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Chong F, Jianping Z, Zhenjie L, Wenxing L, Li Y. Does competition support integrated care to improve quality? Heliyon 2024; 10:e24836. [PMID: 38333801 PMCID: PMC10850910 DOI: 10.1016/j.heliyon.2024.e24836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 01/01/2024] [Accepted: 01/15/2024] [Indexed: 02/10/2024] Open
Abstract
Introduction This work investigates the compatibility of integrated care and competition in China and analyses the impact of integrated care on regional care quality (DeptQ) within a competitive framework. Method The study was built on multivariate correspondence analysis and a two-way fixed-effects model. The data were collected from Xiamen's Big Data Application Open Platform and represent nine specialised departments that regularly performed inter-institutional referrals between 2016 and 2019. Results First, care quality for referred patients (ReferQ) and the relative scale of referred patients (ReferScale) and competition have an antagonistic but not completely mutually exclusive relationship. Second, ReferQ and competition both have a significant effect on DeptQ, but only when competition is weak can ReferQ and competition act synergistically on DeptQ. When competition is fierce, competition will weaken the impact of ReferQ on DeptQ. Conclusion Changes in the intensity of integrated care and competition ultimately affect care quality.
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Affiliation(s)
- Feng Chong
- School of Mathematics and Statistics, Xiamen University of Technology, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
| | - Zhu Jianping
- School of Management, Xiamen University, Fujian, Xiamen, China
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- National Institute for Data Science in Health and Medicine, Xiamen University, Fujian, Xiamen, China
| | - Liang Zhenjie
- Data Mining Research Center, Xiamen University, Fujian, Xiamen, China
- College of Economics and Management, Minjiang University, Fujian, Fuzhou, China
| | - Lin Wenxing
- Xiamen Health and Medical Big Data Center, Fujian, Xiamen, China
| | - Yumin Li
- School of Economics and Management, Nanjing University of Science and Technology, Jiangsu, Nanjing, China
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Lawless MT, Archibald MM, Ambagtsheer RC, Pinero de Plaza MA, Kitson AL. My Wellbeing Journal: Development of a communication and goal-setting tool to improve care for older adults with chronic conditions and multimorbidity. Health Expect 2024; 27:e13890. [PMID: 37830439 PMCID: PMC10726145 DOI: 10.1111/hex.13890] [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: 06/17/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Chronic conditions and multimorbidity, the presence of two or more chronic conditions, are increasingly common in older adults. Effective management of chronic conditions and multimorbidity in older adults requires a collaborative and person-centred approach that considers the individual's goals, preferences and priorities. However, ensuring high-quality personalised care for older adults with multimorbidity can be challenging due to the complexity of their care needs, limited time and a lack of patient preparation to discuss their personal goals and preferences with their healthcare team. OBJECTIVE To codesign a communication and goal-setting tool, My Wellbeing Journal, to support personalised care planning for older adults with chronic conditions and multimorbidity. DESIGN We drew on an experience-based codesign approach to develop My Wellbeing Journal. This article reports on the final end-user feedback, which was collected via an online survey with older adults and their carers. SETTING AND PARTICIPANTS Older adults with chronic conditions, multimorbidity and informal carers living in Australia. Personalised care planning was considered in the context of primary care. RESULTS A total of 88 participants completed the online survey. The survey focused on participants' feedback on the tool in terms of effectiveness, efficiency, satisfaction and errors encountered. This feedback resulted in modifications to My Wellbeing Journal, which can be used during clinical encounters to facilitate communication, goal setting and progress tracking. DISCUSSION AND CONCLUSIONS Clinicians and carers can use the tool to guide discussions with older adults about their care planning and help them set realistic goals that are meaningful to them. The findings of this study could be used to inform the development of recommendations for healthcare providers to implement person-centred, goal-oriented care for older adults with chronic conditions and multimorbidity. PATIENT OR PUBLIC CONTRIBUTION Older adults living with chronic conditions and multimorbidity and their carers have contributed to the development of a tool that has the potential to significantly enhance the experience of personalised care planning. Their direct involvement as collaborators has ensured that the tool is optimised to meet the standards of effectiveness and usability.
