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Bruyère O, Demonceau C, Kergoat MJ. Navigating the Health Care Landscape for an Ageing Population: An International Survey of Strategies and Priorities. J Am Med Dir Assoc 2024; 25:105155. [PMID: 39009063 DOI: 10.1016/j.jamda.2024.105155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/11/2024] [Accepted: 06/12/2024] [Indexed: 07/17/2024]
Abstract
OBJECTIVES The global increase in the older population, which is expected to reach 1.5 billion by 2050, poses significant challenges for publicly funded health care systems. Life expectancy, although positive, is leading to an increase in chronic diseases requiring complex and costly health and social solutions. This study explores key strategies to address these challenges. DESIGN Qualitative interviews followed by a survey. SETTING AND PARTICIPANTS The study involved experts, students, artificial intelligence, and participants at a congress. METHODS We first interviewed 5 experts from different countries representing health care management and psychology from Belgium, health economics from Canada, sociology from France, and geriatrics from Switzerland. In addition, a focus group session with medical students in physical therapy and queries to ChatGPT increased the range of perspectives. A synthesis of all opinions or insights was used to formulate concrete strategies. These strategies were incorporated into an online survey that was distributed to 215 participants of the Geriatric and Gerontologic Congress in Montreal, Canada, in September 2023. RESULTS All 20 potential solutions were duly acknowledged, with particular attention paid to the following 5 priorities: the urgent need to integrate geriatric training into the education of future health professionals, the promotion of home-based care models, the establishment of comprehensive and integrated care systems, the strengthening of primary care services, and the emphasis on primary prevention strategies. CONCLUSION AND IMPLICATIONS This study highlights key priorities for addressing the health needs of the older population. By emphasizing education, home-based care, and integrated services and strengthening primary care and prevention, health systems can respond effectively to the challenges of an ageing population. Although these needs may not be entirely unmet, they indicate areas where existing services are insufficient in providing adequate coverage and support to ensure tailored and sustainable health care solutions for older people.
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Affiliation(s)
- Olivier Bruyère
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium; Department of Physical Activity and Rehabilitation Sciences, University of Liège, Liège, Belgium.
| | - Céline Demonceau
- WHO Collaborating Center for Public Health Aspects of Musculoskeletal Health and Ageing, Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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Malakellis M, Wong Shee A, Murray M, Alston L, Versace VL, Allender S, Mc Namara K. A qualitative system model to describe the causes and drivers of frequent potentially avoidable presentations to the emergency department. Heliyon 2023; 9:e21304. [PMID: 38027925 PMCID: PMC10658286 DOI: 10.1016/j.heliyon.2023.e21304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 10/13/2023] [Accepted: 10/19/2023] [Indexed: 12/01/2023] Open
Abstract
Frequent potentially avoidable presentations to Emergency Departments (EDs) represent a complex problem, driven by multiple interdependent and interacting factors that change over time and influence one another. We sought to describe and map the drivers of frequent potentially avoidable presentations to a regional ED, servicing regional and rural areas, and identify possible solutions from the perspectives of key stakeholders. This study used a qualitative, community-based systems dynamics approach utilising Group Model Building (GMB). Data were collected from two 3-h online workshops embedded with small-group discussions and conducted with stakeholder groups operating within a regional health system. Stakeholders were guided through a series of participatory tasks to develop a causal loop diagram (CLD) using Systems Thinking in Community Knowledge Exchange software (n=29, workshop one), identify potential action points and generate a prioritised action list to intervene in the system (n=21, workshop two). Data were collected through note taking, real-time system mapping, and recording the workshops. Each action was considered against the Public Health 12 framework describing twelve leverage points to intervene in a system. A CLD illustrating the complex and interrelated factors that drive frequent potentially avoidable ED presentations was developed and classified into four categories: (1) access to services; (2) coordination; (3) patient needs; and (4) knowledge and skills. Nine action areas were identified, with many relating to care and service coordination. Most actions aligned with lower-level system impact actions. This study provides an in-depth understanding of influencing factors and potential solutions for frequent potentially avoidable ED presentations across a regional health system. The CLD demonstrates frequent potentially avoidable ED presentations are a complex problem and identified that a prevention response should engage with system- and individual-level solutions. Further work is needed to prioritise actions to support the implementation of higher-level system impacts.
