare utilization of racial/ethnic men with one or more chronic conditions. Results may help inform prevention and treatment interventions for middle-aged and older men of color.

The Coordination Toolkit and Coaching Project: Cluster-Randomized Quality Improvement Initiative to Improve Patient Experience of Care Coordination

BACKGROUND

Given persistent gaps in coordination of care for medically complex primary care patients, efficient strategies are needed to promote better care coordination.

OBJECTIVE

The Coordination Toolkit and Coaching project compared two toolkit-based strategies of differing intensity to improve care coordination at VA primary care clinics.

DESIGN

Multi-site, cluster-randomized QI initiative.

PARTICIPANTS

Twelve VA primary care clinics matched in 6 pairs.

INTERVENTIONS

We used a computer-generated allocation sequence to randomize clinics within each pair to two implementation strategies. Active control clinics received an online toolkit with evidence-based tools and QI coaching manual. Intervention clinics received the online toolkit plus weekly assistance from a distance coach for 12 months.

MAIN MEASURES

We quantified patient experience of general care coordination using the Health Care System Hassles Scale (primary outcome) mailed at baseline and 12-month follow-up to serial cross-sectional patient samples. We measured the difference-in-difference (DiD) in clinic-level-predicted mean counts of hassles between coached and non-coached clinics, adjusting for clustering and patient characteristics using zero-inflated negative binomial regression and bootstrapping to obtain 95% confidence intervals. Other measures included care coordination QI projects attempted, tools adopted, and patient-reported exposure to projects.

KEY RESULTS

N = 2,484 (49%) patients completed baseline surveys and 2,481 (48%) completed follow-ups. Six coached clinics versus five non-coached clinics attempted QI projects. All coached clinics versus two non-coached clinics attempted more than one project or projects that were multifaceted (i.e., involving multiple components addressing a common goal). Five coached versus three non-coached clinics used 1-2 toolkit tools. Both the coached and non-coached clinics experienced pre-post reductions in hassle counts over the study period (- 0.42 (- 0.76, - 0.08) non-coached; - 0.40 (- 0.75, - 0.06) coached). However, the DiD (0.02 (- 0.47, 0.50)) was not statistically significant; coaching did not improve patient experience of care coordination relative to the toolkit alone.

CONCLUSION

Although coached clinics attempted more or more complex QI projects and used more tools than non-coached clinics, coaching provided no additional benefit versus the online toolkit alone in patient-reported outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT03063294.

How Do Patients Define Satisfaction? The Role of Patient Perceptions of Their Participation and Health Provider Emotional Expression

Patient satisfaction is important to patient outcomes. Previous attempts to conceptualize satisfaction have often taken an atheoretical approach and focused on doctors' communication skills. Patients are becoming more active health consumers involved in their health care and current definitions of patient satisfaction may not accurately reflect patient expectations about their health consultations. Earlier research found that meeting patients' emotional needs - through empathy and patient-centered communication - is important to patient satisfaction. New research is needed to explore how those needs can be met given the changing trend in patient behaviors and the focus on patient-centredness. This study employed two communication theories - the Willingness to Communicate Model and Communication Accommodation Theory - to consider both patients' communicative decisions, and the intergroup features of the health context that can influence communicative behaviors. Two hundred and fifty-three patients from health clinics in Canada and Australia described what satisfaction meant to them, and identified what aspects of their health consultation were satisfying (or not), and we investigated their perceptions of doctor's emotional expression. Results suggest that patient perceptions of their participation in the consultation predicts their perceptions of doctor emotional expression, and their satisfaction with the consultation. Patients want both emotional and medical needs met in an environment that balances interpersonal and intergroup communication. Our findings suggest the need to expand current definitions of patient satisfaction, patient-centredness and emotional expression. We discuss the implications of these findings for health practitioners and consider future research that addresses the need for more individualized health care.

Web-Based Health Information Seeking Among African American and Hispanic Men Living With Chronic Conditions: Cross-sectional Survey Study

Background

Previous research has identified disparities in seeking and using web-based health information to inform health-related behaviors. Relatively few studies however have examined the correlations between web-based health information seeking and use based on race, gender, age, and the presence of chronic health conditions.