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Affiliation(s)
- Michael T. Lawless
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Mandy M. Archibald
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Helen Glass Centre for NursingCollege of NursingWinnipegManitobaCanada
| | | | | | - Alison L. Kitson
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
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3
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Lawless MT, Tieu M, Chan RJ, Hendriks JM, Kitson A. Instruments Measuring Self-Care and Self-Management of Chronic Conditions by Community-Dwelling Older Adults: A Scoping Review. J Appl Gerontol 2023:7334648231161929. [PMID: 36880688 DOI: 10.1177/07334648231161929] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2023] Open
Abstract
Given the high prevalence of chronic conditions and multimorbidity in older adults, there is a need to better conceptualize and measure self-care and self-management to promote a person-centered approach. This scoping review aimed to identify and map instruments measuring self-care and self-management of chronic conditions by older adults. We searched six electronic databases, charted data from the studies and tools and reported the results in accordance with the PRISMA-ScR guidelines. A total of 107 articles (103 studies) containing 40 tools were included in the review. There was substantial variation in the tools in terms of their aims and scope, structure, theoretical foundations, how they were developed, and the settings in which they have been used. The quantity of tools demonstrates the importance of assessing self-care and self-management. Consideration of the purpose, scope, and theoretical foundation should guide decisions about tools suitable for use in research and clinical practice.
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Affiliation(s)
- Michael T Lawless
- Caring Futures Institute, College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Matthew Tieu
- Caring Futures Institute, College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia.,College of Humanities, Arts and Social Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Raymond J Chan
- Caring Futures Institute, College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Jeroen M Hendriks
- Caring Futures Institute, College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
| | - Alison Kitson
- Caring Futures Institute, College of Nursing and Health Sciences, 1065Flinders University, Adelaide, SA, Australia
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Gauci J, Bloomfield J, Lawn S, Towns S, Hobbs A, Steinbeck K. A randomized controlled trial evaluating the effectiveness of a self-management program for adolescents with a chronic condition: a study protocol. Trials 2022; 23:850. [PMID: 36199075 PMCID: PMC9532816 DOI: 10.1186/s13063-022-06740-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 09/13/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Self-management support is increasingly viewed as an integral part of chronic condition management in adolescence. It is well recognized that markers of chronic illness control deteriorate during adolescence. Due to the increasing prevalence of long-term chronic health conditions in childhood and improved survival rates of previously life-limiting conditions in children and adolescents, significant numbers of adolescents are having to manage their chronic condition effectively as they transition to adult health care. Therapy adherence has been identified as a major challenge for young people living with a chronic condition such as cystic fibrosis, diabetes, or asthma requiring long-term pharmacological therapy and/or lifestyle modifications. Most systematic reviews on self-management interventions address adult populations. Very few intervention studies are directed at adolescents with a chronic condition who are transitioning to adult health services. This protocol describes a prospective randomized controlled trial of a standardized self-management intervention program delivered to adolescents aged 15-18 years prior to their transfer to adult care. This study has been designed to provide evidence regarding self-management programs for adolescents and is the first study to use the Flinders Program with this important, under-researched age group. METHODS A randomized controlled trial is used to investigate the effectiveness of a modified adolescent-friendly version of an adult self-management program. This program is directed at improving self-management in an adolescent cohort 15-18 years of age with a chronic condition being treated in a specialist pediatric hospital. Participants will be randomized to either usual care or the modified Flinders Program plus usual care. Data collection will include measures of specific illness control, unscheduled hospital admissions, and questionnaires to record self-management competencies, quality of life, self-efficacy, and outcome measures specific to the chronic condition at baseline, 3 months, 6 months, and 12 months after delivery. DISCUSSION This study will provide a better understanding of the elements required for effective self-management programs in adolescents with a chronic condition and address some important knowledge gaps in current literature. The study will be carried out in collaboration with the Discipline of Behavioural Health at Flinders University, Adelaide, Australia, in order to inform the development of an adolescent version of the successful and validated Flinders Program™. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry (ACTRN12621000390886). Registered on April 8, 2021.
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Affiliation(s)
- Jaunna Gauci
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. .,Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.
| | - Jacqueline Bloomfield
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Sharon Lawn
- College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia
| | - Susan Towns
- Department of Adolescent Medicine, The Children's Hospital at Westmead, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.,Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Annabelle Hobbs
- The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, Australia
| | - Katharine Steinbeck
- Discipline of Child & Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, Australia.,The Academic Department of Adolescent Medicine, The Children's Hospital at Westmead, Sydney, Australia
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Barajas-Nava LA, Garduño-Espinosa J, Mireles Dorantes JM, Medina-Campos R, García-Peña MC. Models of comprehensive care for older persons with chronic diseases: a systematic review with a focus on effectiveness. BMJ Open 2022; 12:e059606. [PMID: 36170225 PMCID: PMC9362834 DOI: 10.1136/bmjopen-2021-059606] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Ageing entails a variety of physiological changes that increase the risk of chronic non-communicable diseases. The prevalence of these diseases leads to an increase in the use of health services. The care models implemented by health systems should provide comprehensive long-term healthcare. We conducted this systematic review to determine whether any model of care for older persons have proven to be effective. METHODS A systematic review of literature was carried out to identify randomised clinical trials that have assessed how effective a care model for older patients with chronic diseases. A searches electronic databases such as MEDLINE, Turning Research Into Practice Database, Cochrane Library and Cochrane Central Register of controlled Trials was conducted from January 1966 to January 2021. Two independent reviewers assessed the eligibility of the studies. Interventions were identified and classified according to the taxonomies developed by the Cochrane Effective Practice and Organisation of Care and Cochrane Consumers and Communication groups. RESULTS Of the 4952 bibliographic references that were screened, 577 were potentially eligible and the final sample included 25 studies that evaluated healthcare models in older people with chronic diseases. In the 25 care models, the most frequently implemented interventions were educational, and those based on the provision of healthcare. Only 22% of the outcomes of interventions were identified as being effective, whereas 21% were identified as being partially effective; thus, more than 50% of the outcomes were identified as being ineffective. CONCLUSIONS It was not possible to determine a care model as effective. The interventions implemented in the models are variable. The most effective outcomes were focused on improving the patient-healthcare professional relationship in the early stages of the intervention. The interventions addressed in the studies were similar to public health interventions as their main objectives focused on promoting health. Most studies were of low methodological quality.
