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Wong ELY, Yau JHY, Sze LCY, Kanagawa HS, Leung DKY, Liu T, Wong GHY, Lum TYS. A core competency framework for mental health peer supporters of older adults in a Chinese community: cross-culturally informed Delphi study. BJPsych Bull 2024; 48:92-99. [PMID: 37309186 PMCID: PMC10985733 DOI: 10.1192/bjb.2023.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 04/23/2023] [Indexed: 06/14/2023] Open
Abstract
AIMS AND METHOD Non-Western literature on the core competencies of mental health peer supporters remains limited. Therefore, we used a three-round Delphi study with peer supporters, service users (i.e. someone using peer support services) and mental health professionals to develop a core competency framework for peer supporters in the Chinese context. RESULTS The final framework included 35 core competencies, the conceptual origins of which were local (14.3%), Western (20%) and both local and Western (65.7%). They were grouped into five categories in ascending peer supporter role specificity: (1) self-care and self-development, (2) general work ethics, (3) work with others, (4) work with service users and (5) peer support knowledge. CLINICAL IMPLICATIONS A culturally valid mental health peer support competency framework can minimise role confusion and refine training and practice guidelines. In a Chinese context, peer supporters were valued as generic support companions, whereas functions highlighted in the West, such as role modelling, were perceived as less critical.
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Affiliation(s)
- Edwin Lok Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Jessie Ho-Yin Yau
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Lesley Cai Yin Sze
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Hotinpo Sky Kanagawa
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Dara Kiu Yi Leung
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Tianyin Liu
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Gloria Hoi Yan Wong
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
| | - Terry Yat Sang Lum
- Department of Social Work and Social Administration, The University of Hong Kong, Hong Kong
- Sau Po Centre on Ageing, The University of Hong Kong, Hong Kong
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Zhang J, Chen YC, Shi C, Wang JSH. Developing an Operationalized Framework for Comparing Consumer-Directed Care for Older Adults: Evidence from Expert Survey and Cross-National Comparison. J Aging Soc Policy 2023:1-21. [PMID: 38151708 DOI: 10.1080/08959420.2023.2297594] [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: 08/29/2022] [Accepted: 07/24/2023] [Indexed: 12/29/2023]
Abstract
Consumer-directed care (CDC) programs for older people aim to optimize health outcomes by offering clients control and flexibility regarding service arrangements. However, policy design features may differ due to heterogenous sociostructural systems. By operationalizing a framework with three dimensions of CDC, i.e. control and direct services, variety of service options, and information and support, we analyzed how countries vary in their policy designs to achieve consumer direction. Using an expert survey (n = 20) and cross-national document analysis, we analyzed 12 CDC programs from seven selected countries: the United States, the United Kingdom, Germany, the Netherlands, China, Australia, and Spain. Among the three dimensions, CDC programs placed more emphasis on and displayed more homogenous performance of policy designs that achieve consumer direction in the dimension of control and direct services, while less emphasis was placed on and more heterogenous performance displayed in the dimensions of variety of service options and information and support. We offer a systematically operationalized framework to investigate CDC policy designs. Findings advance our understanding of CDC policy features from a cross-national perspective. Policymakers could incorporate these findings to empower older people in their respective societies.
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Affiliation(s)
- Jinbao Zhang
- Personal Social Service Research Unit, University of Kent, Canterbury, UK
| | - Yu-Chih Chen
- Department of Social Work & Social Administration, The University of Hong Kong, Hong Kong, China
| | - Cheng Shi
- School of Graduate Studies, Lingnan University, Hong Kong, China
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Královcová M, Karvunidis T, Matějovič M. Critical care for multimorbid patients. VNITRNI LEKARSTVI 2023; 69:166-172. [PMID: 37468311 DOI: 10.36290/vnl.2023.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
Multimorbidity - the simultaneous presence of several chronic diseases - is very common in the critically ill patients. Its prevalence is roughly 40-85 % and continues to increase further. Certain chronic diseases such as diabetes, obesity, chronic heart, pulmonary, liver or kidney disease and malignancy are associated with higher risk of developing serious acute complications and therefore the possible need for intensive care. This review summarizes and discusses selected specifics of critical care for multimorbid patients.
