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Mielke J, Cajita MI, Denhaerynck K, Valenta S, Dobbels F, Russell CL, De Geest S. Trust in the Transplant Team Associated With the Level of Chronic Illness Management-A Secondary Data Analysis of the International BRIGHT Study. Transpl Int 2024; 37:11704. [PMID: 38529215 PMCID: PMC10961910 DOI: 10.3389/ti.2024.11704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 01/18/2024] [Indexed: 03/27/2024]
Abstract
A trustful relationship between transplant patients and their transplant team (interpersonal trust) is essential in order to achieve positive health outcomes and behaviors. We aimed to 1) explore variability of trust in transplant teams; 2) explore the association between the level of chronic illness management and trust; 3) investigate the relationship of trust on behavioral outcomes. A secondary data analysis of the BRIGHT study (ID: NCT01608477; https://clinicaltrials.gov/ct2/show/NCT01608477?id=NCT01608477&rank=1) was conducted, including multicenter data from 36 heart transplant centers from 11 countries across four different continents. A total of 1,397 heart transplant recipients and 100 clinicians were enrolled. Trust significantly varied among the transplant centers. Higher levels of chronic illness management were significantly associated with greater trust in the transplant team (patients: AOR= 1.85, 95% CI = 1.47-2.33, p < 0.001; clinicians: AOR = 1.35, 95% CI = 1.07-1.71, p = 0.012). Consultation time significantly moderated the relationship between chronic illness management levels and trust only when clinicians spent ≥30 min with patients. Trust was significantly associated with better diet adherence (OR = 1.34, 95%CI = 1.01-1.77, p = 0.040). Findings indicate the relevance of trust and chronic illness management in the transplant ecosystem to achieve improved transplant outcomes. Thus, further investment in re-engineering of transplant follow-up toward chronic illness management, and sufficient time for consultations is required.
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Affiliation(s)
- Juliane Mielke
- Department of Public Health, Faculty of Medicine, Institute of Nursing Sciences, University of Basel, Basel, Switzerland
| | - Maan Isabella Cajita
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Kris Denhaerynck
- Department of Public Health, Faculty of Medicine, Institute of Nursing Sciences, University of Basel, Basel, Switzerland
| | - Sabine Valenta
- Department of Public Health, Faculty of Medicine, Institute of Nursing Sciences, University of Basel, Basel, Switzerland
- Practice Development and Research Division, Medical Directorate, University Hospital Basel, Basel, Switzerland
| | - Fabienne Dobbels
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
| | | | - Sabina De Geest
- Department of Public Health, Faculty of Medicine, Institute of Nursing Sciences, University of Basel, Basel, Switzerland
- Academic Center for Nursing and Midwifery, Department of Public Health and Primary Care, Faculty of Medicine, KU Leuven, Leuven, Belgium
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Coronado-Vázquez V, Gómez-Salgado J, Cerezo Espinosa de Los Monteros J, Canet Fajas C, Magallón Botaya R. [Equity and patient autonomy in the care strategies for patients with chronic disease of health services in Spain]. GACETA SANITARIA 2018; 33:554-562. [PMID: 30064703 DOI: 10.1016/j.gaceta.2018.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2017] [Revised: 05/09/2018] [Accepted: 05/14/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To examine the chronic care models of the different Spanish health services and to discuss the ethical questions derived from implementing some of their components. METHOD Narrative review of care strategies and programmes for chronic patients in the different Autonomous Communities, searching in official health departments' web pages, using the terms "Programmes", "Strategies", "Chronic patients", and "Chronicity". RESULTS 15 programmes were found. Most of them include all components of the chronic care model, "decision-making support" being under-represented. The main conflicts in the autonomy of patients arise from the use of big data to stratify the population and from telemonitoring. The stratification of population does not consider the social factors that accompany the disease. CONCLUSIONS Chronic care strategies should consider the autonomy and privacy of patients in the use of clinical data and telemonitoring. In order to be equitable, they would have to provide an integrated health care system, incorporating measures to reduce the inequalities due to the social determinants that accompany the disease.