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Affiliation(s)
- Leticia A Barajas-Nava
- Evidence-Based Medicine Research Unit, Hospital Infantil de México Federico Gómez (HIMFG), National Health Institute, México City, México
| | - Juan Garduño-Espinosa
- Head of the Research Office, Hospital Infantil de México Federico Gómez (HIMFG), National Health Institute, México City, México
| | | | - Raúl Medina-Campos
- Deputy Research Director, Instituto Nacional de Geriatría, México City, México
| | - M Carmen García-Peña
- Head of the Research Office, Instituto Nacional de Geriatría, México City, México
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Defining Pooled' Place-Based' Budgets for Health and Social Care: A Scoping Review. Int J Integr Care 2022; 22:16. [PMID: 36186513 PMCID: PMC9479665 DOI: 10.5334/ijic.6507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction Current descriptions of pooled budgets in the literature pose challenges to good quality evaluation of their contribution to integrated care. Addressing this gap is increasingly important given the shift from early models of integrated care targeting segments of the population, to more recent approaches that aim to target 'places', broader geographically defined populations. This review draws on the current international evidence to describe practical examples of pooled health and social care budgets, highlighting specific place-based approaches. Methods We initially conducted a scoping review, a systematic database search ('Medline', 'Embase', 'Econ Lit' and 'Google Scholar') complemented by further snowballing for academic and 'grey literature' publications (1995 - 2020). Results were analysed thematically according to budget characteristics and macro-environment, with additional specific case studies. Results Thirty-six primary studies were included, describing ten broad models of pooled budgets across seven countries. Most budgets targeted specific sub-populations rather than an entire geographically defined population. Specific budget structures varied and were generally under-described. The closest place-based models were for small populations and implemented in a national health system, or insurance-based with natural geographical boundaries. Conclusion Despite their increasing relevance in the current political debate, pooled place-based budgets are still at an early stage of implementation and research. Adequate description is required for future meta-analysis of effectiveness on outcomes.
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Ramachandran J, Smith D, Woodman R, Muller K, Wundke R, McCormick R, Kaambwa B, Wigg A. Psychometric validation of the Partners in Health scale as a self-management tool in patients with liver cirrhosis. Intern Med J 2020; 51:2104-2110. [PMID: 32833278 DOI: 10.1111/imj.15031] [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: 04/19/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Liver cirrhosis is a chronic disease complicated by recurrent hospital admissions. Self-management skills could facilitate optimal disease management. At present there is no validated instrument for measuring self-management in these patients. Hence, we evaluated the internal reliability and construct validity of the Partners in Health (PIH) scale, a chronic condition self-management tool in cirrhotic patients. METHODS In this prospective cohort study, the PIH scale was administered to 133 consenting patients within a Chronic Liver Failure Program of a tertiary hospital from February 2017 to May 2018. A Bayesian confirmatory factor analysis was used to evaluate a priori four-factor structure. Omega coefficients and 95% credible intervals (CrI) were used to assess internal reliability. Known-group validity was assessed in patients receiving active case management (n = 60) versus those without (n = 73). RESULTS The mean (± standard deviation (SD)) age of the participants was 62 (±11) years. Model fit for the hypothesised model was adequate (posterior predictive P-value = 0.073) and all hypothesised factor loadings were substantial (>0.6) and significant (P < 0.001). Omega coefficients (95% CrI) for the PIH subscales of Knowledge, Partnership, Management and Coping were 0.88 (0.82-0.91), 0.68 (0.57-0.76), 0.92 (0.89-0.94) and 0.89 (0.85-0.92) respectively. The mean (±SD) overall PIH score was higher in patients receiving case management compared to those without case management (81 ± 12 vs 73 ± 17, P < 0.001). CONCLUSION The dimensionality, known-group validity and reliability of the PIH scale for measuring self-management in patients with liver cirrhosis were confirmed. Its clinical predictive value requires further assessment.
