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Koehn S, Jones CA, Barber C, Jasper L, Pham A, Lindeman C, Drummond N. Candidacy 2.0 (CC) - an enhanced theory of access to healthcare for chronic conditions: lessons from a critical interpretive synthesis on access to rheumatoid arthritis care. BMC Health Serv Res 2024; 24:986. [PMID: 39187885 PMCID: PMC11348652 DOI: 10.1186/s12913-024-11438-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 08/14/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The Dixon-Woods et al. Candidacy Framework, a valuable tool since its 2006 introduction, has been widely utilized to analyze access to various services in diverse contexts, including healthcare. This social constructionist approach examines micro, meso, and macro influences on access, offering concrete explanations for access challenges rooted in socially patterned influences. This study employed the Candidacy Framework to explore the experiences of individuals living with rheumatoid arthritis (RA) and their formal care providers. The investigation extended to assessing supports and innovations in RA diagnosis and management, particularly in primary care. METHODS This systematic review is a Critical Interpretive Synthesis (CIS) of qualitative and mixed methods literature. The CIS aimed to generate theory from identified constructs across the reviewed literature. The study found alignment between the seven dimensions of the Candidacy Framework and key themes emerging from the data. Notably absent from the framework was an eighth dimension, identified as the "embodied relational self." This dimension, central to the model, prompted the proposal of a revised framework specific to healthcare for chronic conditions. RESULTS The CIS revealed that the eight dimensions, including the embodied relational self, provided a comprehensive understanding of the experiences and perspectives of individuals with RA and their care providers. The proposed Candidacy 2.0 (Chronic Condition (CC)) model demonstrated how integrating approaches like Intersectionality, concordance, and recursivity enhanced the framework when the embodied self was central. CONCLUSIONS The study concludes that while the original Candidacy Framework serves as a robust foundation, a revised version, Candidacy 2.0 (CC), is warranted for chronic conditions. The addition of the embodied relational self dimension enriches the model, accommodating the complexities of accessing healthcare for chronic conditions. TRIAL REGISTRATION This study did not involve a health care intervention on human participants, and as such, trial registration is not applicable. However, our review is registered with the Open Science Framework at https://doi.org/10.17605/OSF.IO/ASX5C .
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Affiliation(s)
- Sharon Koehn
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Claire Barber
- Division of Rheumatology, Cumming School of Medicine, Health Sciences Center, University of Calgary, Room #B130Z 3300, Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Lisa Jasper
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - Anh Pham
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Cliff Lindeman
- Prescribing, Analytics & Tracked Prescription Program Alberta, College of Physicians & Surgeons, 2700 - 10020 100 Street NW, Edmonton, AB, T5J 0N3, Canada
| | - Neil Drummond
- Faculty of Medicine and Dentistry - Family Medicine Department, University of Alberta, 6- 10L4 University Terrace, 8303 - 112 Street NW, Edmonton, AB, T6G 2T4, Canada
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Pryde SJ, Williams O, O'Hare MP, Murdock C, Pedlow K. Exploring access to community neurorehabilitation for people with progressive neurological conditions: a qualitative study. Disabil Rehabil 2024:1-14. [PMID: 38632940 DOI: 10.1080/09638288.2024.2338198] [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: 06/12/2023] [Accepted: 03/28/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE Community neurorehabilitation enables people with progressive neurological conditions (PNCs) to manage their symptoms to live an active, fulfilling life; however, it is not accessible to all. This study explored the factors influencing access to community neurorehabilitation in Northern Ireland from the perspective of people with PNCs and their carers. METHODS Eleven people living with a PNC and three carers took part in virtual focus groups. Data was thematically analysed using the framework method. RESULTS Access to neurorehabilitation was described as a staged journey, driven by people with PNCs, and impacted by interactions with others. Four themes were identified: the person in the driving seat, describing the value of person-centred care and the need for proactivity; the traffic lights, depicting the role and influence of health care professionals (HCPs); the need for direction; and roadworks and roadblocks, identifying additional barriers to access. In addition, six fundamentals of good access were identified. CONCLUSIONS This study adds depth to our understanding of the complexity, and the roles and needs of people with PNCs and HCPs, in accessing community neurorehabilitation. Further research is needed to determine how best to empower people to access rehabilitation.
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Affiliation(s)
- Shona J Pryde
- School of Health Sciences, Ulster University, Londonderry, UK
- Physiotherapy Department, Belfast Health and Social Care Trust, Belfast, UK
| | | | | | - Carolyn Murdock
- School of Health Sciences, Ulster University, Londonderry, UK
| | - Katy Pedlow
- School of Health Sciences, Ulster University, Londonderry, UK
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Müller A, Hebben F, Dillen K, Dunkl V, Goereci Y, Voltz R, Löcherbach P, Warnke C, Golla H. "So at least now I know how to deal with things myself, what I can do if it gets really bad again"-experiences with a long-term cross-sectoral advocacy care and case management for severe multiple sclerosis: a qualitative study. BMC Health Serv Res 2024; 24:453. [PMID: 38600493 PMCID: PMC11007872 DOI: 10.1186/s12913-024-10851-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 03/11/2024] [Indexed: 04/12/2024] Open
Abstract
BACKGROUND Persons with severe Multiple Sclerosis (PwsMS) face complex needs and daily limitations that make it challenging to receive optimal care. The implementation and coordination of health care, social services, and support in financial affairs can be particularly time consuming and burdensome for both PwsMS and caregivers. Care and case management (CCM) helps ensure optimal individual care as well as care at a higher-level. The goal of the current qualitative study was to determine the experiences of PwsMS, caregivers and health care specialists (HCSs) with the CCM. METHODS In the current qualitative sub study, as part of a larger trial, in-depth semi-structured interviews with PwsMS, caregivers and HCSs who had been in contact with the CCM were conducted between 02/2022 and 01/2023. Data was transcribed, pseudonymized, tested for saturation and analyzed using structuring content analysis according to Kuckartz. Sociodemographic and interview characteristics were analyzed descriptively. RESULTS Thirteen PwsMS, 12 caregivers and 10 HCSs completed interviews. Main categories of CCM functions were derived deductively: (1) gatekeeper function, (2) broker function, (3) advocacy function, (4) outlook on CCM in standard care. Subcategories were then derived inductively from the interview material. 852 segments were coded. Participants appreciated the CCM as a continuous and objective contact person, a person of trust (92 codes), a competent source of information and advice (on MS) (68 codes) and comprehensive cross-insurance support (128 codes), relieving and supporting PwsMS, their caregivers and HCSs (67 codes). CONCLUSIONS Through the cross-sectoral continuous support in health-related, social, financial and everyday bureaucratic matters, the CCM provides comprehensive and overriding support and relief for PwsMS, caregivers and HCSs. This intervention bears the potential to be fine-tuned and applied to similar complex patient groups. TRIAL REGISTRATION The study was approved by the Ethics Committee of the University of Cologne (#20-1436), registered at the German Register for Clinical Studies (DRKS00022771) and in accordance with the Declaration of Helsinki.