Objective

In this study, we identify factors associated with seeking and using web-based health information among a uniquely vulnerable and intersectional population—middle-aged and older (40 years and older) African American and Hispanic men living with one or more chronic conditions.

Methods

Survey responses were collected from a purposive sample of African American and Hispanic men using Qualtrics web-based survey management software. To qualify for inclusion in the study, respondents had to identify as African American or Hispanic men, report having at least one chronic condition, and be aged 40 years and older. A series of binary logistic regression models was created using backward elimination. Statistical significance was determined at P<.05 for all analyses.

Results

Web-based health information seeking among African American and Hispanic men is a function of education, the presence of multiple chronic conditions, frustration with health care providers, internet use, and the perceived reliability of web-based health information. The use of web-based health information to inform interactions with health care providers was more common among African American and Hispanic men, who rated their health as relatively good, perceived barriers to care, used technology regularly, and took more daily medications.

Conclusions

Understanding the factors that influence African American and Hispanic men seeking web-based health information may help improve the care and treatment of chronic conditions. African American and Hispanic men seek web-based health information as a substitute for routine care and to inform their discussions with health care providers.

Multimorbidity in General Practice: Unmet Care Needs From a Patient Perspective

Introduction: In the Netherlands, as in many other countries, current clinical guidelines are directed at single diseases. Patients with multiple chronic conditions may benefit from a more patient-tailored approach. Therefore, our objective is to explore the general practice care needs of patients with multimorbidity from a patient perspective. We also assessed their care experiences and the impact of chronic conditions on their daily functioning. Methods: We conducted a qualitative study, using semi-structured interviews complemented with self-report questionnaire assessments for triangulation, with consenting community-dwelling patients with three or more chronic conditions. Participants were identified through purposeful sampling in three general practices. Two researchers independently coded and thematically analyzed the audiotaped and anonymously transcribed interviews using the constant comparative method. The self-report questionnaire assessments were used to describe the patient characteristics and for triangulation of the data retrieved from the semi-structured interviews. Results: After 12 interviews, saturation was achieved. Overall, most participants were positive about their relationship with the general practitioner (GP) and practice nurse (PN) as well as the care they received in general practice. However, several unmet care need themes were observed: firstly, lack of a holistic approach (by the GP and PN), in particular, insufficient attention to the patient's state of functioning, their limitations in daily life, and their well-being; secondly, they mentioned that personal continuity of care was important to them and sometimes lacking; thirdly, lack of patient-tailored explanations about diseases and treatments. Conclusion: From a community-dwelling multimorbid patient perspective, general practice care could benefit from improving personal continuity of care, attention to personal circumstances and daily functioning, and patient-tailored communication.

Fiction, Falsehoods, and Few Facts: Cross-Sectional Study on the Content-Related Quality of Atopic Eczema-Related Videos on YouTube

Background

In recent years, YouTube has become a recognized source of medical information for health care consumers. Although YouTube has advantages in this context, there are potential dangers as videos may contain nonscientific, misleading, or even harmful information.

Objective

As little is known about YouTube as a source of information on atopic dermatitis (AD), we investigated the content-related quality of AD videos and their perception among YouTube users.

Methods

The quality of the 100 most viewed AD videos was assessed by using the Global Quality Scale (GQS) and the DISCERN instrument. Videos were classified as “useful,” “misleading,” and “potentially harmful,” and the correlations of viewers’ ratings (likes) with the GQS and DISCERN scores were assessed.

Results

Among the 100 videos, 68.0% (68/100) and 62.0% (62/100) were of poor and very poor scientific quality, respectively. Additionally, 32.0% (32/100) of the videos were classified as useful, 48.0% (48/100) were classified as misleading, and 34.0% (34/100) were classified as potentially harmful. Viewers’ ratings did not correlate with the GQS and DISCERN scores. Overall, 50.0% (50/100) of the videos were posted by private individuals and promoters of complementary/alternative treatments, 42.0% (42/100) by therapeutical advertisers, and only 8.0% (8/100) by nonprofit organizations/universities.

Conclusions

Our study demonstrated that two-thirds of the videos analyzed were below acceptable medical quality standards and that many videos were disseminating misleading or even dangerous content. Subjective and anecdotal content was overrepresented, and viewers did not appear to be able to distinguish between high- and low-quality videos. Health promotion strategies by professional medical organizations are needed to improve their presence and visibility on YouTube.