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Affiliation(s)
- Mary Malakellis
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Anna Wong Shee
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
- Grampians Health, Ballarat, Victoria, Australia
| | - Margaret Murray
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Laura Alston
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
- Colac Area Health Research Unit, Colac, Victoria, Australia
| | - Vincent L. Versace
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
| | - Steven Allender
- Global Centre for Preventative Health and Nutrition, Institute for Health Transformation, Deakin University, Geelong, Victoria, Australia
| | - Kevin Mc Namara
- Deakin Rural Health, School of Medicine, Deakin University, Warrnambool, Victoria, Australia
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van Niekerk M, Richey A, Vorhies J, Wong C, Tileston K. Effectiveness of psychosocial interventions for pediatric patients with scoliosis: a systematic review. WORLD JOURNAL OF PEDIATRIC SURGERY 2023; 6:e000513. [PMID: 36919027 PMCID: PMC10008171 DOI: 10.1136/wjps-2022-000513] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 02/13/2023] [Indexed: 03/09/2023] Open
Abstract
Background Pediatric patients affected by scoliosis have complex psychological and social care needs, and may benefit from psychosocial interventions. We therefore aimed to summarize evidence of the efficacy of psychosocial interventions for this patient population. Methods Literature was identified by searching Medline, PsycINFO, Embase, EBSCO Cumulated Index to Nursing and Allied Health Literature (CINAHL), and Cochrane Central Register of Controlled Trials (CENTRAL) from database inception to 20 March 2022. Articles that evaluated the effectiveness of psychosocial interventions for pediatric patients diagnosed with scoliosis and reported at least one quantitative outcome were included. Article eligibility, data extraction, and quality assessment (using the Cochrane Collaboration's Risk of Bias Tool and Methodological Index for Non-Randomized Studies) were performed by two independent researchers. Findings are presented using narrative synthesis. Results We identified ten studies, all of which focused on adolescent idiopathic scoliosis. Studies included a total of 1007 participants, most of whom were female. Three studies focused on patients undergoing bracing, six on patients undergoing spinal surgery, and one on patients broadly. Brace compliance monitoring and counseling were found to significantly improve brace compliance quality and quantity. Proactive mental healthcare delivery by nurses after spinal surgery was similarly found to improve outcomes. Several studies examined the efficacy of brief educational interventions; most did not report clear evidence of their efficacy. The methodological quality of studies was often unclear due to limitations in articles' reporting quality. Conclusions Research on the efficacy of psychosocial interventions for pediatric patients with scoliosis is limited, with interventions involving frequent patient-provider interactions showing the most promise. Future clinical and research efforts should focus on developing and testing psychosocial interventions for this patient population, with emphasis on multidisciplinary teams delivering holistic care. Trial registration number PROSPERO number CRD42022326957.
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Affiliation(s)
- Maike van Niekerk
- Pediatric Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Ann Richey
- Pediatric Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - John Vorhies
- Pediatric Orthopaedic Surgery, Stanford University, Stanford, California, USA
| | - Connie Wong
- Lane Medical Library, Stanford University, Stanford, California, USA
| | - Kali Tileston
- Pediatric Orthopaedic Surgery, Stanford University, Stanford, California, USA
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Brinkmann C, Radic M, Kasprick L. [Cost-Effectiveness of Case and Care Management in Older Populations in Germany: a Systematic Literature Review]. DAS GESUNDHEITSWESEN 2022; 85:332-338. [PMID: 36126951 PMCID: PMC10125341 DOI: 10.1055/a-1845-1054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
BACKGROUND Despite trends toward longer-lasting health, the complexity of older people's health problems is increasing, raising the need for interprofessional care in all settings. A lack of coordination among providers risks fragmented care, leading to a repetition or gaps in services, conflicting treatment recommendations, medication errors and higher costs. Accordingly, new integrated models of care are needed that are based on patient needs. Case and Care Management (CCM) is currently being tested in Germany in a variety of settings to improve care. AIM OF THE STUDY The aim of the present study was to analyze the results of health economic evaluations of CCM interventions in Germany in populations over 60 years of age compared to standard care. MATERIAL AND METHODS The study is based on a systematic literature review conducted via Pubmed and Livivo and supplemented by a comprehensive hand search. The primary studies included for analysis were assessed using the CHEERS statement and narratively synthesized. RESULTS A total of five cost-effectiveness studies were included, predominantly based on randomized controlled trials. Results regarding cost effectiveness were mixed. Individual studies found significant differences on effectiveness and cost endpoints. CONCLUSIONS The mixed, small number of studies does not currently provide a clear picture of whether CCM interventions have health economic advantages over standard care. Further research is indicated. Innovation fund projects on the topic area are expected to generate new evidence in the future.