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Affiliation(s)
- Anne Müller
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany.
| | - Fabian Hebben
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Kim Dillen
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Veronika Dunkl
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Yasemin Goereci
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Raymond Voltz
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
- Center for Integrated Oncology Aachen Bonn Cologne Düsseldorf (CIO ABCD), University of Cologne, Cologne, Germany
- Center for Health Services Research, University of Cologne, Cologne, Germany
| | - Peter Löcherbach
- German Society of Care and Case Management E.V. (DGCC), Münster, Germany
| | - Clemens Warnke
- Department of Neurology, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
| | - Heidrun Golla
- Department of Palliative Medicine, Faculty of Medicine and University Hospital, University of Cologne, Cologne, Germany
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Woodward A, Nimmons D, Davies N, Walters K, Stevenson FA, Protheroe J, Chew‐Graham CA, Armstrong M. A qualitative exploration of the barriers and facilitators to self-managing multiple long-term conditions amongst people experiencing socioeconomic deprivation. Health Expect 2024; 27:e14046. [PMID: 38623837 PMCID: PMC11019445 DOI: 10.1111/hex.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Globally, it is estimated that one in three adults live with two or more long-term conditions (multiple long-term conditions, MLTCs), that require self-management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient-healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self-managing MLTCs, amongst people who experience socioeconomic deprivation. METHODS Semistructured one-to-one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods. FINDINGS Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self-management, including social isolation, area-based and economic exclusion, and health-related stigma and (4) adapting self-management strategies, including cost-effective, and culturally/lifestyle appropriate strategies. CONCLUSIONS Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self-management of MLTCs are of great importa. PATIENT OR PUBLIC CONTRIBUTION A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data.
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Affiliation(s)
- Abi Woodward
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Danielle Nimmons
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Nathan Davies
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Kate Walters
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Fiona A. Stevenson
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | | | | | - Megan Armstrong
- Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
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Emery H, Padgett C, Ownsworth T, Honan CA. "Oh it's changed, it's changed 10-fold": understanding the experience of self-concept change from the perspectives of people with multiple sclerosis. Disabil Rehabil 2023; 45:3262-3271. [PMID: 36106857 DOI: 10.1080/09638288.2022.2121865] [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: 03/03/2022] [Revised: 08/07/2022] [Accepted: 09/02/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE The relevance of self-concept change in the process of psychosocial adjustment following multiple sclerosis (MS) diagnosis has become more apparent in recent years. The current study aimed to investigate the experience of self-concept change as described by an MS sample. METHODS Sixteen people (aged 26-67 years, 62.5% female) who had been living with MS for an average of 12 years, participated in a single online semi-structured interview. All interviews were audio-recorded and transcribed verbatim. RESULTS Thematic analysis guided by phenomenology produced three superordinate themes: 1) Changing life (salient external events that were related to changing views of self), 2) Changing self (the experience of self-concept change), and 3) Changing thoughts (the internal thought processes that served as the filter between changing life circumstances and changing self-views). Overall, external events appeared to facilitate a process of internally driven revaluations and redefinitions of self-concept both globally and within specific self domains. CONCLUSION Self-concept change due to MS emerges as a complex internal process, often arising from external challenges and changes in everyday life. These novel findings illustrate the need to better support people with MS to make sense of changes to their self-concept, particularly during key transitions across the illness.Implications for RehabilitationSelf-concept change following MS diagnosis and throughout the disease course has wide-ranging impacts on psychological adjustment.Several key external events contribute to changing the self-views of people living with MS.While external events prompt change, key internal processes likely facilitate the redefinition of self-concept.Targeted support during key transitional periods to assist pwMS to productively renegotiate and manage these changes to their self-concept is needed.
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Affiliation(s)
- Holly Emery
- School of Psychological Sciences, University of Tasmania, Launceston, Australia
| | - Christine Padgett
- School of Psychological Sciences, University of Tasmania, Hobart, Australia
| | - Tamara Ownsworth
- School of Applied Psychology & The Hopkins Centre, Griffith University, Mount Gravatt, Australia
| | - Cynthia A Honan
- School of Psychological Sciences, University of Tasmania, Launceston, Australia
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Persson S, Andersson AC, Gäre BA, Lindenfalk B, Lind J. Lived experience of persons with multiple sclerosis: A qualitative interview study. Brain Behav 2023:e3104. [PMID: 37246453 DOI: 10.1002/brb3.3104] [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: 02/09/2023] [Revised: 04/04/2023] [Accepted: 05/18/2023] [Indexed: 05/30/2023] Open
Abstract
INTRODUCTION Multiple sclerosis (MS) is a chronic autoimmune disease with a substantial impact on quality of life and functional capability. The prognosis of MS has changed over time due to the development of increasingly effective therapies. As the knowledge and perceptions of persons living with chronic conditions increasingly have been acknowledged, it has become important to understand lived experiences with a focus on everyday events and experiences as a way of knowing and interpreting the world. Exploring context-specific lived experiences as a source of knowledge about the disease and care may contribute to more precision in designing care services. The aim of this study was to explore the lived experience of persons living with MS in a Swedish context. MATERIALS AND METHODS A qualitative interview study was conducted with both purposeful and random sampling strategies, resulting in 10 interviews. Data were analyzed using inductive thematic content analysis. RESULTS The analysis generated 4 overarching themes with 12 subthemes, the 4 themes were: perspectives on life and health, influence on everyday life, relations with healthcare, and shared healthcare processes. The themes are concerned with the patients' own perspectives and context as well as medical and healthcare-related perspectives. Patterns of shared experiences were found, for example, in the diagnosis confirmation, future perspectives, and planning and coordination. More diverse experiences appeared concerning relations with others, one's individual requirements, symptoms and consequences, and knowledge building. CONCLUSION The findings suggest a need for a more diverse and coproduced development of healthcare services to meet diverse needs in the population with greater acknowledgement of the person's lived experience, including consideration of the complexity of the disease, personal integrity, and different ways of knowing. Findings from this study will be further explored together with other quantitative and qualitative data.