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Affiliation(s)
- Jeyamani Ramachandran
- Hepatology and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
| | - David Smith
- College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
| | - Richard Woodman
- College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
| | - Kate Muller
- Hepatology and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Wundke
- Hepatology and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Rosemary McCormick
- Hepatology and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
| | - Alan Wigg
- Hepatology and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
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Ford JA, Lenaghan E, Salter C, Turner D, Shiner A, Clark AB, Murdoch J, Green C, James S, Koopmans I, Lipp A, Moseley A, Wade T, Winterburn S, Steel N. Can goal-setting for patients with multimorbidity improve outcomes in primary care? Cluster randomised feasibility trial. BMJ Open 2019; 9:e025332. [PMID: 31164362 PMCID: PMC6561432 DOI: 10.1136/bmjopen-2018-025332] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
INTRODUCTION Goal-setting is recommended for patients with multimorbidity, but there is little evidence to support its use in general practice. OBJECTIVE To assess the feasibility of goal-setting for patients with multimorbidity, before undertaking a definitive trial. DESIGN AND SETTING Cluster-randomised controlled feasibility trial of goal-setting compared with control in six general practices. PARTICIPANTS Adults with two or more long term health conditions and at risk of unplanned hospital admission. INTERVENTIONS General practitioners (GPs) underwent training and patients were asked to consider goals before an initial goal-setting consultation and a follow-up consultation 6 months later. The control group received usual care planning. OUTCOME MEASURES Health-related quality of life (EQ-5D-5L), capability (ICEpop CAPability measure for Older people), Patient Assessment of Chronic Illness Care and healthcare use. All consultations were video-recorded or audio-recorded, and focus groups were held with participating GPs and patients. RESULTS Fifty-two participants were recruited with a response rate of 12%. Full follow-up data were available for 41. In the goal-setting group, mean age was 80.4 years, 54% were female and the median number of prescribed medications was 13, compared with 77.2 years, 39% female and 11.5 medications in the control group. The mean initial consultation time was 23.0 min in the goal-setting group and 19.2 in the control group. Overall 28% of patient participants had no cognitive impairment. Participants set between one and three goals on a wide range of subjects, such as chronic disease management, walking, maintaining social and leisure interests, and weight management. Patient participants found goal-setting acceptable and would have liked more frequent follow-up. GPs unanimously liked goal-setting and felt it delivered more patient-centred care, and they highlighted the importance of training. CONCLUSIONS This goal-setting intervention was feasible to deliver in general practice. A larger, definitive study is needed to test its effectiveness. TRIAL REGISTRATION NUMBER ISRCTN13248305; Post-results.
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Affiliation(s)
- John A Ford
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Elizabeth Lenaghan
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Charlotte Salter
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - David Turner
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Alice Shiner
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Allan B Clark
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Jamie Murdoch
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Carole Green
- Patient and public involvement representative, Norwich, UK
| | - Sarah James
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Imogen Koopmans
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | | | - Annie Moseley
- Patient and public involvement representative, Norwich, UK
| | - Tom Wade
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Sandra Winterburn
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
| | - Nicholas Steel
- Faculty of Medicine and Health Sciences, University of East Anglia, Norwich, UK
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Leach MJ, Eaton H, Agnew T, Thakkar M, Wiese M. The effectiveness of integrative healthcare for chronic disease: A systematic review. Int J Clin Pract 2019; 73:e13321. [PMID: 30721565 DOI: 10.1111/ijcp.13321] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 12/14/2018] [Accepted: 02/01/2019] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND The past few decades have witnessed a surge in consumer, clinician and academic interest in the field of integrative healthcare (IHC). Yet, there is still uncertainty regarding the effectiveness of IHC for complex, long-term health conditions. OBJECTIVE To assess the effectiveness of IHC for the management of any chronic health condition. METHODS Seven databases and four clinical trial registries were searched from inception through to May 2018 for comparative/controlled clinical trials investigating the effectiveness of IHC for any chronic disease, and assessing any outcome. Risk of bias was assessed using the Cochrane Collaboration Risk of Bias tool. RESULTS The search yielded 6,926 results. Eight studies met the inclusion criteria. All studies had at least three design features that carried an uncertain/high risk of bias. Differences in physiological, psychological and functional outcomes, and quality of life between patients receiving IHC and patients receiving conventional/usual care were varied and inconsistent. Changes in patient satisfaction with care were inconclusive. No studies reported the effectiveness of IHC on workforce- or administration-related parameters. Evidence from one trial suggested IHC may be more cost-effective than conventional care. CONCLUSIONS The findings indicate some promising effects for the use of IHC to manage chronic disease. However, the uncertain/high risk of bias across multiple domains, diverse and inconsistent findings, and heterogeneity of outcome measures and study populations prevents firm conclusions from being reached. Along with conducting further well-designed, long-term studies in this field, there is a need to ensure interventions closely align with the definition/principles of IHC.