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Schulze J, Glassen K, Pohontsch NJ, Blozik E, Eißing T, Breckner A, Höflich C, Rakebrandt A, Schäfer I, Szecsenyi J, Scherer M, Lühmann D. Measuring the Quality of Care for Older Adults With Multimorbidity: Results of the MULTIqual Project. THE GERONTOLOGIST 2022; 62:1135-1146. [PMID: 35090014 PMCID: PMC9451020 DOI: 10.1093/geront/gnac013] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Providing health care for older adults with multimorbidity is often complex, challenging, and prone to fragmentation. Although clinical decision making should take into account treatment interactions, individual burden, and resources, current approaches to assessing quality of care mostly rely on indicators for single conditions. The aim of this project was to develop a set of generic quality indicators for the management of patients aged 65 and older with multimorbidity that can be used in both health care research and clinical practice. RESEARCH DESIGN AND METHODS Based on the findings of a systematic literature review and eight focus groups with patients with multimorbidity and their family members, we developed candidate indicators. Identified aspects of quality were mapped to core domains of health care to obtain a guiding framework for quality-of-care assessment. Using nominal group technique, indicators were rated by a multidisciplinary expert panel (n = 23) following standardized criteria. RESULTS We derived 47 candidate quality indicators from the literature and 4 additional indicators from the results of the focus groups. The expert panel selected a set of 25 indicators, which can be assigned to the levels of patient factors, patient-provider communication, and context and organizational structures of the conceptual framework. DISCUSSION AND IMPLICATIONS We developed a comprehensive indicator set for the management of multimorbidity that can help to highlight areas with potential for improving the quality of care and support application of multimorbidity guidelines. Furthermore, this study may serve as a blueprint for participatory designs in the development of quality indicators.
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Affiliation(s)
- Josefine Schulze
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katharina Glassen
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Nadine J Pohontsch
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Eva Blozik
- Institute of Primary Care, University of Zurich and University Hospital Zurich, Zurich, Switzerland
| | - Tabea Eißing
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Amanda Breckner
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Charlotte Höflich
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Anja Rakebrandt
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ingmar Schäfer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Dagmar Lühmann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Yang C, Lee DTF, Wang X, Chair SY. Developing a Medication Self-management Program to Enhance Medication Adherence among Older Adults with Multimorbidity Using Intervention Mapping. THE GERONTOLOGIST 2022; 63:637-647. [PMID: 35583327 DOI: 10.1093/geront/gnac069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Suboptimal medication adherence is prevalent in older adults with multimorbidity. However, intervention programs for enhancing adherence in this population are limited. This study describes the development process of a medication self-management program for older adults with multimorbidity. RESEARCH DESIGN AND METHODS We adopted the first four steps of the Intervention Mapping to develop the program: (1) needs assessment, including a literature review, a systematic review, and a cross-sectional study, (2) development of program outcomes and objectives, (3) selection of theory-based intervention methods and practical applications, and (4) development of the program. RESULTS We conducted a needs assessment to identify factors affecting medication adherence among older adults with multimorbidity and created a logic model of the adherence problem in Step 1. In Step 2, we developed the specific program outcomes and objectives and then selected adherence information, personal motivation, social motivation, behavioral skills, and treatment experiences as modifiable and important targets that needed to change in this program. In Step 3, we chose several theory-based methods and strategies for practical applications. We finally created a nurse-led medication self-management program in Step 4. Feedback from relevant stakeholders refined the intervention protocol and materials. DISCUSSION AND IMPLICATIONS The newly developed medication self-management program incorporated theory and evidence from literature and empirical studies with the engagement of multiple stakeholders, making it a contextually and culturally appropriate intervention. This study provides insights into strategies for geriatrics healthcare professionals to support medication self-management among older adults with multimorbidity.