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Affiliation(s)
- Sofia Persson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum Academy for Health and Care, Jönköping, Sweden
| | - Ann-Christine Andersson
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Department of Care Science, Malmö University, Malmö, Sweden
| | - Boel Andersson Gäre
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
- Futurum Academy for Health and Care, Jönköping, Sweden
| | - Bertil Lindenfalk
- Jönköping Academy for Improvement of Health and Welfare, School of Health and Welfare, Jönköping University, Jönköping, Sweden
| | - Jonas Lind
- Section of Neurology, Department of Internal Medicine, County Hospital Ryhov, Jönköping, Sweden
- Division of Neurobiology, Department of Biomedical and Clinical Sciences, Linköping University, Sweden
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Douglas J, Winkler D, McLeod A, Oliver S, Gardner K, Supple J, Pearce C. Primary healthcare needs and service utilisation of people with disability: a data linkage protocol. BMJ Open 2023; 13:e068059. [PMID: 37076156 PMCID: PMC10124289 DOI: 10.1136/bmjopen-2022-068059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/21/2023] Open
Abstract
INTRODUCTION General practitioners (GPs) play a crucial role in the early management and treatment of the comorbidities and complications experienced by people with disability. However, GPs experience multiple constraints, including limited time and disability-related expertise. Knowledge gaps around the health needs of people with disability as well as the frequency and extent of their engagement with GPs mean evidence to inform practice is limited. Using a linked dataset, this project aims to enhance the knowledge of the GP workforce by describing the health needs of people with disability. METHODS AND ANALYSIS This project is a retrospective cohort study using general practice health records from the eastern Melbourne region in Victoria, Australia. The research uses Eastern Melbourne Primary Health Network (EMPHN)-owned de-identified primary care data from Outcome Health's POpulation Level Analysis and Reporting Tool (POLAR). The EMPHN POLAR GP health records have been linked with National Disability Insurance Scheme (NDIS) data. Data analysis will involve comparisons across disability groups and the rest of the population to explore utilisation (eg, frequency of visits), clinical and preventative care (eg, cancer screening, blood pressure readings) and health needs (eg, health conditions, medications). Initial analyses will focus on NDIS participants as a whole and NDIS participants whose condition is either an acquired brain injury, stroke, spinal cord injury, multiple sclerosis or cerebral palsy, as classified by the NDIS. ETHICS AND DISSEMINATION Ethics approval was obtained from the Eastern Health Human Research Ethics Committee (E20/001/58261), and approval for the general collection, storage and transfer of data was from the Royal Australian College of General Practitioners National Research Ethics and Evaluation Committee (protocol ID: 17-088). Dissemination mechanisms will include the engagement of stakeholders through reference groups and steering committees, as well as the production of research translation resources in parallel with peer-reviewed publications and conference presentations.
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Affiliation(s)
- Jacinta Douglas
- Research and Innovation, Summer Foundation, Melbourne, Victoria, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Di Winkler
- Research and Innovation, Summer Foundation, Melbourne, Victoria, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Adam McLeod
- Department of Primary Care Research, Outcome Health, Melbourne, Victoria, Australia
| | - Stacey Oliver
- Research and Innovation, Summer Foundation, Melbourne, Victoria, Australia
- Living with Disability Research Centre, La Trobe University, Melbourne, Victoria, Australia
| | - Karina Gardner
- Department of Primary Care Research, Outcome Health, Melbourne, Victoria, Australia
| | - Jamie Supple
- Department of Primary Care Research, Outcome Health, Melbourne, Victoria, Australia
| | - Christopher Pearce
- Department of Primary Care Research, Outcome Health, Melbourne, Victoria, Australia
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Liković M, Buljevac M. ‶You look really good, I don't know why you came here″: persons with multiple sclerosis´ perspectives on social support. Home Health Care Serv Q 2023:1-22. [PMID: 36913915 DOI: 10.1080/01621424.2023.2189645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/15/2023]
Abstract
The aim of this qualitative study is to gain insight into the perspectives of persons with multiple sclerosis on social support. Semi-structured interviews were conducted with eleven persons with multiple sclerosis. The results on informal support for persons with multiple sclerosis reveal perceived support and the lack of support from different persons. The results on formal support for persons with multiple sclerosis show perceived support from healthcare professionals, professionals working outside healthcare and social care systems, and associations of persons with MS, but also inadequate support from healthcare professionals and social workers. Close emotional relationship, empathy, knowledge and understanding are the basis for provision of all types of support from informal support system, while perceived support from formal support system is based on professionals´ empathy, their professionalism and knowledge. Persons with multiple sclerosis need accurate and timely emotional, informational, practical and financial support.
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Affiliation(s)
- Maja Liković
- Department of Social Work, Faculty of Law, University of Zagreb, Zagreb, Croatia
| | - Marko Buljevac
- Department of Social Work, Faculty of Law, University of Zagreb, Zagreb, Croatia
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Maguire R, Deane-King J, Fahy A, Larkin A, Coote S. An evaluation of the role of community care in meeting the needs of people with multiple sclerosis in Ireland. Mult Scler Relat Disord 2023; 69:104419. [PMID: 36413916 DOI: 10.1016/j.msard.2022.104419] [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: 01/27/2022] [Revised: 11/11/2022] [Accepted: 11/15/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND People with MS (PwMS) can experience a number of diverse needs which may be met by community-based services such as those delivered by MS Ireland (MSI), where Community Workers (CWs) provide support to PwMS on an individualised basis. However, while such support may be critical in helping PwMS adapt and cope with the challenges of living with MS, there has been little evaluation of the outcomes and impacts of this service to date. This study aimed to explore the perceived effectiveness and impacts of community work from the perspectives of both PwMS and CWs. METHODS Using stakeholder engagement and public and patient involvement (PPI), two surveys were developed for (1) CWs, and (2) services users of MSI. A series of open and closed questions centred on the effectiveness of community work in meeting twelve distinct categories of needs taken from an adapted framework of rehabilitation and healthcare needs of PwMS. Both CWs and service users rated the extent to which these various needs were met through community work, as well as describing the mechanisms by which needs were met, and the challenges faced in meeting these needs. Separately, both groups described the perceived impacts of community work using open-text responses. RESULTS Fifteen CWs and 367 PwMS, 269 (73%) of whom knew their CW, participated. Both groups rated community work positively in meeting the needs for information, emotional/psychological support and coordination of care, with lower perceived capacity for community work to meet needs for employment accommodations, caregiver support and homecare. Mann Whitney U tests did not find any significant difference between groups in the perceived capacity of community work to meet the various needs examined (p>.05). Core mechanisms by which CWs meet needs are by signposting to relevant services, listening, and facilitating peer support. Difficulty accessing external services was the primary challenge identified in meeting needs. Positive impacts of community work included the role that CWs play in fostering confidence and acceptance of MS, and in helping service users overcome the challenges of MS. CONCLUSION Results suggest how CWs can help meet the needs of PwMS, while also highlighting the numerous positive impacts that community work has for this group. While it is clear that a number of unmet needs may remain due to a lack of access to other external services, this study shows how community-based services may play an important role in helping PwMS adapt to living with MS.
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Affiliation(s)
- Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Ireland; Assisting Living and Learning Institute, Maynooth University, Maynooth, Ireland.
