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Skovgaard AL, Jørgensen MJ, Tjørnhøj-Thomsen T, Høybye MT. Tinkering with symptoms, causes and solutions: Tracing the enactments of multiple chronic illnesses in specialised outpatient check-ups. SOCIOLOGY OF HEALTH & ILLNESS 2024; 46:627-643. [PMID: 38078784 DOI: 10.1111/1467-9566.13738] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 10/12/2023] [Indexed: 05/22/2024]
Abstract
People living with multiple chronic illnesses and an increasing need for acute care is a global health challenge, which questions the conventional ways of managing illness. A central issue is how medical practices can become more patient-centred and aligned with the everyday life of patients. Communicative strategies for eliciting the patient's goals and preferences are often proposed. In this article, we draw on ethnographic data from fieldwork conducted during 2019-2020 in health-care settings and among people living with multiple chronic illness(es) and repeated acute admissions in Denmark. Inspired by science and technology studies of chronic illness and care, we trace the enactments of illness and illness work in a patient trajectory marked by persistent symptoms and medical complexity. We analyse three medical encounters, and we show how 'tinkering' with clinical signs and utterances in each encounter constantly enacts new versions, shaping how the patient could and should live with his illness. We argue that specialised outpatient check-ups for these patients must provide space for continuous tinkering with the concrete effects of illness in everyday life.
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Affiliation(s)
- Anna Louise Skovgaard
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Research, Horsens Regional Hospital, Horsens, Denmark
| | | | - Tine Tjørnhøj-Thomsen
- National Institute of Public Health, University of Southern Denmark, Copenhagen K, Denmark
| | - Mette Terp Høybye
- Interacting Minds Centre, Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Elective Surgery Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
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Bogerd MJ, Exmann CJ, Slottje P, Bont J, Van Hout HP. Predicting anticipated benefit from an extended consultation to personalise care in multimorbidity: a development and internal validation study of a prioritisation algorithm in general practice. Br J Gen Pract 2024; 74:e307-e314. [PMID: 38164549 PMCID: PMC11044021 DOI: 10.3399/bjgp.2023.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 10/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Persons with multimorbidity may gain from person-centred care compared with the current protocolised chronic-disease management in Dutch general practice. Given time constraints and limited resources, it is essential to prioritise those most in need of an assessment of person-centred chronic-care needs. AIM To develop and validate a prioritisation algorithm based on routine electronic medical record (EMR) data that distinguishes between patients with multimorbidity who would, and those who would not, benefit from an extended person-centred consultation to assess person-centred chronic-care needs, as judged by GPs. DESIGN AND SETTING A mixed-methods study was conducted in five general practices in the north-west region of the Netherlands. Four out of the five practices were situated in rural areas. METHOD Multivariable logistic regression using EMR data to predict the GPs' judgement on patients' anticipated benefit from an extended consultation, as well as a thematic analysis of a focus group exploring GPs' clinical reasoning for this judgement were conducted. Internal validation was performed using 10-fold cross-validation. Multimorbidity was defined as the presence of ≥3 chronic conditions. RESULTS In total, EMRs from 1032 patients were included in the analysis; of these, 352 (34.1%) were judged to have anticipated benefit. The model's cross-validated C-statistic was 0.72 (95% confidence interval = 0.70 to 0.75). Calibration was good. Presence of home visit(s) and history of myocardial infarction were associated with anticipated benefit. Thematic analysis revealed three dimensions feeding anticipated benefit: GPs' cause for concern, patients' mindset regarding their conditions, and balance between received care/expected care needed. CONCLUSION This algorithm may facilitate automated prioritisation, potentially avoiding the need for GPs to personally triage the whole practice population that has multimorbidity. However, external validation of the algorithm and evaluation of actual benefit of consultation is recommended before implementation.