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Affiliation(s)
- Chen Yang
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Diana Tze Fan Lee
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
| | - Xiuhua Wang
- Xiangya Nursing School of Central South University, Changsha, China
| | - Sek Ying Chair
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong SAR, China
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Ginting ML, Wong CH, Lim ZZB, Choo RWM, Carlsen SCH, Sum G, Vrijhoef HJM. A Patient-Centred Medical Home Care Model for Community-Dwelling Older Adults in Singapore: A Mixed-Method Study on Patient's Care Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19084778. [PMID: 35457642 PMCID: PMC9030670 DOI: 10.3390/ijerph19084778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 04/13/2022] [Accepted: 04/14/2022] [Indexed: 02/05/2023]
Abstract
Patient-Centred Medical Home (PCMH) is a strategy to enhance patient-centredness to improve care experience. We aimed to understand patient experience of an integrated PCMH model for complex community-dwelling older adults in Singapore. We used a mixed-method design with a prospective single-group pre-post quantitative component and a concurrent qualitative component. Participants were administered the validated Consumer Assessment of Health Providers and Systems Clinician & Group Survey (CG-CAHPS) at baseline (N = 184) and 6-month (N = 166) post-enrolment. We conducted focus group discussions (FGDs) on a purposive sample of 24 participants. Both methods suggest better care experience in PCMH relative to usual care. There were improvements in the CG-CAHPS measures on patient–provider communication, care coordination, office staff interactions, support for patients in caring for their own health, and provider rating in PCMH relative to usual care. In the FGDs, participants reported benefits of consolidated appointments and positive experience in sustained patient–provider relationship, shared-decision making, and family/caregiver engagement in PCMH. Participants may not fully comprehend the concept of integrated care, hindering both the effective communication of the intended care model and perceived benefits such as the provision of multidisciplinary team-based care.
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Affiliation(s)
- Mimaika Luluina Ginting
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (C.H.W.); (Z.Z.B.L.); (R.W.M.C.); (S.C.H.C.); (G.S.)
- Correspondence:
| | - Chek Hooi Wong
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (C.H.W.); (Z.Z.B.L.); (R.W.M.C.); (S.C.H.C.); (G.S.)
- Tsao Foundation, Singapore 168730, Singapore
- Health Services & Systems Research, Duke-NUS, Singapore 169857, Singapore
| | - Zoe Zon Be Lim
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (C.H.W.); (Z.Z.B.L.); (R.W.M.C.); (S.C.H.C.); (G.S.)
| | - Robin Wai Munn Choo
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (C.H.W.); (Z.Z.B.L.); (R.W.M.C.); (S.C.H.C.); (G.S.)
| | - Sheena Camilla Hirose Carlsen
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (C.H.W.); (Z.Z.B.L.); (R.W.M.C.); (S.C.H.C.); (G.S.)
| | - Grace Sum
- Geriatric Education and Research Institute, Singapore 768024, Singapore; (C.H.W.); (Z.Z.B.L.); (R.W.M.C.); (S.C.H.C.); (G.S.)
| | - Hubertus Johannes Maria Vrijhoef
- Panaxea, B.V., 1098 XH Amsterdam, The Netherlands;
- Department of Patient & Care, Maastricht University Medical Center+, 6229 HX Maastricht, The Netherlands
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Kanat M, Schaefer J, Kivelitz L, Dirmaier J, Voigt-Radloff S, Heimbach B, Glattacker M. Patient-centeredness in the multimorbid elderly: a focus group study. BMC Geriatr 2021; 21:567. [PMID: 34663223 PMCID: PMC8522160 DOI: 10.1186/s12877-021-02448-8] [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: 04/23/2021] [Accepted: 09/01/2021] [Indexed: 04/21/2023] Open
Abstract
Background Patient-centeredness (PC) aims to adapt health care to the individual needs and preferences of patients. An existing integrative model of PC comprises several dimensions of PC which have not yet been investigated from the patients’ perspective. Older patients with multimorbidity represent a target group for patient-centered care, as their care needs are particularly complex and should be addressed individually. We aimed to assess the perspective that older patients with multimorbidity have of patient-centered care and to examine the transferability of the integrative model of PC to this specific population. Method We performed 4 guided focus group interviews with a total of 20 older individuals with multimorbidity. The focus group interviews were audio-recorded and transcribed verbatim. Patients’ statements were content-analyzed applying an a priori designed system of categories that included the dimensions of PC from the integrative model and the additional category ‘prognosis and life expectancy’, which had emerged from an initial literature search on aspects of PC specific to the multimorbid elderly. Results The new category ‘prognosis and life expectancy’ was confirmed and expanded to ‘individual care needs related to aging and chronic disesase’. All dimensions of our integrative PC model were confirmed for older patients with multimorbidity. Among these, we found that eight dimensions (individual care needs related to aging and chronic disease, biopsychosocial perspective, clinician-patient communication, essential characteristics of the clinician, clinician-patient-relationship, involvement of family and friends, coordination and continuity of care, access to care) were complemented by aspects specific to this target population. Conclusions The integrative PC model is applicable to the population of older patients with multimorbidity. For a population-specific adaptation, it might be complemented by the dimension ‘individual care needs in aging and chronic disease’, in conjunction with age-specific aspects within existing dimensions. Together with corresponding results from a Delphi survey, our adapted PC model will serve as the basis for a subsequent systematic review of instruments measuring PC in older patients with multimorbidity. Trial registration PROSPERO (https://www.crd.york.ac.uk/prospero; CRD42018084057; 2018/02/01), German Clinical Trials Register (www.drks.de; DRKS00013309; 2018/01/23). Supplementary Information The online version contains supplementary material available at 10.1186/s12877-021-02448-8.