| | | | - Austin Fahy
- Department of Psychology, Maynooth University, Maynooth, Ireland
| | - Aidan Larkin
- The Multiple Sclerosis Society of Ireland, Dublin, Ireland
| | - Susan Coote
- The Multiple Sclerosis Society of Ireland, Dublin, Ireland; School of Allied Health, Physical Activity for Health Research Cluster, University of Limerick, Limerick. Ireland
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Oliver S, Douglas J, Winkler D, Pearce C, Minter E, Jarman HK, Topping M. The healthcare needs and general practice utilization of people with acquired neurological disability and complex needs: A scoping review. Health Expect 2022; 25:2726-2745. [PMID: 36322481 PMCID: PMC9700155 DOI: 10.1111/hex.13640] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 07/13/2022] [Accepted: 10/16/2022] [Indexed: 06/21/2024] Open
Abstract
BACKGROUND For people with acquired neurological disabilities and complex needs, general practitioners (GPs) play an important role in health management and early intervention for the prevention of comorbidities and health complications. People with disability are a vulnerable group who need and have the right to, quality general practice services. It is therefore important to understand the health needs and service use of this group. The aim of this review was to identify the healthcare needs and general practice utilization of people with acquired neurological disabilities and complex needs. METHODS A scoping review methodological framework was utilized. Six databases (MEDLINE, PsycInfo, CINAHL, Scopus, Embase and the Cochrane Library) were searched. Articles were included if they reported on general practice service utilization of people with acquired neurological disabilities and complex needs aged between 18 and 65. Articles were required to be peer-reviewed, written in English and published between 2010 and 2021. RESULTS Thirty-one articles were included in the review. Studies originated from Canada (9), the United States (8), Australia (4), Switzerland (4), the United Kingdom (2), England (1), Norway (1), France (1) and Denmark (1). For many people, GPs were the main healthcare provider. People with disability consult multiple healthcare providers and navigate complex healthcare systems. Commonly presented healthcare needs were bladder, bowel and skin problems, pain and chronic pain, medication needs and mental health concerns. CONCLUSIONS People with acquired neurological disabilities and complex needs were vulnerable to receiving suboptimal healthcare. The literature highlighted issues regarding the accessibility of services, the fragmentation of health services and inadequate preventative care. GPs were challenged to offer adequate disability-related expertise and to meet the mental health needs of people with disability within time constraints. PATIENT AND PUBLIC INVOLVEMENT This manuscript was prepared in collaboration with a GP, who is one of the authors. A person with lived experience of acquired neurological disability was engaged to check the alignment of the findings with their personal experience and provide feedback.
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Affiliation(s)
- Stacey Oliver
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Jacinta Douglas
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Dianne Winkler
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | | | - Ella‐Rose Minter
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
| | - Hannah K. Jarman
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
| | - Megan Topping
- Department of Research and InnovationSummer Foundation LimitedVictoriaBlackburnAustralia
- School of Allied Health, Human Services & Sport, Living with Disability Research CentreLa Trobe UniversityMelbourneVictoriaAustralia
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Devlin I, Williams KL, Shrubsole K. Fragmented care and missed opportunities: the experiences of adults with myasthenia gravis in accessing and receiving allied health care in Australia. Disabil Rehabil 2022:1-9. [PMID: 35786287 DOI: 10.1080/09638288.2022.2094481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE Although allied health services are important adjuncts to medical care for people with myasthenia gravis (MG), the underutilisation of these services is not well understood within the Australian context. It is critical to explore patients' perceptions to develop services that meet consumer needs. This study, therefore, sought to obtain insight into MG patients' perspectives and experiences, in addition to the outcomes, of accessing allied health services. MATERIALS AND METHODS Thirteen Australian adults with MG participated in semi-structured interviews. Qualitative analysis was conducted inductively using thematic content analysis. RESULTS Four themes were identified: (1) missed opportunities and unmet care needs were common, due to frequent patient-provider communication breakdowns and a lack of referral protocols, (2) personal factors - patient self-advocacy influenced their perceived need, with some lacking confidence to seek help, (3) perceived benefit and health provider capacities - most valued allied health despite differing perceptions of health professionals' attitudes, skills, and willingness to learn, and (4) a resultant fragmentation of care between services was universal. CONCLUSIONS Findings highlighted a need for clear referral pathways, coordinated multidisciplinary care, improved access to community-based services and education for allied health professionals about MG.Implications for rehabilitationAdults with myasthenia gravis (MG) report a lack of referral pathways to allied health services, leading to unmet needs and fragmented care.Although there is a perceived benefit to allied health care, experiences are impacted by health provider capacity and attitudes.There needs to be an overall shift towards multidisciplinary care for people with MG, and the development of clear referral pathways.Specific education about MG should be available for allied health professionals to improve their knowledge and skills in treating this population.
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Affiliation(s)
- Isobel Devlin
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Katrina L Williams
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia
| | - Kirstine Shrubsole
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.,Faculty of Health, Southern Cross University, Gold Coast, Australia.,Queensland Aphasia Research Centre, The University of Queensland, Brisbane, Australia
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12
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Ståhl D, Bjereld Y, Dunér A. Disabled in Society - A Scoping Review on Persons Living with Multiple Sclerosis and Disability. J Multidiscip Healthc 2022; 15:375-390. [PMID: 35237043 PMCID: PMC8884705 DOI: 10.2147/jmdh.s353347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 01/28/2022] [Indexed: 01/02/2023] Open
Abstract
Multiple sclerosis (MS) is a chronic neurological disease with an increasing prevalence. As such, most studies are devoted to various medical aspects of the disease. The theoretical framework used in this scoping review was the social model of disability – a perspective focusing on environmental barriers and discrimination that disabled people face in society. The aim was to explore previous research on disabling barriers and discrimination against persons with MS, and to identify research gaps in connection with this population. The scoping review was performed in two steps: (1) a main search in 8 databases, followed by (2) citation and reference searches. The final sample consisted of 96 included articles. The result showed that most studies had been conducted in the US, and the dominant area of research was employment discrimination. Previous research has studied MS related to various areas, such as employment, social welfare and social services, transportation, housing and accessibility of public places, health services, and in relation to others within society. However, this scoping review showed that although several areas of disability and MS had been included in the previous research, most of the identified areas were researched in few studies without the possibility to generalize the findings to a larger population or a cross-cultural context. Few studies compared differences between persons with MS based on gender, age, and ethnicity. What impact the invisible symptoms of MS had on disability was also researched to a limited extent. The findings have implications for future research and clinical practice. To better understand living conditions for persons with MS from a global perspective, more research across countries is needed. Healthcare professionals need to assess the individual’s situation regarding both symptoms of the disease and the impact of societal barriers and discrimination to optimize care of persons with MS.
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Affiliation(s)
- Daniel Ståhl
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
- Correspondence: Daniel Ståhl, Department of Social Work, University of Gothenburg, Sprängkullsgatan 23, PO Box 720, Gothenburg, SE 405 30, Sweden, Tel +46 766 186 878, Fax +46 31 786 1888, Email
| | - Ylva Bjereld
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
- Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden
| | - Anna Dunér
- Department of Social Work, University of Gothenburg, Gothenburg, Sweden
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13
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Dadsetan F, Shahrbabaki PM, Mirzai M, Nouhi E. Palliative care needs of patients with multiple sclerosis in southeast Iran. BMC Palliat Care 2021; 20:169. [PMID: 34706707 PMCID: PMC8554857 DOI: 10.1186/s12904-021-00867-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 10/19/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Due to the chronic nature of multiple sclerosis, palliative care can play a significant role in improving the quality of life and well-being of the affected patients. An essential step for developing appropriate palliative care for these patients is to determine the types of palliative care necessary, from different points of view. Therefore, this study was conducted to compare the palliative care needs from the nurses' and patients' points of view in southeast Iran in 2017. METHOD This descriptive-analytical cross-sectional study was conducted on 154 nurses working in neurology wards of teaching hospitals associated with Kerman University of Medical Sciences and 132 patients with multiple sclerosis who were referred to these hospitals in southeast Iran. The data were collected using a questionnaire for assessing the palliative care needs of patients with multiple sclerosis. Pearson correlation coefficient, independent t-test, ANOVA, chi-square, and the Mann-Whitney and Kruskal-Wallis tests were used to examine the data. RESULTS Both nurses and patients mentioned the palliative needs of patients with multiple sclerosis in terms of physical, social, spiritual, psychological, and economic dimensions, respectively, but the results showed that there was a significant difference between the two groups in all dimensions of palliative needs (P < 0.0001). CONCLUSION Given the differences in how patients and nurses prioritize palliative care needs, it is essential to consider the different dimensions of palliative needs of patients with multiple sclerosis.