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Affiliation(s)
- Mieke Jl Bogerd
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Collin Jc Exmann
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Pauline Slottje
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jettie Bont
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Hein Pj Van Hout
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Bogerd MJ, Slottje P, Bont J, Van Hout HP. Development of a person-centred care approach for persons with chronic multimorbidity in general practice by means of participatory action research. BMC PRIMARY CARE 2024; 25:114. [PMID: 38627610 PMCID: PMC11020638 DOI: 10.1186/s12875-024-02364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The management of persons with multimorbidity challenges healthcare systems tailored to individual diseases. A person-centred care approach is advocated, in particular for persons with multimorbidity. The aim of this study was to describe the co-creation and piloting of a proactive, person-centred chronic care approach for persons with multimorbidity in general practice, including facilitators and challenges for successful implementation. METHODS A participatory action research (PAR) approach was applied in 13 general practices employing four subsequent co-creation cycles between 2019 and 2021. The target population included adults with ≥3 chronic conditions. Participating actors were general practitioners (GPs), practice nurses (PNs), patients (target group), the affiliated care cooperation, representatives of a health insurer and researchers. Each cycle consisted of a try-out period in practice and a reflective evaluation through focus groups with healthcare providers, interviews with patients and analyses of routine care data. In each cycle, facilitators, challenges and follow-up actions for the next cycle were identified. Work satisfaction among GPs and PNs was measured pre and at the end of the final co-creation cycle. RESULTS Identified essential steps in the person-centred chronic care approach include (1) appropriate patient selection for (2) an extended person-centred consultation, and (3) personalised goalsetting and follow-up. Key facilitators included improved therapeutic relationships, enhanced work satisfaction for care providers, and patient appreciation of extended time with their GP. Deliberate task division and collaboration between GPs and PNs based on patient, local setting, and care personnel is required. Challenges and facilitators for implementation encompassed a prioritisation tool to support GPs appropriately who to invite first for extended consultations, appropriate remuneration and time to conduct extended consultations, training in delivering person-centred chronic care available for all general practice care providers and an electronic medical record system accommodating comprehensive information registration. CONCLUSIONS A person-centred chronic care approach targeting patients with multimorbidity in general practice was developed and piloted in co-creation with stakeholders. More consultation time facilitated better understanding of persons' situations, their functioning, priorities and dilemma's, and positively impacted work satisfaction of care providers. Challenges need to be tackled before widespread implementation. Future evaluation on the quadruple aims is recommended.
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Affiliation(s)
- Mieke Jl Bogerd
- Amsterdam UMC, location VUmc, Department of General Practice, Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.
| | - Pauline Slottje
- Amsterdam UMC, location VUmc, Department of General Practice, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Jettie Bont
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Amsterdam UMC, location AMC, Department of General Practice, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hein Pj Van Hout
- Amsterdam UMC, location VUmc, Department of General Practice, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later life, Amsterdam, the Netherlands
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Rijken M, Stüssgen R, Leemrijse C, Bogerd MJL, Korevaar JC. Priorities and preferences for care of people with multiple chronic conditions. Health Expect 2021; 24:1300-1311. [PMID: 33938597 PMCID: PMC8369115 DOI: 10.1111/hex.13262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background To guide the development of high‐quality care for people with multiple chronic conditions, partners of the European Joint Action CHRODIS developed the Integrated Multimorbidity Care Model. To assess its suitability for improving care for people with multimorbidity in the Netherlands, the model was piloted in a primary care setting with both patients and care providers. Aim This paper reports on the patient perspective, and aims to explore the priorities, underlying values and preferences for care of people with multimorbidity. Participants and methods Twenty persons with multimorbidity (selected from general practice registries) participated in a focus group or telephone interview. Subsequently, a questionnaire was completed by 863 persons with multimorbidity registered with 14 general practices. Qualitative data were thematically analysed and quantitative data by means of descriptive statistics. Results Frequently prioritized elements of care were the use of shared electronic health records, regular comprehensive assessments, self‐management support and shared decision making, and care coordination. Preferences for how these elements should be specifically addressed differed according to individual values (eg weighing safety against privacy) and needs (eg ways of coping with multimorbidity). Conclusion The JA‐CHRODIS Integrated Multimorbidity Care Model reflects the priorities and preferences for care of people with multimorbidity in the Netherlands, which supports its relevance to guide the development of person‐centred integrated care for people with multiple chronic conditions in the Netherlands. Patient contribution European patient experts contributed to the development and applicability assessment of the JA‐CHRODIS Integrated Multimorbidity Care Model; Dutch patients participated in focus groups, interviews and a survey.