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Affiliation(s)
- Valle Coronado-Vázquez
- Grupo de Investigación de Bioética de Aragón, Dirección General de Asistencia Sanitaria, Departamento de Sanidad, Gobierno de Aragón, Zaragoza, España
| | - Juan Gómez-Salgado
- Departamento de Enfermería, Facultad de Enfermería, Universidad de Huelva, España; Universidad Espíritu Santo, Guayaquil, Ecuador.
| | | | | | - Rosa Magallón Botaya
- Centro de Salud Arrabal, Servicio Aragonés de Salud, Instituto Aragonés de Ciencias de la Salud, Zaragoza, España
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Adams K, Liebzeit A, Browne J, Atkinson P. How's Your Sugar? Evaluation of a Website for Aboriginal People With Diabetes. JMIR Diabetes 2017; 2:e6. [PMID: 30291066 PMCID: PMC6238832 DOI: 10.2196/diabetes.6930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 01/11/2017] [Accepted: 03/06/2017] [Indexed: 12/03/2022] Open
Abstract
Background Australia’s Aboriginal and Torres Strait Islander peoples (hereafter referred to as “Aboriginal people”) have the longest continuing culture in the world, living sustainably for at least 65,000 years on the Australian continent. In relatively recent times, colonization processes have resulted in Aboriginal people experiencing unacceptable health inequalities compared with other Australians. One disease introduced due to colonization is diabetes, the second leading cause of death for Aboriginal peoples. Objectives The objective of this study was to describe the construction and utilization of the website “How’s Your Sugar, ” a website for Aboriginal people with type 2 diabetes (herein after referred to as diabetes). The questions for the evaluation were as follows: how was the website constructed; did target groups utilize the website; and did engagement with the website improve diabetes management. Methods A mixed-method study design was employed. A content analysis of project documents provided information about the website construction. Data from Google analytics provided information about website utilization. To describe patterns of website sessions, percentages and numbers were calculated. A voluntary survey provided more information on website utilization and diabetes self-management. Percentage, numbers, and 95% CIs were calculated for each variable. A chi-square test was performed for Aboriginal status, age, gender, and Aboriginal diabetic status using Australian population estimates and Aboriginal diabetes rates. Results The website development drew on Aboriginal health, social marketing, interactive health promotion frameworks, as well as evidence for diabetes self-management. The website build involved a multidisciplinary team and participation of Aboriginal diabetics, Aboriginal diabetic family members, and Aboriginal health workers. This participation allowed for inclusion of Aboriginal ways of knowing and being. The highest number of website sessions came from Australia, 98.15% (47,717/48,617) and within Australia, Victoria 50.97% (24,323/47,717). There were 129 survey respondents, and the distribution had more female, 82.9% (107/129, 95% CI 76-88), Aboriginal, 21.7% (28/129, 95% CI 16-30), and Aboriginal diabetic, 48% (13/27, 95% CI 31-66) respondents than expected with P<.001 for these three groups. Most common reasons for visits were university assignment research, 40.6% (41/101), and health workers looking for information, 20.8% (21/101). The sample size was too small to calculate diabetes self-management change. Conclusions Inclusion of Aboriginal ways of knowing and being alongside other theoretical and evidence models in Web design is possible. Aboriginal people do utilize Web-based health promotion, and further understanding about reaching to this population would be of use. Provision of an education resource would likely have enhanced educational engagement. Web-based technologies are rapidly evolving, and these can potentially measure behavior change in engaging ways that also have benefits for the participant. A challenge for designers is inclusivity of cultural diversity for self-determination.