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Affiliation(s)
- Fatemeh Dadsetan
- M.s Medical Surgical Nursing, Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran.,Razi Faculty of Nursing and Midwifery, Department of Critical Care Nursing, Kerman University of Medical Sciences, Kerman, Iran
| | - Moghadameh Mirzai
- Health Modeling Research Center, Kerman University of Medical Sciences, Kerman, Iran
| | - Esmat Nouhi
- Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran. .,Razi Faculty of Nursing and Midwifery, Department of Medical Surgical Nursing, Kerman University of Medical Sciences, Kerman, Iran.
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14
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Price E, Lucas R, Lane J. Experiences of healthcare for people living with multiple sclerosis and their healthcare professionals. Health Expect 2021; 24:2047-2056. [PMID: 34480516 PMCID: PMC8628581 DOI: 10.1111/hex.13348] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 07/21/2021] [Accepted: 08/06/2021] [Indexed: 12/13/2022] Open
Abstract
Background Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative condition of the central nervous system that commonly strikes in young adulthood and has no cure. Many people living with MS (PwMS) will have significant contact with a range of healthcare professionals (HCPs). To achieve optimal health outcomes in MS, it is important to understand factors that contribute to positive or negative healthcare experiences. Previous studies have shown that PwMS want clear communication and in‐depth relationships with their HCPs. However, many studies have lacked qualitative feedback from HCPs. Objective This study aimed to investigate healthcare experiences of PwMS and HCPs and identify areas that are working well and areas that could be improved. Methods Semistructured interviews with 15 PwMS and 11 HCPs (seven neurologists, four MS nurses) from across Australia were conducted. Interviews were transcribed verbatim and analysed thematically. Results Both PwMS and HCPs valued clear communication, recognized uncertainties associated with MS and highlighted the importance of rapport. PwMS focused on decision‐making, understanding roles and expectations, self‐directed management and their needs for support. HCPs discussed issues related to medical management, providing hope and reassurance, barriers to healthcare and multidisciplinary care. Conclusion Greater transparency and communication, particularly around the approach to care and the roles played by HCPs, is likely to enhance healthcare experiences and contribute to better health outcomes for PwMS. Public Contribution PwMS and HCPs volunteered to be interviewed, and PwMS assisted with the development of interview content and structure.
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Affiliation(s)
- Eluned Price
- Australian National University Medical School, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Robyn Lucas
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
| | - Jo Lane
- National Centre for Epidemiology and Population Health, Research School of Population Health, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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15
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Pétrin J, McColl MA, Donnelly C, French S, Finlayson M. Prioritizing the healthcare access concerns of Canadians with MS. Mult Scler J Exp Transl Clin 2021; 7:20552173211029672. [PMID: 34290879 PMCID: PMC8276490 DOI: 10.1177/20552173211029672] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 06/10/2021] [Indexed: 11/16/2022] Open
Abstract
Background Canadians with MS are high users of healthcare services, yet they report multiple unmet needs, high disease burden, and low satisfaction with care. Engaging patients in healthcare planning can lead to improvements in access and care. There is currently limited evidence that has harnessed the perspectives of Canadians with MS. Objective To identify and prioritize the healthcare access concerns of Canadians with MS. Methods A cross-sectional online survey informed by the Concerns Report Methodology was used to address the objective. Participants were recruited through multiple methods. Descriptive statistics were used to identify the main barriers to healthcare providers, and concerns report methods were used to calculate needs indexes to prioritize concerns of participants. Results 324 Canadians with MS participated in the study between November 18, 2019 and March 27, 2020. The most pressing healthcare access concerns of Canadians with MS were related to availability of healthcare providers with MS knowledge and affordability of services that aim to improve wellness. Conclusion These findings provide healthcare planners with prioritized access concerns of Canadians with MS, which can be used to guide strategic planning to improve the quality of life of these individuals.
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Affiliation(s)
- Julie Pétrin
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Simon French
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada
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16
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Parkinson A, Drew J, Hall Dykgraaf S, Fanning V, Chisholm K, Elisha M, Lueck C, Phillips C, Desborough J. 'They're getting a taste of our world': A qualitative study of people with multiple sclerosis' experiences of accessing health care during the COVID-19 pandemic in the Australian Capital Territory. Health Expect 2021; 24:1607-1617. [PMID: 34227728 PMCID: PMC8483188 DOI: 10.1111/hex.13284] [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: 01/22/2021] [Revised: 04/13/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background People with multiple sclerosis (MS), who are often immunocompromised, require complex care and engage with a variety of health‐care providers to manage their health. Objective To elucidate people with MS' experiences of accessing health care during the COVID‐19 pandemic in Australia. Design A qualitative study involving semi‐structured interviews and thematic analysis. Settings and participants Eight adults with a clinical diagnosis of MS participated in telephone or video call interviews between June and July 2020. Results Participants were aware that having MS made them more vulnerable to contracting COVID‐19. In some cases, usual care was postponed or not sought. Some circumstances warranted the risk of a face‐to‐face consultation. Benefits of telehealth consultations included improved access, convenience and being contact‐free. In comparison with video consultations, those via telephone were considered less personal and limited capacity to read body language, and for physical examination. Most participants hoped to incorporate telehealth into their future health‐care routines. Discussion and conclusion Personal risk assessment and trust in health‐care professionals are determinants of the mode through which people with MS accessed health care during the COVID‐19 pandemic. Telehealth has been a valuable tool to mitigate COVID‐19 transmission through enabling contact‐free consultations. People with MS may find specific value in video consultations, which enable visualization of physical function. There is a need for training and support for all clinicians to conduct remote consultations. Patient or public contribution This study was conducted by a team comprised of four people with MS, a neurologist and four health services researchers.
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Affiliation(s)
- Anne Parkinson
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Janet Drew
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | | | - Vanessa Fanning
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Katrina Chisholm
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Mark Elisha
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
| | - Christian Lueck
- Medical School, Australian National University, Canberra, ACT, Australia.,Department of Neurology, Canberra Hospital, Canberra, ACT, Australia
| | - Christine Phillips
- Medical School, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services, Research and Policy, Australian National University, Canberra, ACT, Australia
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17
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Pétrin J, Finlayson M, Donnelly C, McColl MA. Healthcare access experiences of persons with MS explored through the Candidacy Framework. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:789-799. [PMID: 33606904 DOI: 10.1111/hsc.13320] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 12/14/2020] [Accepted: 01/26/2021] [Indexed: 06/12/2023]
Abstract
Canada has one of the highest rates of multiple sclerosis (MS) in the world, affecting 1 in every 385 individuals. This neurodegenerative condition is unpredictable and variable in symptom profile and disease course making it difficult to manage. Canadians with MS are high users of healthcare services; however, they report multiple unmet needs, high disease burden, and low satisfaction with healthcare. Access to healthcare is vital to health maintenance and may explain these poor experiences. Access is often measured using utilisation as a proxy, which may fail to capture the complexities of access experiences that this population faces. The Candidacy Framework offers an alternative to utilisation measures, by examining the process of accessing care, while considering the impact of social patterning and health system environments on this process. The aim of the current study is to align the experiences of persons with MS in accessing healthcare services with the stages of the Candidacy Framework. Forty-eight individuals with MS living across Ontario were recruited to participate in one of five focus groups or ten individual interviews. Analysis included a first inductive phase, using constant comparative methods, followed by a deductive phase, using content analysis. The Candidacy Framework was not able to capture all experiences shared by persons with MS, including patient-centred care, past experiences and outcome expectation, and care outcomes. We propose these concepts be included as refinements to the current Framework, providing a more thorough explanation of the experiences of persons with MS in accessing care to manage their condition.