Patient satisfaction with primary care physician performance in a multicultural population

BACKGROUND

A key component of the quality of health care is patient satisfaction, particularly in regard to Primary Care Physician (PCP), which represents the first contact with health care services. Patient satisfaction is associated with ethnic, regional and socio-demographic differences, due to differences in service quality, patient-doctor communication, and the patient's perceptions. The aim of this study was to evaluate patients' satisfaction related to primary care physicians' (PCP) performance and to explore potential differences by ethnicity in a multicultural population.

METHODS

A national cross-sectional telephone survey was conducted, among a random sample of the Israeli population aged ≥25 years. Satisfaction level from performance of PCP was assessed using a validated questionnaire (30 items; 6 different domains).

RESULTS

The final sample included (n = 827 Jews; n = 605 Arabs, mean age 54.7(±14.9). In the adjusted logistic regression models, Arabs reported lower general satisfaction related to PCPs' performance as compared to Jews (adjusted odds ratio (AOR), 0.63; (95% CI: 0.40-0.98). Arabs reported lower satisfaction related to PCPs' performance across the following domains: communication skills (AOR, 0.42; 95% CI, 0.22-0.82); interpersonal manners (AOR, 0.37; 95% CI, 0.24-0.58); and time spent with the patients (AOR, 0.60; 95% CI, 0.43-0.85).

CONCLUSIONS

Jews and Arabs were very satisfied with PCPs' performance. However, there are ethnic differences in the extent of satisfaction level related to the performance of PCP. Satisfaction from PCPs' performance may be achieved by improving the communication skills of the PCP, encouraging interpersonal interaction between the PCP and the patient, and devoting more time to the patient during the visits.

Adherence to treatment and related factors among patients with chronic conditions in primary care: a cross-sectional study

Background

Adherence to treatment, a public health issue, is of particular importance in chronic disease therapies. Primary care practices offer ideal venues for the effective care and management of these conditions. The aim of this study is to assess adherence to treatment and related-factors among patients with chronic conditions in primary care settings.

Methods

A cross-sectional study was conducted among 299 adult patients with ≥1 chronic condition(s) and prescribed medication in primary healthcare centers of Spain. The Morisky-Green-Levine questionnaire was used to assess medication adherence via face-to-face interviews. Crude and adjusted multivariable logistic regression models were used to analyze factors associated with adherence using the Multidimensional Model proposed by the World Health Organization — social and economic, healthcare team and system-related, condition-related, therapy-related, and patient-related factors.

Results

The proportion of adherent patients to treatment was 55.5%. Older age (adjusted odds ratio 1.31 per 10-year increment, 95% CI 1.01–1.70), lower number of pharmacies used for medication refills (0.65, 95% CI 0.47–0.90), having received complete treatment information (3.89, 95% CI 2.09–7.21), having adequate knowledge about medication regimen (4.17, 95% CI 2.23–7.80), and self-perception of a good quality of life (2.17, 95% CI 1.18–4.02) were independent factors associated with adherence.

Conclusions

Adherence to treatment for chronic conditions remained low in primary care. Optimal achievement of appropriate levels of adherence through tailored multifaceted interventions will require attention to the multidimensional factors found in this study, particularly those related to patients’ education and their information needs.

Electronic supplementary material

The online version of this article (10.1186/s12875-019-1019-3) contains supplementary material, which is available to authorized users.

Connecting People With Multimorbidity to Interprofessional Teams Using Telemedicine

PURPOSE

Most models for managing chronic disease focus on single diseases. Managing patients with multimorbidity is an increasing challenge in family medicine. We evaluated the feasibility of a novel approach to caring for patients with multimorbidity, performing a case study of TIP-Telemedicine IMPACT (Interprofessional Model of Practice for Aging and Complex Treatments) Plus-a 1-time interprofessional consultation with primary care physicians (PCPs) and their patients in Toronto, Canada.

METHODS

We assessed feasibility of the TIP model from the number of referrals from PCPs and emergency departments in Toronto, Canada; the intervention cost; and the satisfaction of patients, PCPs, and team members with the new model. One patient and PCP story highlights the model's impact. We also performed thematic analysis of written feedback.