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Affiliation(s)
- Matthew J Leach
- Department of Rural Health, University of South Australia, Adelaide, South Australia
| | - Heather Eaton
- School of Nursing & Midwifery, University of South Australia, Adelaide, South Australia
| | - Tamara Agnew
- School of Nursing & Midwifery, University of South Australia, Adelaide, South Australia
| | - Manisha Thakkar
- Department of Bioscience, Endeavour College of Natural Health, Adelaide, South Australia
| | - Marlene Wiese
- Southgate Institute for Health, Society & Equity, Flinders University of SA, Bedford Park, South Australia
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Convery E, Hickson L, Keidser G, Meyer C. The Chronic Care Model and Chronic Condition Self-Management: An Introduction for Audiologists. Semin Hear 2019; 40:7-25. [PMID: 30728646 PMCID: PMC6363546 DOI: 10.1055/s-0038-1676780] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Hearing health care is biomedically focused, device-centered, and clinician-led. There is emerging evidence that these characteristics-all of which are hallmarks of a health care system designed to address acute, rather than chronic, conditions-may contribute to low rates of help-seeking and hearing rehabilitation uptake among adults with hearing loss. In this review, we introduce audiologists to the Chronic Care Model, an organizational framework that describes best-practice clinical care for chronic conditions, and suggest that it may be a viable model for hearing health care to adopt. We further introduce the concept of chronic condition self-management, a key component of chronic care that refers to the knowledge and skills patients use to manage the effects of a chronic condition on all aspects of daily life. Drawing on the chronic condition evidence base, we demonstrate a link between the provision of effective self-management support and improved clinical outcomes and discuss validated methods with which clinicians can support the acquisition and application of self-management skills in their patients. We examine the extent to which elements of chronic condition self-management have been integrated into clinical practice in audiology and suggest directions for further research in this area.
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Affiliation(s)
- Elizabeth Convery
- HEARing Cooperative Research Centre, Melbourne, Australia
- National Acoustic Laboratories, Sydney, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Louise Hickson
- HEARing Cooperative Research Centre, Melbourne, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Gitte Keidser
- HEARing Cooperative Research Centre, Melbourne, Australia
- National Acoustic Laboratories, Sydney, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Carly Meyer
- HEARing Cooperative Research Centre, Melbourne, Australia
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
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11
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Reed RL, Roeger L, Howard S, Oliver-Baxter JM, Battersby MW, Bond M, Osborne RH. A self-management support program for older Australians with multiple chronic conditions: a randomised controlled trial. Med J Aust 2019; 208:69-74. [PMID: 29385967 DOI: 10.5694/mja17.00127] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Accepted: 06/15/2017] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To determine whether a clinician-led chronic disease self-management support (CDSMS) program improves the overall self-rated health level of older Australians with multiple chronic health conditions. DESIGN Randomised controlled trial: participants were allocated to a clinician-led CDSMS group (including client-centred goal setting and the development of individualised care plans) or to a control group in which they received positive attention only. SETTING AND PARTICIPANTS Patients aged 60 years or more with at least two chronic conditions, recruited between September 2009 and June 2010 from five general practices in Adelaide. MAIN OUTCOME MEASURES The primary outcome was self-rated health. Secondary outcome measures related to health status (fatigue, pain, health distress, energy, depression, illness intrusiveness), health behaviour (exercise, medication adherence), and health service utilisation. RESULTS 254 participants were randomised to the CDSMS and control groups, of whom 231 (117 control and 114 CDSMS participants) completed the 6-month programs and provided complete outcomes data (91%). An intention-to-treat analysis found that CDSMS participants were more likely than control participants to report improved self-rated health at 6 months (odds ratio, 2.50; 95% confidence interval, 1.13-5.50; P = 0.023). Between-group differences for secondary outcomes were not statistically significant. CONCLUSION CDSMS may benefit some older people with multiple chronic conditions to a greater extent than positive attention and health education. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12609000726257.