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Affiliation(s)
- Julie Pétrin
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Mary Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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18
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Mayo CD, Farzam-Kia N, Ghahari S. Identifying Barriers to and Facilitators of Health Service Access Encountered by Individuals with Multiple Sclerosis. Int J MS Care 2021; 23:37-44. [PMID: 33658905 DOI: 10.7224/1537-2073.2020-026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Background The symptoms of multiple sclerosis (MS) can be diverse, complex, and progressive, creating a need for frequent and long-standing health care services. The purpose of this scoping review was to identify the barriers people with MS encounter when attempting to access multidisciplinary health services and the reported facilitators for better access to health services. Methods The MEDLINE, Embase, and CINAHL databases were searched, without date or geographic restrictions, using the following terms: multiple sclerosis, health services accessibility, health care access, health care delivery, and delivery of health care. After screening based on exclusion criteria, 23 articles were included in the final review. Results Five main themes were identified as barriers and facilitators to accessing health services: 1) information (information available to people with MS, health care provider knowledge of and familiarity with MS), 2) interactions (interactions between health care providers and people with MS, social networks and support of people with MS, collaboration among health care providers), 3) beliefs and skills (personal values and beliefs, perceived time to travel to and attend appointments, and self-assessment of symptoms and needs of people with MS), 4) practical considerations (wait times, physical barriers, affordability of services), and 5) nature of MS (complexity and unpredictability of disease symptoms). Conclusions People with MS and their health care providers may benefit from structured and comprehensive MS-specific education to address barriers to accessing health care services. The education can ultimately facilitate the process of addressing unmet health care needs and contribute to a greater quality of life for people with MS.
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19
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Matin BK, Williamson HJ, Karyani AK, Rezaei S, Soofi M, Soltani S. Barriers in access to healthcare for women with disabilities: a systematic review in qualitative studies. BMC WOMENS HEALTH 2021; 21:44. [PMID: 33516225 PMCID: PMC7847569 DOI: 10.1186/s12905-021-01189-5] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2019] [Accepted: 01/21/2021] [Indexed: 01/15/2023]
Abstract
Background Studies show that different socio-economic and structural factors can limit access to healthcare for women with disabilities. The aim of the current study was to review barriers in access to healthcare services for women with disabilities (WWD) internationally. Methods We conducted a systematic review of relevant qualitative articles in PubMed, Web of Science and Scopus databases from January 2009 to December 2017. The search strategy was based on two main topics: (1) access to healthcare; and (2) disability. In this review, women (older than 18) with different kinds of disabilities (physical, sensory and intellectual disabilities) were included. Studies were excluded if they were not peer-reviewed, and had a focus on men with disabilities. Results Twenty four articles met the inclusion criteria for the final review. In each study, participants noted various barriers to accessing healthcare. Findings revealed that WWD faced different sociocultural (erroneous assumptions, negative attitudes, being ignored, being judged, violence, abuse, insult, impoliteness, and low health literacy), financial (poverty, unemployment, high transportation costs) and structural (lack of insurance coverage, inaccessible equipment and transportation facilities, lack of knowledge, lack of information, lack of transparency, and communicative problems) factors which impacted their access healthcare. Conclusions Healthcare systems need to train the healthcare workforce to respect WWD, pay attention to their preferences and choices, provide non-discriminatory and respectful treatment, and address stigmatizing attitudinal towards WWD. In addition, families and communities need to participate in advocacy efforts to promote WWD’s access to health care.
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Affiliation(s)
- Behzad Karami Matin
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | | | - Ali Kazemi Karyani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Satar Rezaei
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Moslem Soofi
- Social Development and Health Promotion Research Center, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shahin Soltani
- Research Center for Environmental Determinants of Health (RCEDH), Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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20
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Celius EG, Thompson H, Pontaga M, Langdon D, Laroni A, Potra S, Bharadia T, Yeandle D, Shanahan J, van Galen P, Alexandri N, Kesselring J. Disease Progression in Multiple Sclerosis: A Literature Review Exploring Patient Perspectives. Patient Prefer Adherence 2021; 15:15-27. [PMID: 33447018 PMCID: PMC7802794 DOI: 10.2147/ppa.s268829] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 11/20/2020] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Multiple sclerosis (MS) prognosis is often uncertain. This literature review considers patients' understanding of, and perspectives on, MS progression to better comprehend the unmet needs of people with MS (PwMS), in order to improve treatment adherence and quality of life (QoL). METHODS Literature searches for peer-reviewed papers concerning patient perspectives on the progression of MS and comparable conditions, published between January 2000 and January 2020, were conducted. RESULTS Little qualitative evidence exists that examines PwMS' perspectives on MS progression. The understanding and meaning ascribed to terms such as "disease progression" vary. Some PwMS find disease labels stigmatizing, confusing, and disconnected from reality. The lack of a clear definition of progression and discrepancies between PwMS and healthcare professional (HCP) perspectives may contribute to misunderstanding and poor communication. Patient descriptions of progression and relapses include symptoms in addition to those evaluated by standard severity and disability measures. Compared with HCPs, PwMS are still focused on relapse prevention but place higher priority on QoL and ascribe different relative importance to the causes of poor adherence to treatment plans. PwMS want to discuss progression and likely prognosis. Such communication needs to be personalized and delivered with sensitivity, at an appropriate time. Poor treatment adherence may arise from a lack of understanding and poor communication, particularly around treatment goals. The few studies that directly considered patient perspectives on the progression of comparable conditions supported and extended the perspectives of PwMS. Lack of adequate communication by HCPs was the most common theme. CONCLUSION Patient perspectives on disease progression in MS and other chronic progressive conditions are under-investigated and under-reported. The limited evidence available highlights the importance of providing adequate information and effective HCP communication. While further studies are needed, the current evidence base offers information and insights that may help HCPs to enhance patient care, well-being, and treatment adherence.