RESULTS

A total of 76 patients were referred from 53 PCPs and 4 emergency departments, and 65 PCPs participated in TIP. All 74 patient survey respondents indicated TIP improved their access to interdisciplinary resources, and 97% reported feeling hopeful their conditions would improve as a result. Of 21 PCP survey respondents, 100% reported they would use TIP again, and 90% reported improved confidence in managing their patient's care. Of 87 team member survey respondents, 97% rated TIP as effective. Qualitative findings indicated benefits to both patients and health professionals. The cost was about 22% less than that of a 1-day hospital admission through the emergency department (C$854 vs C$1,088).

CONCLUSIONS

TIP is a feasible intervention in multiple primary care settings that gives patients an active role in their health management, supported by their team. The model effectively addresses the needs of the most complex patients and their PCPs.

Patient-centred access to health care: a framework analysis of the care interface for frail older adults

Background

The objective of this study was to explore the issues surrounding access to health and social care services for frail older adults with Polish stakeholders, including healthy and frail/pre-frail older adults, health care providers, social care providers, and caregivers, in order to determine their views and perspectives on the current system and to present suggestions for the future development of a more accessible and person-centred health and social care system.

Methods

Focus groups were used to gather qualitative data from stakeholders. Data were analysed using framework analysis according to five dimensions of accessibility to care: approachability, acceptability, availability and accommodation, affordability and appropriateness.

Results

Generally services were approachable and acceptable, but unavailable. Poor availability related to high staff turnover, staff shortages and a lack of trained personnel. There were problems of long waiting times for specialist care and rehabilitation services, and geographically remote clinics. Critically, there were shortages of long-term inpatient care places, social care workers and caregivers. The cost of treatments created barriers to care and inequities in the system. Participants described a lack of integration between health and social care systems with differing priorities and disconnected budgets. They described an acute medical system that was inappropriate for patients with complex needs, alongside a low functioning social care system, where bureaucratisation caused delays in providing services to the vulnerable. An integrated system with a care coordinator to improve connections between services and patients was suggested.

Conclusions

There is an immediate need to improve access to health and social care systems for pre-frail and frail patients, as well as their caregivers. Health and social care services need to be integrated to reduce bureaucracy and increase the timeliness of treatment and care.

Restricted Social Engagement among Adults Living with Chronic Conditions

Background: Social engagement is key to health and quality of life. Little is known about social engagement patterns of middle-aged and older adults who live with one or more chronic illnesses. This study investigated social engagement restrictions among middle-aged and older adults with chronic conditions and factors associated with these restrictions. Methods: Cross-sectional representative data from the National Council on Aging Chronic Care Survey were examined for relationships between social engagement restrictions and chronic conditions, health status, support, quality of life implications, self-care barriers, caregiving, and demographics. Associations were tested using bivariate analyses and binary logistic regression. Results: Participants were 793 middle-aged (age 44-64) and older adults (age 65+) with one or more chronic conditions. Factors associated with social engagement restrictions included having higher education, receiving care, having more physician visits and hospitalizations, being disabled, being unemployed, and having higher Emotional and Physical Problems Scale scores. Conclusions: Findings reveal the prevalence of social engagement restrictions among middle-aged and older adults with chronic conditions. Results highlight the importance of promoting research, assessments, and interventions to increase social engagement among this aging population.

Effectiveness of Healthcare Coordination in Patients with Chronic Respiratory Diseases

Coordination of healthcare effectively prevents exacerbations and reduces the number of hospitalizations, emergency visits, and the mortality rate in patients with chronic respiratory diseases. The purpose of this study was to determine clinical effectiveness of ambulatory healthcare coordination in chronic respiratory patients and its effect on the level of healthcare services as an indicator of direct medical costs. We conducted a retrospective health record survey, using an online database of 550 patients with chronic respiratory diseases. There were decreases in breathing rate, heart rate, and the number of cigarettes smoked per day, and forced vital capacity (FVC) and forced expired volume in 1 s (FEV1) increased after the implementation of the coordinated healthcare structure. These benefits were accompanied by increases in the number of visits to the pulmonary outpatient clinic (p < 0.001), diagnostic costs (p < 0.001), and referrals to other outpatient clinics (p < 0.003) and hospitals (p < 0.001). The advantageous effects of healthcare coordination on clinical status of respiratory patients above outlined persisted over a 3-year period being reviewed.