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Affiliation(s)
- Carolin Brinkmann
- Hamburg Center for Health Economics, Universität Hamburg, Hamburg, Germany
| | - Marija Radic
- Preis- und Dienstleistungsmanagement, Fraunhofer-Zentrum für Internationales Management und Wissensökonomie, Leipzig, Germany
| | - Lysann Kasprick
- Gerinet e.V., Leipzig, Germany.,Universität Halle-Wittenberg, Halle, Germany
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Organization of primary care. Prim Health Care Res Dev 2022; 23:e49. [PMID: 36047002 PMCID: PMC9472237 DOI: 10.1017/s1463423622000275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Strong primary care does not develop spontaneously but requires a well-developed organizational planning between levels of care. Primary care-oriented health systems are required to effectively tackle unmet health needs of the population, and efficient primary care organization (PCO) is crucial for this aim. Via strong primary care, health delivery, health outcomes, equity, and health security could be improved. There are several theoretical models on how primary care can be organized. In this position paper, the key aspects and benchmarks of PCO will be explored based on previously mentioned frameworks and domains. The aim of this position paper is to assist primary care providers, policymakers, and researchers by discussing the current context of PCO and providing guidance for implementation, development, and evaluation of it in a particular setting. The conceptual map of this paper consists of structural and process (PC service organization) domains and is adapted from frameworks described in literature and World Health Organization resources. Evidence we have gathered for this paper shows that for establishing a strong PCO, it is crucial to ensure accessible, continuous, person-centered, community-oriented, coordinated, and integrated primary care services provided by competent and socially accountable multiprofessional teams working in a setting where clear policy documents exist, adequate funding is available, and primary care is managed by dedicated units.
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van Niekerk M, Tileston K. Letter to the editor: Improving biopsychosocial care for adolescents with scoliosis “A systematic scoping review and textual narrative synthesis of the qualitative evidence related to adolescent idiopathic scoliosis”. Int J Orthop Trauma Nurs 2022; 46:100961. [DOI: 10.1016/j.ijotn.2022.100961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 11/25/2022]
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Jerez-Barranco D, Gutiérrez-Rodríguez L, Morilla-Herrera JC, Cuevas Fernandez-Gallego M, Rojano-Perez R, Camuñez-Gomez MD, Sanchez-Del Campo JL, García-Mayor S. Components of case management in caring for patients with dementia: a mixed-methods study. BMC Nurs 2022; 21:163. [PMID: 35739550 PMCID: PMC9219194 DOI: 10.1186/s12912-022-00935-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 06/10/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Case management has shown improvements in some health outcomes for dementia patients and their families. However, despite its benefits the components of case management in order to provide effective patient and family care remain unknown at present. Thus, the aim of this study is to identify the specific components of case management in caring for patients with dementia and to determine the necessary intensity of its deployment to enhance outcomes for these patients and their caregivers. METHODS Mixed-methods study with a qualitative phase to characterise forms of service provision, according to the case management components involved, followed by a quantitative phase to analyse the correlations between different patterns of service provision, adverse events in patients and caregiver overload. This study will be based on the variables described in the RANGE.COM register. DISCUSSION This research is expected to achieve a reproducible, evaluable set of interventions that can be modelled to optimise case management effectiveness for patients with dementia. Interactions between patients with dementia, their family caregivers and case management healthcare services, the components of these interactions and their association with the conditions of the individuals concerned are issues of great interest in the field of case management, which is constantly evolving.