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Affiliation(s)
- Karen Adams
- Gukwonderuk, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, Australia
| | | | - Jennifer Browne
- Victorian Aboriginal Community Controlled Health Organisation, Collingwood, Australia
| | - Petah Atkinson
- Gukwonderuk, Faculty of Medicine Nursing and Health Science, Monash University, Clayton, Australia
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Kromme NMH, Ahaus CTB, Gans ROB, van de Wiel HBM. 'It just has to click': Internists' views of: what constitutes productive interactions with chronically ill patients. BMC Health Serv Res 2016; 16:191. [PMID: 27233772 PMCID: PMC4884358 DOI: 10.1186/s12913-016-1430-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 05/05/2016] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND According to the Chronic Care Model, productive interactions are crucial to patient outcomes. Despite productive interactions being at the heart of the Model, however, it is unclear what constitutes such an interaction. The aim of this study was to gain a better understanding of physician views of productive interactions with the chronically ill. METHOD We conducted a qualitative study and interviewed 20 internists working in an academic hospital. The data were analyzed using a constructivist approach of grounded theory. To categorize the data, a coding process within which a code list was developed and tested with two other coders was conducted. RESULTS The participants engaged in goal-directed reasoning when reflecting on productive interactions. This resulted in the identification of four goal orientations: (a) health outcome; (b) satisfaction; (c) medical process; and (d) collaboration. Collaboration appeared to be conditional for reaching medical process goals and ultimately health outcome and satisfaction goals. Achieving rapport with the patient ('clicking,' in the term of the participants) was found to be a key condition that catalyzed collaboration goals. Clicking appeared to be seen as a somewhat unpredictable phenomenon that might or might not emerge, which one had to accept and work with. Goal orientations were found to be related to the specific medical context (i.e., a participant's subspecialty and the nature of a patient's complaint). CONCLUSIONS The participants viewed a productive interaction as essentially goal-directed, catalyzed by the two parties clicking, and dependent on the nature of a patient's complaint. Using the findings, we developed a conceptual process model with the four goal orientations as wheels and with clicking in the center as a flywheel. Because clicking was viewed as important, but somewhat unpredictable, teaching physicians how to click, while taking account of the medical context, may warrant greater attention.
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Affiliation(s)
- N M H Kromme
- Division of Chronic and Vascular Disease, University of Groningen, University Medical Centre, Hanzeplein 1, 9751 RB, Groningen, The Netherlands.
| | - C T B Ahaus
- Faculty of Economics and Business, Centre of Expertise Healthwise, University of Groningen, University Medical Centre Groningen, Nettelbosje 2, 9747 AE, Groningen, The Netherlands
| | - R O B Gans
- Department of Internal Medicine, University of Groningen, University Medical Centre Groningen, 9751 RB, Groningen, The Netherlands
| | - H B M van de Wiel
- Wenckebach Institute, University of Groningen, University Medical Centre Groningen, Hanzeplein 1, 9751 RB, Groningen, The Netherlands
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Sheesley AP. Counselors Within the Chronic Care Model: Supporting Weight Management. JOURNAL OF COUNSELING AND DEVELOPMENT 2016. [DOI: 10.1002/jcad.12079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Alison Phillips Sheesley
- Department of Applied Psychology and Counselor Education; University of Northern Colorado; Greeley
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Hujala A, Rijken M, Laulainen S, Taskinen H, Rissanen S. People with multimorbidity: forgotten outsiders or dynamic self-managers? J Health Organ Manag 2015; 28:696-712. [PMID: 25735425 DOI: 10.1108/jhom-10-2013-0221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of patients are discursively constructed in scientific articles addressing care for people with multiple chronic conditions. DESIGN/METHODOLOGY/APPROACH The study is based on the postmodern assumptions about the power of talk and language in the construction of reality. Totally 20, scientific articles were analysed by critically oriented discourse analysis. The interpretations of the findings draw on the agency theories and principals of critical management studies. FINDINGS Four discourses were identified: medical, technical, collaborative and individual. The individual discourse challenges patients to become self-managers of their health. It may, however, go too far in the pursuit of patients' active agency. The potential restrictions and consequences of a "business-like" orientation must be paid careful attention when dealing with patients with multimorbidity. RESEARCH LIMITATIONS/IMPLICATIONS The data consisted solely of scientific texts and findings therefore serve as limited illustrations of the discursive construction of multimorbidity. In future, research focusing for example on political documents and practice talk of professionals and patients is needed. Social implications - The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups. ORIGINALITY/VALUE By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.