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Affiliation(s)
- Elisabeth G Celius
- Deparment of Neurology, Oslo University Hospital and University of Oslo, Oslo, Norway
- Correspondence: Elisabeth G Celius Department of Neurology, Oslo University Hospital, Rikshospitalet, Postboks 4950 Nydalen, Oslo0424, NorwayTel +47 91 50 27 70 Email
| | - Heidi Thompson
- The Neurology Centre, Craigavon Area Hospital, Portadown, UK
| | | | - Dawn Langdon
- Department of Psychology, Royal Holloway, University of London, London, UK
| | - Alice Laroni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Italy and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Stanca Potra
- Patient Member of the MS in the 21st Century Steering Group, Bucharest, Romania
| | - Trishna Bharadia
- Patient Member of the MS in the 21st Century Steering Group, Buckinghamshire, UK
| | - David Yeandle
- Patient Member of the MS in the 21st Century Steering Group, Southampton, UK
| | - Jane Shanahan
- Patient Member of the MS in the 21st Century Steering Group, Ascot, UK
| | - Pieter van Galen
- Patient Member of the MS in the 21st Century Steering Group, Overijse, Belgium
| | - Nektaria Alexandri
- Global Medical Affairs, Neurology and Immunology, Merck KGaA, Darmstadt, Germany
| | - Jürg Kesselring
- Department of Neurology & Neurorehabilitation, Kliniken Valens, Valens, Switzerland
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21
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Pétrin J, Donnelly C, McColl MA, Finlayson M. Is it worth it?: The experiences of persons with multiple sclerosis as they access health care to manage their condition. Health Expect 2020; 23:1269-1279. [PMID: 33145866 PMCID: PMC7696118 DOI: 10.1111/hex.13109] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 06/30/2020] [Accepted: 07/04/2020] [Indexed: 12/01/2022] Open
Abstract
Background People with multiple sclerosis (MS) require complex care throughout life. Canadians with MS are high users of health‐care services, yet still report unmet health‐care needs and low satisfaction with services received. Objective This study aimed to investigate the health‐care access experiences of Ontarians with MS as they manage their condition. Design and Participants Interpretive description guided data collection and analysis. Forty‐eight people living across seven communities participated. Thirty‐eight participated in one of five focus groups; the remaining 10 participated in an individual semi‐structured interview. Results Participants described the experience of accessing care as a decisional process, guided by a form of cost‐benefit analysis. The process determined whether seeking conventional health‐care services ‘is worth it’. Most participants felt that the energy and resources required to access the health‐care system outweighed their expected outcomes, based on past experiences. Participants who did not see the benefit of care seeking turned to self‐treatment, use of complementary and alternative services, and engaged in patterns of health‐care avoidance until a crisis arose. Discussion and Conclusion Findings suggest that a renewed effort to promote patient‐centred care and a biopsychosocial approach may improve the health‐care access experiences of persons with MS and reduce service avoidance.
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Affiliation(s)
- Julie Pétrin
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Catherine Donnelly
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Mary-Ann McColl
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
| | - Marcia Finlayson
- School of Rehabilitation Therapy, Queen's University, Kingston, ON, Canada
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22
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Vermersch P, Shanahan J, Langdon D, Yeandle D, Alexandri N, Schippling S. Knowledge Is Power, but Is Ignorance Bliss? Optimising Conversations About Disease Progression in Multiple Sclerosis. Neurol Ther 2020; 9:1-10. [PMID: 31748873 PMCID: PMC7229099 DOI: 10.1007/s40120-019-00170-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2019] [Indexed: 02/07/2023] Open
Abstract
Communication about multiple sclerosis (MS) disease progression between healthcare professionals (HCPs) and people with MS (PwMS) has historically been considered difficult, and attention to improving it has been neglected. However, a growing number of studies have shown that this is a key area to get right, since negative experiences can affect patient satisfaction, treatment adherence, and clinical outcomes. This article reports on a symposium at the European Charcot Foundation, 2018, led by a panel of leading clinicians and patient experts from MS in the 21st Century, who debated the benefits, drawbacks, and challenges of communicating about disease progression, for both HCPs and PwMS, and potential ways to optimise these discussions. PwMS' preferences and priorities regarding conversations about disease progression vary widely. While the majority want to have these conversations, some will be reluctant and/or emotionally unready. Communication therefore needs to be personalised, and HCPs should always be prepared to have such conversations in an appropriate and sensitive manner. Clinical information can be opaque for PwMS, so HCPs also need to use language that is clear, easily understandable, and patient-friendly. MS in the 21st Century is in the process of developing several resources and programmes to help improve disease progression communication between HCPs and PwMS. FUNDING: Merck KGaA, Darmstadt, Germany. Plain language summary available for this article.
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Affiliation(s)
- Patrick Vermersch
- University of Lille, INSERM U995, CHU Lille, FHU Imminent, 59000, Lille, France.
| | | | - Dawn Langdon
- Royal Holloway, University of London, London, UK
| | - David Yeandle
- MS in the 21st Century Steering Group, Southampton, UK
| | - Nektaria Alexandri
- Global Medical Affairs, Neurology and Immunology, Merck KGaA, Darmstadt, Germany
| | - Sven Schippling
- Universitätsspital Zürich and Neuroimmunology and Multiple Sclerosis Research, University Hospital Zurich, Zurich, Switzerland
- Center for Neuroscience and Federal Institute of Technology (ETH) Zurich, University of Zurich, Zurich, Switzerland
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Meehan M, Doody O. The role of the clinical nurse specialist multiple sclerosis, the patients' and families' and carers' perspective: An integrative review. Mult Scler Relat Disord 2020; 39:101918. [PMID: 31927154 DOI: 10.1016/j.msard.2019.101918] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Revised: 11/30/2019] [Accepted: 12/24/2019] [Indexed: 11/17/2022]
Abstract
BACKGROUND MS is a common, neurological disease and it's unpredictable, progressive disabling nature can have a devastating effect on patients, their families' and carers. It is therefore important that the MS Clinical Nurse Specialist develops appropriate skills, services and professional expertise to support individuals along the disease trajectory. DESIGN An integrative literature review. METHOD A systematic search of nine databases; Cinahl, Medline, Scopus, Embase, Ovid, AMED, Academic Search Complete, Web of Science, PsycINFO up to January 31, 2018. Hand searching and review of secondary references also undertaken. Reporting using the PRISMA guidelines, quality appraised (Crowe Critical Appraisal Tool) and thematic data analysis approach (Braun and Clarke 2006). RESULTS Findings from the 17 studies were extracted, synthesised and analysed thematically. Three themes emerged; the MS CNS as a longitudinal care co-ordinator, a bespoke care provider, and an expert resource. The findings suggest a strong desire for the MS CNS to be a leading health care professional to meet the needs of patient, family, and carer. CONCLUSION It can be argued that MS CNSs are best placed to meet the complex, variable needs individuals with MS, their families and carers. Further evidence is required to explore the variability of the disease and the progressive effect and impact of cognitive decline on MS patient, families' and carers' in order to meet their fluctuating and often complex needs. Findings from the review suggest a multifaceted role, and additionally, the needs of patients, families and carers are difficult to define as they vary over time as the disease progresses.
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Affiliation(s)
- Michelle Meehan
- University Hospital Coventry and Warwickshire, United Kingdom
| | - Owen Doody
- Health Research Institute, Department of Nursing and Midwifery, University of Limerick, Ireland.