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Affiliation(s)
| | | | | | | | | | | | - Richard H Osborne
- Health System Improvement Unit, Centre for Population Health Research, Deakin University, Geelong, VIC
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12
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Brown S, Lhussier M, Dalkin SM, Eaton S. Care Planning: What Works, for Whom, and in What Circumstances? A Rapid Realist Review. QUALITATIVE HEALTH RESEARCH 2018; 28:2250-2266. [PMID: 29676217 DOI: 10.1177/1049732318768807] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Care planning has been described as a "better conversation" that helps people with long-term conditions to be in control of planning their care. Each person with long-term conditions faces individual challenges and each health care setting is fundamentally different, so there is a need for empirical testing of the specific mechanisms through which care planning may lead to health improvements. A rapid realist review was conducted to unearth underpinning mechanisms leading to outcomes in particular contexts. These are expressed in the form of realist theories, which are developed and refined through the review process. Fifty-one full text studies were included in the review. Seven program theories were iteratively tested and refined. A detailed description of what care planning is and what it should look like in practice has been achieved in the form of realist theories.
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Affiliation(s)
- Sarah Brown
- 1 Northumbria University, Newcastle upon Tyne, UK
| | | | | | - Simon Eaton
- 2 Northumbria Healthcare NHS Foundation Trust, Newcastle upon Tyne, UK
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Munro V, Morello A, Oster C, Redmond C, Vnuk A, Lennon S, Lawn S. E-learning for self-management support: introducing blended learning for graduate students - a cohort study. BMC MEDICAL EDUCATION 2018; 18:219. [PMID: 30249238 PMCID: PMC6154791 DOI: 10.1186/s12909-018-1328-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Accepted: 09/16/2018] [Indexed: 05/25/2023]
Abstract
BACKGROUND E-learning allows delivery of education in many diverse settings and researchers have demonstrated it can be as effective as learning conducted in traditional face-to-face settings. However, there are particular practices and skills needed in the area of providing patient self-management support (SMS), that may not be achievable online. The aim of this study was to compare three approaches in the training of university students regarding the preparation of a Chronic Condition Self-Management Care Plan: 1) traditional face-to-face delivery of SMS training, 2) an e-learning approach and 3) a blended approach (combining e-learning and face-to-face teaching). METHODS Graduate entry physiotherapy students and medical students at Flinders University were recruited. Depending on the cohort, students were either exposed to traditional face-to-face training, e-learning or a blended model. Outcomes were compared between the three groups. We measured adherence to care plan processes in the preparation of an assessment piece using the Flinders Program Chronic Care Self Management tools. A total of 183 care plans were included (102 traditional, 52 blended, 29 e-learning,). All students submitted the Flinders Program Chronic Care Plan for university assessment and these were later assessed for quality by researchers. The submission was also assigned a consumer engagement score and a global competence score as these are integral to successful delivery of SMS and represent the patient perspective. RESULTS The blended group performed significantly better than the traditional group in quality use of the Flinders Program tools: Problem and Goals (P < 0.0001). They also performed significantly better in the total care plan score (P < 0.0001) and engagement score (P < 0.0001). There was no significant difference between the groups for the Partners in Health tool. CONCLUSIONS In this pilot study, the blended learning model was a more effective method for teaching self-management skills than the traditional group, as assessed in the development of a chronic condition self-management care plan. We anticipate that future research with identical groups of students would yield similar results but in the meantime, academics can have confidence that blended learning is at least as effective as traditional learning methods.
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Affiliation(s)
- Virginia Munro
- College of Medicine and Public Health, Flinders University, PO Box 2100, Adelaide, South Australia 5001 Australia
| | - Andrea Morello
- Flinders Human Behaviour & Health Research Unit, Department of Psychiatry, Flinders University, PO Box 2100, Adelaide, South Australia 5001 Australia
| | - Candice Oster
- Flinders Human Behaviour & Health Research Unit, Department of Psychiatry, Flinders University, PO Box 2100, Adelaide, South Australia 5001 Australia
| | - Christine Redmond
- Discipline of Physiotherapy, School of Nursing & Health Sciences, Flinders University, PO Box 2100, Adelaide, South Australia 5001 Australia
| | - Anna Vnuk
- College of Medicine and Public Health, Flinders University, PO Box 2100, Adelaide, South Australia 5001 Australia
| | - Sheila Lennon
- Discipline of Physiotherapy, School of Nursing & Health Sciences, Flinders University, PO Box 2100, Adelaide, South Australia 5001 Australia
| | - Sharon Lawn
- Flinders Human Behaviour & Health Research Unit, Department of Psychiatry, Flinders University, PO Box 2100, Adelaide, South Australia 5001 Australia