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Affiliation(s)
- Manuela Kanat
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
| | - Jonas Schaefer
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany.
| | - Laura Kivelitz
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Jörg Dirmaier
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
| | - Sebastian Voigt-Radloff
- Center for Geriatric Medicine and Gerontology Freiburg, Institute for Evidence in Medicine (for Cochrane Germany Foundation), Faculty of Medicine and Medical Center - University of Freiburg, Breisacher Str. 86, 79110, Freiburg, Germany
| | - Bernhard Heimbach
- Center for Geriatric Medicine and Gerontology Freiburg, Faculty of Medicine and Medical Center - University of Freiburg, Lehener Str. 88, 79106, Freiburg, Germany
| | - Manuela Glattacker
- Section of Health Care Research and Rehabilitation Research, Institute of Medical Biometry and Statistics, Faculty of Medicine and Medical Center - University of Freiburg, Hugstetter Str. 49, 79106, Freiburg, Germany
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Beil M, Flaatten H, Guidet B, Sviri S, Jung C, de Lange D, Leaver S, Fjølner J, Szczeklik W, van Heerden PV. The management of multi-morbidity in elderly patients: Ready yet for precision medicine in intensive care? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2021; 25:330. [PMID: 34507597 PMCID: PMC8431262 DOI: 10.1186/s13054-021-03750-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 08/27/2021] [Indexed: 11/16/2022]
Abstract
There is ongoing demographic ageing and increasing longevity of the population, with previously devastating and often-fatal diseases now transformed into chronic conditions. This is turning multi-morbidity into a major challenge in the world of critical care. After many years of research and innovation, mainly in geriatric care, the concept of multi-morbidity now requires fine-tuning to support decision-making for patients along their whole trajectory in healthcare, including in the intensive care unit (ICU). This article will discuss current challenges and present approaches to adapt critical care services to the needs of these patients.
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Affiliation(s)
- Michael Beil
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Hans Flaatten
- Department of Anaesthesia and Intensive Care Medicine, Haukeland University Hospital, Bergen, Norway
| | - Bertrand Guidet
- Service de Reanimation, Hopital Saint-Antoine, Paris, France
| | - Sigal Sviri
- Department of Medical Intensive Care, Hadassah Medical Center and Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Christian Jung
- Department of Cardiology, Pulmonology and Vascular Medicine, Faculty of Medicine, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany
| | - Dylan de Lange
- Department of Intensive Care Medicine, University Medical Center, University of Utrecht, Utrecht, The Netherlands
| | - Susannah Leaver
- Department of Adult Critical Care, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Jesper Fjølner
- Department of Intensive Care, Aarhus University Hospital, Aarhus, Denmark
| | - Wojciech Szczeklik
- Center for Intensive Care and Perioperative Medicine, Jagiellonian University Medical College, Kraków, Poland
| | - Peter Vernon van Heerden
- General Intensive Care Unit, Department of Anesthesiology, Critical Care and Pain Medicine, Hadassah Medical Center and Faculty of Medicine, Hadassah University Hospital, Hebrew University of Jerusalem, Jerusalem, Israel.
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