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24
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Descriptive analysis of free-text comments on healthcare priorities and experiences in a national sample of people with multiple sclerosis. Mult Scler Relat Disord 2019; 34:141-149. [DOI: 10.1016/j.msard.2019.06.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Revised: 05/25/2019] [Accepted: 06/17/2019] [Indexed: 01/20/2023]
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Russell RD, Black LJ, Sherriff JL, Begley A. Dietary responses to a multiple sclerosis diagnosis: a qualitative study. Eur J Clin Nutr 2018; 73:601-608. [PMID: 29941913 DOI: 10.1038/s41430-018-0252-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 06/07/2018] [Indexed: 02/03/2023]
Abstract
BACKGROUND/OBJECTIVES Multiple sclerosis (MS) is an immune-mediated disease with no known cure and insufficient evidence to support a special therapeutic diet to alter symptom management or disease progression. Several studies have reported dietary changes made by people with MS, but there has been limited investigation into experiences surrounding diet in those recently diagnosed. This study explored responses to diet after a recent diagnosis of MS in people living in Western Australia. SUBJECTS/METHODS Eleven adults with MS (mean time since diagnosis 8 months) participated in semi-structured interviews focusing on responses to diet since MS diagnosis. Interviews were transcribed, coded and analysed using grounded theory principles. RESULTS Three theme responses emerged; (1) the perceived incompatibility of lack of/or generalised dietary advice with disease seriousness at the time of diagnosis; (2) extensive personal research and information seeking with difficulty judging credibility, and (3) self-experimentation with diet to either control MS symptoms or to cure MS. CONCLUSIONS Given the seriousness of the disease, there is a perceived gap in dietary information provided at the time of diagnosis. Healthcare professionals should address concerns with alternative therapeutic diets advertised to treat or cure MS, and clearly convey the reasoning for the general healthy dietary recommendations. This would better align advice with the perceptions about the role of diet in MS, assist people with MS in need of information and minimise dietary self-experimentation. Future research should explore the importance of diet for those who have had MS for a longer period of time.
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Affiliation(s)
| | - Lucinda J Black
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Jill L Sherriff
- School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrea Begley
- School of Public Health, Curtin University, Perth, WA, Australia.
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26
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Buijs M, Spruit M. Asynchronous social search as a single point of access to information. LIBRARY HI TECH 2017. [DOI: 10.1108/lht-01-2017-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
The purpose of this paper is to present asynchronous social search as a novel and intuitive approach to search for information in which people collaborate to find the information they are looking for.
Design/methodology/approach
A prototype was built to test the feasibility in a business environment. A case study was performed at an organisation with over 1,000 employees to evaluate the quality of asynchronous social search as a single point of access to information.
Findings
Based on the results, the authors conclude that asynchronous social search has great potential as a single point of access to organisational information. Key strengths include that the implementation requires no integration with the existing information technology infrastructure of organisations and participants were very satisfied with the results provided by the prototype.
Originality/value
This work demonstrates that asynchronous social search indeed provides a very good starting point for a single point of access to information, as integration with existing software systems is not necessary, and due to the lightweightness of the approach it also performs really well which, in turn, stimulates the technology’s acceptance by its end-users.
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Medical homelessness and candidacy: women transiting between prison and community health care. Int J Equity Health 2017; 16:130. [PMID: 28728555 PMCID: PMC5520372 DOI: 10.1186/s12939-017-0627-6] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Accepted: 07/12/2017] [Indexed: 11/10/2022] Open
Abstract
Background Women in contact with the prison system have high health needs. Short periods in prison and serial incarcerations are common. Examination of their experiences of health care both in prison and in the community may assist in better supporting their wellbeing and, ultimately, decrease their risk of returning to prison. Methods We interviewed women in prisons in Sydney, Australia, using pre-release and post-release interviews. We undertook thematic analysis of the combined interviews, considering them as continuing narratives of their healthcare experiences. We further reviewed the findings using the theoretical lens of candidacy to generate additional insights on healthcare access. Results Sixty-nine interviews were conducted with 40 women pre-release and 29 of these post-release. Most had histories of substance misuse. Women saw prison as an opportunity to address neglected health problems, but long waiting lists impeded healthcare delivery. Both in prison and in the community, the dual stigmas of substance misuse and being a prisoner could lead to provider judgements that their claims to care were not legitimate. They feared they would be blocked from care even if seriously ill. Family support, self-efficacy, assertiveness, overcoming substance misuse, compliance with health system rules and transitional care programs increased their personal capacity to access health care. Conclusions For women in transition between prison and community, healthcare access could be experienced as ‘medical homelessness’ in which women felt caught in a perpetual state of waiting and exclusion during cycles of prison- and community-based care. Their healthcare experiences were characterized by ineffectual attempts to access care, transient relationships with healthcare providers, disrupted medical management and a fear that stigma would prevent candidacy to health care even in the event of serious illness. Consideration of the vulnerabilities and likely points of exclusion for women in contact with the criminal justice system will assist in increasing healthcare access for this marginalised population.
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Solari A, Giordano A, Patti F, Grasso MG, Confalonieri P, Palmisano L, Ponzio M, Borreani C, Rosato R, Veronese S, Zaratin P, Battaglia MA. Randomized controlled trial of a home-based palliative approach for people with severe multiple sclerosis. Mult Scler 2017; 24:663-674. [PMID: 28381133 PMCID: PMC5946675 DOI: 10.1177/1352458517704078] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Evidence on the efficacy of palliative care in persons with severe multiple sclerosis (MS) is scarce. OBJECTIVE To assess the efficacy of a home-based palliative approach (HPA) for adults with severe MS and their carers. METHODS Adults with severe MS-carer dyads were assigned (2:1 ratio) to either HPA or usual care (UC). At each center, a multi-professional team delivered the 6-month intervention. A blind examiner assessed dyads at baseline, 3 months, and 6 months. Primary outcome measures were Palliative care Outcome Scale-Symptoms-MS (POS-S-MS) and Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW, not assessed in severely cognitively compromised patients). RESULTS Of 78 dyads randomized, 76 (50 HPA, 26 UC) were analyzed. Symptom burden (POS-S-MS) significantly reduced in HPA group compared to UC ( p = 0.047). Effect size was 0.20 at 3 months and 0.32 at 6 months, and statistical significance was borderline in per-protocol analysis ( p = 0.062). Changes in SEIQoL-DW index did not differ in the two groups, as changes in secondary patient and carer outcomes. CONCLUSION HPA slightly reduced symptoms burden. We found no evidence of HPA efficacy on patient quality of life and on secondary outcomes.
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Affiliation(s)
- Alessandra Solari
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Andrea Giordano
- Unit of Neuroepidemiology, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Francesco Patti
- MS Centre, Neurology Clinic, University Hospital Policlinico Vittorio Emanuele, Catania, Italy
| | | | - Paolo Confalonieri
- Department of Neuroimmunology and Neuromuscular Diseases, Foundation IRCCS Neurological Institute C. Besta, Milan, Italy
| | - Lucia Palmisano
- National Center for Drug Evaluation and Research, Istituto Superiore di Sanità, Rome, Italy
| | - Michela Ponzio
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
| | - Claudia Borreani
- Unit of Clinical Psychology, Foundation IRCCS Istituto Nazionale per la Cura dei Tumori, Milan, Italy
| | - Rosalba Rosato
- Department of Psychology, University of Turin, Turin, Italy
| | | | - Paola Zaratin
- Scientific Research Area, Italian Multiple Sclerosis Foundation (FISM), Genoa, Italy
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