Factors Associated With Pain Frequency Among Adults With Chronic Conditions

CONTEXT

Chronic pain affects approximately 100 million Americans, but little is known about the factors associated with pain frequency.

OBJECTIVES

This article examines participants' sociodemographics, medical history, health care access and utilization, self-management barriers, and social support associated with pain frequency among a sample of middle-aged and older adults with one or more chronic condition.

METHODS

Data were from the National Council on Aging Chronic Care Survey. An ordinal regression model was fitted to examine factors associated with self-reported pain frequency.

RESULTS

Having more chronic conditions (P < 0.001), taking more medication daily (P < 0.001), and visiting the physician five or more times a year (P = 0.011) were associated with more frequent pain. Always getting the help and support needed to manage their health problems was associated with less frequent pain (P < 0.001).

CONCLUSION

More attention should be given to pain management during interactions with health care providers. Providing resources and support for disease self-management may help reduce pain frequency and self-management in middle-aged and older adults with chronic conditions.

A content analysis of peripheral arterial disease patient-reported outcome measures using the International Classification of Functioning, Disability and Health

BACKGROUND

The purpose of this study was to link, classify and describe the content of peripheral arterial disease (PAD)-specific patient-reported outcome measures using the International Classification of Functioning. The results were then analyzed to determine if these assessments provide clinicians and researchers with a comprehensive understanding of the lived experience of patients with PAD.

METHODS

Each meaningful concept in identified PAD assessments was linked to the International Classification of Functioning, Disability and Health to determine included and excluded content areas. An overall perspective was assigned to each assessment item. Inter-rater reliability was established using a kappa statistic.

RESULTS

The body functions component is most frequently addressed overall followed by the activities and participation component. International Classification of Functioning chapter and category distribution vary greatly between assessments and no assessment comprehensively examines community participation and relationships. The majority of the assessment items are of the health status-disability and quality of life perspectives.

CONCLUSIONS

The results of this study suggest the need for the development of a comprehensive PAD assessment that includes a more even distribution of International Classification of Functioning topics and subtopics. A more comprehensive assessment would better capture the lived experience of this patient population. Implications for Rehabilitation A better understanding of the data collected using the current peripheral arterial disease-specific patient-reported outcome measures may contribute to the development of more comprehensive assessment tools that will ultimately lead to improved patient care. This study contributes to the preliminary foundation for the development of a peripheral arterial disease International Classification of Functioning, Disability and Health Core Set. Clinicians and researchers interested in using peripheral arterial disease-specific patient-reported outcome measures for clinical and research purposes can better understand what topics are included and excluded in the collection and what perspectives are addressed.

Self-care difficulties and reliance on support among vulnerable middle-aged and older adults with chronic conditions: A cross-sectional study

OBJECTIVES

Chronic conditions are pervasive among middle-aged and older adults. This study identified: (1) factors associated with participants reporting difficulties self-managing their chronic condition(s); and (2) factors associated with participants' reliance on external sources for ongoing help and support to improve their health and manage their health conditions.

STUDY DESIGN

Cross-sectional data were collected using the National Council on Aging Chronic Care Survey, a nationally representative telephone survey of adults aged 45 years and older with at least one chronic condition.

MAIN OUTCOME MEASURES

Self-care difficulties among middle-aged and older adults with one or more chronic conditions and factors associated with reliance on ongoing help and support were examined.

RESULTS

Among 731 middle-aged and older adults with one or more chronic conditions, 31% of participants reported their health condition(s) made it difficult for them to care for themselves. Participants who were Hispanic (OR=3.08, P=0.009), had three or more chronic conditions (OR=3.05, P <0.001), took more medications daily (OR=1.07, P=0.046), and experienced certain healthcare-related frustrations (P≤0.023) were more likely to report difficulties self-managing their chronic condition(s). Participants relied on healthcare providers (40%), friends/relatives (20%), internet (9%), people with similar problems (6%), and community groups (3%) for help and support. Reliance on sources of support varied with participants' sociodemographic factors as well as healthcare and medication use.

CONCLUSIONS

Simultaneously considering patients' disease profiles, patient characteristics, difficulties managing their chronic conditions at home, and interactions with the healthcare system can inform tailored approaches and strategies to enhance patient education and resource identification, and can support service linkages.