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de Oliveira MG, de Carvalho AT, Pagliuca LMF, Pinheiro AKB, Bezerra CP, Machado MMT. Attention Model for Chronic Conditions: Blind Women and Their Sons. Health (London) 2015. [DOI: 10.4236/health.2015.76089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Raivio R, Jääskeläinen J, Holmberg-Marttila D, Mattila KJ. Decreasing trends in patient satisfaction, accessibility and continuity of care in Finnish primary health care - a 14-year follow-up questionnaire study. BMC FAMILY PRACTICE 2014; 15:98. [PMID: 24885700 PMCID: PMC4030039 DOI: 10.1186/1471-2296-15-98] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/07/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim here was to explore trends in patient satisfaction with primary health care and its accessibility and continuity, and to explore whether through reforms and improvements some of the essential goals had been achieved over a 14-year period of time in Finland. METHODS Nine questionnaire surveys were conducted over a period of 14 years among patients attending within one week in the 65 health centres in the Tampere University Hospital catchment area. A total of 147,394 responded out of a sample of 333,648 patients. The response rate varied yearly from 53% to 37%. RESULTS Patient satisfaction with care in Finnish health centres decreased by nearly 9 percentage units from 1998 to 2011. The fall-off was most marked in the age-group over 64 years. There was a 20 percentage unit's reduction in ease of access as reported by patients. Respondents also reported that the continuity of care had deteriorated. CONCLUSIONS Despite major reforms in Finnish health care policy, patients seem to be less satisfied. Our findings challenge both Finnish authorities and GPs to improve the accessibility and continuity of care in primary health services.
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Affiliation(s)
- Risto Raivio
- Primary Care Unit, Joint Authority for Päijät-Häme Social and Health Care Group, Keskussairaalankatu 7, FI-15850 Lahti, Finland
- School of Medicine, Department of General Practice, FI-33014 University of Tampere, Tampere, Finland
| | - Juhani Jääskeläinen
- School of Medicine, Department of General Practice, FI-33014 University of Tampere, Tampere, Finland
| | - Doris Holmberg-Marttila
- Centre of General Practice, Pirkanmaa Hospital District, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Kari J Mattila
- School of Medicine, Department of General Practice, FI-33014 University of Tampere, Tampere, Finland
- Centre of General Practice, Pirkanmaa Hospital District, P.O. Box 2000, FI-33521 Tampere, Finland
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Lafata JE, Morris HL, Dobie E, Heisler M, Werner RM, Dumenci L. Patient-reported use of collaborative goal setting and glycemic control among patients with diabetes. PATIENT EDUCATION AND COUNSELING 2013; 92:94-9. [PMID: 23433777 PMCID: PMC4301400 DOI: 10.1016/j.pec.2013.01.016] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2012] [Revised: 01/15/2013] [Accepted: 01/22/2013] [Indexed: 05/12/2023]
Abstract
OBJECTIVE Little is known about how patient-clinician communication leads to better outcomes. Among patients with diabetes, we describe patient-reported use of collaborative goal setting and evaluate whether perceived competency and physician trust mediate the association between collaborative goal setting and glycemic control. METHODS Data from a patient survey administered in 2008 to a cohort of insured patients aged 18+ years with diabetes who initiated oral mono-therapy between 2000 and 2005 were joined with pharmaceutical claims data for the prior 12 months and laboratory data for the prior and subsequent 12 months (N=1065). A structural equation model (SEM) was used to test mediation models controlling for baseline HbA1c. RESULTS The hypothesized mediation model was supported. Patient-reported use of more collaborative goal setting was associated with greater perceived self-management competency and increased level of trust in the physician (p<0.05). In turn, both greater perceived competence and increased trust were associated with increased control (p<0.05). CONCLUSIONS Findings indicate that engaging patients in collaborative goal setting during clinical encounters has potential to foster a trusting patient-clinician relationship as well as enhance patient perceived competence, thereby improving clinical control. PRACTICE IMPLICATIONS Fostering collaborative goal setting may yield payoffs in improved clinical outcomes among patients with diabetes.
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Affiliation(s)
- Jennifer Elston Lafata
- Social and Behavioral Health, School of Medicine, Virginia Commonwealth University, Richmond, USA.