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Affiliation(s)
- Desirée Jerez-Barranco
- Faculty of Health Sciences, Department of Nursing (Spain), University of Málaga, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain
- Andalusian Health Service, District Costa del Sol, Málaga, Spain
| | - Laura Gutiérrez-Rodríguez
- Faculty of Health Sciences, Department of Nursing (Spain), University of Málaga, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain.
- Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain.
| | - Juan Carlos Morilla-Herrera
- Faculty of Health Sciences, Department of Nursing (Spain), University of Málaga, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain
- Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
- Andalusian Health Service, District Málaga-Guadalhorce, Málaga, Spain
| | - Magdalena Cuevas Fernandez-Gallego
- Faculty of Health Sciences, Department of Nursing (Spain), University of Málaga, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain
- Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
- Andalusian Health Service, District Málaga-Guadalhorce, Málaga, Spain
| | | | | | | | - Silvia García-Mayor
- Faculty of Health Sciences, Department of Nursing (Spain), University of Málaga, C/Arquitecto Francisco Peñalosa, 3, Campus Universitario de Teatinos, 29071, Málaga, Spain
- Institute of Biomedical Research in Malaga (IBIMA), Málaga, Spain
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Mayer V, Mijanovich T, Egorova N, Flory J, Mushlin A, Calvo M, Deshpande R, Siscovick D. Impact of New York State's Health Home program on access to care among patients with diabetes. BMJ Open Diabetes Res Care 2021; 9:9/Suppl_1/e002204. [PMID: 34933873 PMCID: PMC8679110 DOI: 10.1136/bmjdrc-2021-002204] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/04/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Access to care is essential for patients with diabetes to maintain health and prevent complications, and is important for health equity. New York State's Health Homes (HHs) provide care management services to Medicaid-insured patients with chronic conditions, including diabetes, and aim to improve quality of care and outcomes. There is inconsistent evidence on the impact of HHs, and care management programs more broadly, on access to care. RESEARCH DESIGN AND METHODS Using a cohort of patients with diabetes derived from electronic health records from the INSIGHT Clinical Research Network, we analyzed Medicaid data for HH enrollees and a matched comparison group of HH non-enrollees. We estimated HH impacts on several access measures using natural experiment methods. RESULTS We identified and matched 11 646 HH enrollees; patients were largely non-Hispanic Black (29.9%) and Hispanic (48.7%), and had high rates of dual eligibility (33.0%), Supplemental Security Income disability enrollment (49.1%), and multiple comorbidities. In the 12 months following HH enrollment, HH enrollees had one more month of Medicaid coverage (p<0.001) and 4.6 more outpatient visits than expected (p<0.001, evenly distributed between primary and specialty care). There were also positive impacts on the proportions of patients with follow-up visits within 7 days (4 percentage points (pp), p<0.001) and 30 days (6pp, p<0.001) after inpatient care, and on the proportion of patients with follow-up visits within 30 days after emergency department (ED) care (4pp, p<0.001). We did not find meaningful differences in continuity of care. We found small positive impacts on the proportion of patients with an inpatient visit and the proportion with an ED visit. CONCLUSIONS New York State's HH program improved access to care for Medicaid recipients with diabetes. These findings have implications for New York State Medicaid as well as other providers and care management programs.
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Affiliation(s)
- Victoria Mayer
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Division of General Internal Medicine, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - Tod Mijanovich
- Department of Applied Statistics, Social Sciences, and Humanities, Steinhardt School, New York University, New York City, New York, USA
| | - Natalia Egorova
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - James Flory
- Endocrinology Service, Department of Subspecialty Medicine, Memorial Sloan Kettering Cancer Center, New York City, New York, USA
| | - Alvin Mushlin
- Departments of Population Health Sciences and Medicine, Weill Cornell Medicine, New York City, New York, USA
| | - Michele Calvo
- Research, Evaluation & Policy, New York Academy of Medicine, New York City, New York, USA
| | - Richa Deshpande
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
- Center for Biostatistics, Icahn School of Medicine at Mount Sinai, New York City, New York, USA
| | - David Siscovick
- Research, Evaluation & Policy, New York Academy of Medicine, New York City, New York, USA
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