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Affiliation(s)
- Mieke Rijken
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - René Stüssgen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Zorginstituut Nederland, (National Health Care Institute), Diemen, The Netherlands
| | - Chantal Leemrijse
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Mieke J L Bogerd
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Joke C Korevaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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Rimmelzwaan LM, Bogerd MJL, Schumacher BMA, Slottje P, Van Hout HPJ, Reinders ME. Multimorbidity in General Practice: Unmet Care Needs From a Patient Perspective. Front Med (Lausanne) 2021; 7:530085. [PMID: 33415113 PMCID: PMC7783195 DOI: 10.3389/fmed.2020.530085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 11/23/2020] [Indexed: 11/13/2022] Open
Abstract
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.
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Affiliation(s)
- Lisanne M Rimmelzwaan
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Mieke J L Bogerd
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Bregitta M A Schumacher
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Pauline Slottje
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Hein P J Van Hout
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Marcel E Reinders
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Risco E, Sauch G, Albero A, Acar-Denizli N, Zabalegui A, Kostov B, Amil P, Alonso A, Rios A, Martín J, Fabrellas N. Spanish Validation of the "User Reported Measure of Care Coordination" Questionnaire for Older People with Complex, Chronic Conditions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186608. [PMID: 32932760 PMCID: PMC7558675 DOI: 10.3390/ijerph17186608] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/25/2020] [Accepted: 08/26/2020] [Indexed: 12/22/2022]
Abstract
Introduction: Older people with complex, chronic conditions often receive insufficient or inefficient care provision, and few instruments are able to measure their perception of care provision. The “User Reported Measure of Care Coordination” instrument has been satisfactorily used to evaluate chronic care provision and integration. The aim of this study is to validate this instrument in Spanish. Methods: The questionnaire was adapted and validated in two phases: translation and cultural adaptation of the questionnaire and psychometric property measurement. Study population were chronic care conditions patients. Results: A total of 332 participants completed test re-test as part of the questionnaire validation process. The final version of the questionnaire had 6 domains: Health and Well-being (D1), Health day to day (D2), Social Services (D3), Planned Care (D4), Urgent Care (D5), and Hospital Care (D6). Cronbach’s alpha for the overall questionnaire was 0.86, indicating good internal consistency. When analyzing each domain, only Planned Care (D4) and Urgent Care (D5) had Cronbach’s Alphas slightly lower than 0.7, although this could be related to the low number of items in each domain. A good temporal stability was observed for the distinct subscales and items, with intraclass correlation coefficients varying from 0.412 to 0.929 (p < 0.05). Conclusion: The adapted version of the “User Reported Measure of Care Coordination” into Spanish proved to be a practical tool for use in our daily practice and an efficient instrument for assessment of care coordination in chronic, complex conditions in older people across services and levels of care.
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Affiliation(s)
- Ester Risco
- Intermediated Care Hospital Parc Sanitari Pere Virgili, 08035 Barcelona, Spain;
| | - Glòria Sauch
- Research Support Unit Catalunya Central, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Catalan Health Institute, Catalunya Central, 08272 Sant Fruitós del Bages, Spain
- Correspondence:
| | - Anna Albero
- Emergency Department, Hospital Clínic de Barcelona, 08036 Barcelona, Spain;
| | - Nihan Acar-Denizli
- Department of Statistics, Faculty of Science and Letters, Mimar Sinan Fine Arts University, 34427 Istanbul, Turkey;
| | | | - Belchin Kostov
- Primary Healthcare Transversal Research Group, Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Primary Care Centre Les Corts, Consorci d’Atenció Primària de Salut Barcelona Esquerra (CAPSBE), 08036 Barcelona, Spain;
| | - Paloma Amil
- Chronicity Prevention and Care Programme, Health Planning General Directorate, Ministry of Health, Government of Catalonia, 08028 Barcelona, Spain;
| | - Albert Alonso
- Fundació Clínic per a la Recerca Biomèdica, 08036 Barcelona, Spain;
| | - Ana Rios
- Catalan Health Institute, 08007 Barcelona, Spain;
| | - Jaume Martín
- Research Suport Unit Barcelona, Fundació Institut Universitari per a la Recerca a l’Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Catalan Health Institute Barcelona, 08025 Barcelona, Spain;
| | - Núria Fabrellas
- Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, 08907 Barcelona, Spain;
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