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. Understanding new models of integrated care in developed countries: a systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06290] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BackgroundThe NHS has been challenged to adopt new integrated models of service delivery that are tailored to local populations. Evidence from the international literature is needed to support the development and implementation of these new models of care.ObjectivesThe study aimed to carry out a systematic review of international evidence to enhance understanding of the mechanisms whereby new models of service delivery have an impact on health-care outcomes.DesignThe study combined rigorous and systematic methods for identification of literature, together with innovative methods for synthesis and presentation of findings.SettingAny setting.ParticipantsPatients receiving a health-care service and/or staff delivering services.InterventionsChanges to service delivery that increase integration and co-ordination of health and health-related services.Main outcome measuresOutcomes related to the delivery of services, including the views and perceptions of patients/service users and staff.Study designEmpirical work of a quantitative or qualitative design.Data sourcesWe searched electronic databases (between October 2016 and March 2017) for research published from 2006 onwards in databases including MEDLINE, EMBASE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, Science Citation Index, Social Science Citation Index and The Cochrane Library. We also searched relevant websites, screened reference lists and citation searched on a previous review.Review methodsThe identified evidence was synthesised in three ways. First, data from included studies were used to develop an evidence-based logic model, and a narrative summary reports the elements of the pathway. Second, we examined the strength of evidence underpinning reported outcomes and impacts using a comparative four-item rating system. Third, we developed an applicability framework to further scrutinise and characterise the evidence.ResultsWe included 267 studies in the review. The findings detail the complex pathway from new models to impacts, with evidence regarding elements of new models of integrated care, targets for change, process change, influencing factors, service-level outcomes and system-wide impacts. A number of positive outcomes were reported in the literature, with stronger evidence of perceived increased patient satisfaction and improved quality of care and access to care. There was stronger UK-only evidence of reduced outpatient appointments and waiting times. Evidence was inconsistent regarding other outcomes and system-wide impacts such as levels of activity and costs. There was an indication that new models have particular potential with patients who have complex needs.LimitationsDefining new models of integrated care is challenging, and there is the potential that our study excluded potentially relevant literature. The review was extensive, with diverse study populations and interventions that precluded the statistical summary of effectiveness.ConclusionsThere is stronger evidence that new models of integrated care may enhance patient satisfaction and perceived quality and increase access; however, the evidence regarding other outcomes is unclear. The study recommends factors to be considered during the implementation of new models.Future workLinks between elements of new models and outcomes require further study, together with research in a wider variety of populations.Study registrationThis study is registered as PROSPERO CRD37725.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Maxine Johnson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anthea Sutton
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Andrew Booth
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Zimbudzi E, Lo C, Misso ML, Ranasinha S, Kerr PG, Teede HJ, Zoungas S. Effectiveness of self-management support interventions for people with comorbid diabetes and chronic kidney disease: a systematic review and meta-analysis. Syst Rev 2018; 7:84. [PMID: 29898785 PMCID: PMC6001117 DOI: 10.1186/s13643-018-0748-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/24/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Self-management support interventions may potentially delay kidney function decline and associated complications in patients with comorbid diabetes and chronic kidney disease. However, the effectiveness of these interventions remains unclear. We investigated the effectiveness of current self-management support interventions and their specific components and elements in improving patient outcomes. METHODS Electronic databases were systematically searched from January 1, 1994, to December 19, 2017. Eligible studies were randomized controlled trials on self-management support interventions for adults with comorbid diabetes and chronic kidney disease. Primary outcomes were systolic blood pressure, diastolic blood pressure, estimated glomerular filtration rate, and glycated hemoglobin. Secondary outcomes included self-management activity, health service utilization, health-related quality of life, medication adherence, and death. RESULTS Of the 48 trials identified, eight studies (835 patients) were eligible. There was moderate-quality evidence that self-management support interventions improved self-management activity (standard mean difference 0.56, 95% CI 0.15 to 0.97, p < 0.007) compared to usual care. There was low-quality evidence that self-management support interventions reduced systolic blood pressure (mean difference - 4.26 mmHg, 95% CI - 7.81 to - 0.70, p = 0.02) and glycated hemoglobin (mean difference - 0.5%, 95% CI - 0.8 to - 0.1, p = 0.01) compared to usual care. CONCLUSIONS Self-management support interventions may improve self-care activities, systolic blood pressure, and glycated hemoglobin in patients with comorbid diabetes and chronic kidney disease. It was not possible to determine which self-management components and elements were more effective, but interventions that utilized provider reminders, patient education, and goal setting were associated with improved outcomes. More evidence from high-quality studies is required to support future self-management programs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015017316 .