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Lhussier M, Eaton S, Forster N, Thomas M, Roberts S, Carr SM. Care planning for long-term conditions – a concept mapping. Health Expect 2013; 18:605-24. [PMID: 23565881 DOI: 10.1111/hex.12063] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2013] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVE This article focuses on approaches within clinical practice that seek to actively involve patients with long-term conditions (LTCs) and how professionals may understand and implement them. Personalized care planning is one such approach, but its current lack of conceptual clarity might have impeded its widespread implementation to date. A variety of overlapping concepts coexist in the literature, which have the potential to impair both clinical and research agendas. The aim of this article is therefore to explore the meaning of the concept of care planning in relation to other overlapping concepts and how this translates into clinical practice implementation. METHODS Searches were conducted in the Cochrane database for systematic reviews, CINHAL and MEDLINE. A staged approach to conducting the concept mapping was undertaken, by (i) an examination of the literature on care planning in LTCs; (ii) identification of related terms; (iii) locating reviews of those terms. Retrieved articles were subjected to a content analysis, which formed the basis of our concept maps. (iv) We then appraised these against knowledge and experience of the implementation of care planning in clinical practice. RESULTS AND CONCLUSIONS Thirteen articles were retrieved, in which the core importance of patient-centredness, shared decision making and self-management was highlighted. Literature searches on these terms retrieved a further 24 articles. Our concept mapping exercise shows that whilst there are common themes across the concepts, the differences between them reflect the context and intended outcomes within clinical practice. We argue that this clarification exercise will allow for further development of both research and clinical implementation agendas.
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Affiliation(s)
- Monique Lhussier
- Northumbria University, Newcastle Upon Tyne, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
| | - Simon Eaton
- Year of Care Partnerships, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | | | - Mathew Thomas
- NHS County Durham and Darlington, Durham, UK.,NHS North East, Newcastle Upon Tyne, Tyne and Wear, UK
| | - Sue Roberts
- Year of Care Partnerships, Northumbria Healthcare NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Susan M Carr
- Northumbria University, Newcastle Upon Tyne, UK.,FUSE, UKCRC Centre for Translational Research in Public Health, Newcastle Upon Tyne, UK
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Walters BH, Adams SA, Nieboer AP, Bal R. Disease management projects and the Chronic Care Model in action: baseline qualitative research. BMC Health Serv Res 2012; 12:114. [PMID: 22578251 PMCID: PMC3464135 DOI: 10.1186/1472-6963-12-114] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2011] [Accepted: 04/04/2012] [Indexed: 12/05/2022] Open
Abstract
Background Disease management programs, especially those based on the Chronic Care Model (CCM), are increasingly common in the Netherlands. While disease management programs have been well-researched quantitatively and economically, less qualitative research has been done. The overall aim of the study is to explore how disease management programs are implemented within primary care settings in the Netherlands; this paper focuses on the early development and implementation stages of five disease management programs in the primary care setting, based on interviews with project leadership teams. Methods Eleven semi-structured interviews were conducted at the five selected sites with sixteen professionals interviewed; all project directors and managers were interviewed. The interviews focused on each project’s chosen chronic illness (diabetes, eating disorders, COPD, multi-morbidity, CVRM) and project plan, barriers to development and implementation, the project leaders’ action and reactions, as well as their roles and responsibilities, and disease management strategies. Analysis was inductive and interpretive, based on the content of the interviews. After analysis, the results of this research on disease management programs and the Chronic Care Model are viewed from a traveling technology framework. Results This analysis uncovered four themes that can be mapped to disease management and the Chronic Care Model: (1) changing the health care system, (2) patient-centered care, (3) technological systems and barriers, and (4) integrating projects into the larger system. Project leaders discussed the paths, both direct and indirect, for transforming the health care system to one that addresses chronic illness. Patient-centered care was highlighted as needed and a paradigm shift for many. Challenges with technological systems were pervasive. Project leaders managed the expenses of a traveling technology, including the social, financial, and administration involved. Conclusions At the sites, project leaders served as travel guides, assisting and overseeing the programs as they traveled from the global plans to local actions. Project leaders, while hypothetically in control of the programs, in fact shared control of the traveling of the programs with patients, clinicians, and outside consultants. From this work, we can learn what roadblocks and expenses occur while a technology travels, from a project leader’s point of view.
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Affiliation(s)
- Bethany Hipple Walters
- Institute of Health Policy and Management, Erasmus University, Rotterdam, The Netherlands.
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Entwistle VA. Brief reflections - from Vikki. Health Expect 2010. [DOI: 10.1111/j.1369-7625.2010.00642_1.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Entwistle VA. Enabling consultations: the facilitative significance of relational aspects of interpersonal communication. Health Expect 2010. [PMID: 20443986 DOI: 10.1111/j.1369-7625.2010.00599.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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