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Affiliation(s)
- Edward Zimbudzi
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
- Department of Nephrology, Monash Health, Melbourne, Victoria Australia
| | - Clement Lo
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria Australia
| | - Marie L. Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
| | - Peter G. Kerr
- Department of Nephrology, Monash Health, Melbourne, Victoria Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria Australia
| | - Sophia Zoungas
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria Australia
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales Australia
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Baxter S, Johnson M, Chambers D, Sutton A, Goyder E, Booth A. The effects of integrated care: a systematic review of UK and international evidence. BMC Health Serv Res 2018; 18:350. [PMID: 29747651 PMCID: PMC5946491 DOI: 10.1186/s12913-018-3161-3] [Citation(s) in RCA: 301] [Impact Index Per Article: 50.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 04/29/2018] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Healthcare systems around the world have been responding to the demand for better integrated models of service delivery. However, there is a need for further clarity regarding the effects of these new models of integration, and exploration regarding whether models introduced in other care systems may achieve similar outcomes in a UK national health service context. METHODS The study aimed to carry out a systematic review of the effects of integration or co-ordination between healthcare services, or between health and social care on service delivery outcomes including effectiveness, efficiency and quality of care. Electronic databases including MEDLINE; Embase; PsycINFO; CINAHL; Science and Social Science Citation Indices; and the Cochrane Library were searched for relevant literature published between 2006 to March 2017. Online sources were searched for UK grey literature, and citation searching, and manual reference list screening were also carried out. Quantitative primary studies and systematic reviews, reporting actual or perceived effects on service delivery following the introduction of models of integration or co-ordination, in healthcare or health and social care settings in developed countries were eligible for inclusion. Strength of evidence for each outcome reported was analysed and synthesised using a four point comparative rating system of stronger, weaker, inconsistent or limited evidence. RESULTS One hundred sixty seven studies were eligible for inclusion. Analysis indicated evidence of perceived improved quality of care, evidence of increased patient satisfaction, and evidence of improved access to care. Evidence was rated as either inconsistent or limited regarding all other outcomes reported, including system-wide impacts on primary care, secondary care, and health care costs. There were limited differences between outcomes reported by UK and international studies, and overall the literature had a limited consideration of effects on service users. CONCLUSIONS Models of integrated care may enhance patient satisfaction, increase perceived quality of care, and enable access to services, although the evidence for other outcomes including service costs remains unclear. Indications of improved access may have important implications for services struggling to cope with increasing demand. TRIAL REGISTRATION Prospero registration number: 42016037725 .
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Affiliation(s)
- Susan Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Maxine Johnson
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Duncan Chambers
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Anthea Sutton
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Elizabeth Goyder
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
| | - Andrew Booth
- School of Health and Related Research, University of Sheffield, Regent Court, Regent Street, Sheffield, S14DA UK
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Battersby M, Lawn S, Kowanko I, Bertossa S, Trowbridge C, Liddicoat R. Chronic condition self-management support for Aboriginal people: Adapting tools and training. Aust J Rural Health 2018; 26:232-237. [PMID: 29682843 DOI: 10.1111/ajr.12413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2017] [Indexed: 11/28/2022] Open
Abstract
PROBLEM Chronic conditions are major health problems for Australian Aboriginal people. Self-management programs can improve health outcomes. However, few health workers are skilled in self-management support and existing programs are not always appropriate in Australian Aboriginal contexts. DESIGN The goal was to increase the capacity of the Australian health workforce to support Australian Aboriginal people to self-manage their chronic conditions by adapting the Flinders Program of chronic condition self-management support for Australian Aboriginal clients and develop and deliver training for health professionals to implement the program. STRATEGIES FOR CHANGE Feedback from health professionals highlighted that the Flinders Program assessment and care planning tools needed to be adapted to suit Australian Aboriginal contexts. Through consultation with Australian Aboriginal Elders and other experts, the tools were condensed into an illustrated booklet called 'My Health Story'. Associated training courses and resources focusing on cultural safety and effective engagement were developed. EFFECTS OF CHANGE A total of 825 health professionals across Australia was trained and 61 people qualified as accredited trainers in the program, ensuring sustainability. LESSONS LEARNT The capacity and skills of the Australian health workforce to engage with and support Australian Aboriginal people to self-manage their chronic health problems significantly increased as a result of this project. The adapted tools and training were popular and appreciated by the health care organisations, health professionals and clients involved. The adapted tools have widespread appeal for cultures that do not have Western models of health care and where there are health literacy challenges. My Health Story has already been used internationally.
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Affiliation(s)
- Malcolm Battersby
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
- Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Sharon Lawn
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Inge Kowanko
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Sue Bertossa
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Coral Trowbridge
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
| | - Raylene Liddicoat
- Flinders Human Behaviour and Health Research Unit, Flinders University, Adelaide, South Australia, Australia
- Maryborough District Health Service, Maryborough, Victoria, Australia
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Fu Y, Yu G, McNichol E, Marczewski K, Closs S. The association between patient-professional partnerships and self-management of chronic back pain: A mixed methods study. Eur J Pain 2018; 22:1229-1244. [DOI: 10.1002/ejp.1210] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/25/2018] [Indexed: 11/10/2022]
Affiliation(s)
- Y. Fu
- School of Healthcare; University of Leeds; UK
| | - G. Yu
- Epidemiology and Cancer Statistics Group; Department of Health Sciences; University of York; UK
| | - E. McNichol
- School of Healthcare; University of Leeds; UK
| | | | - S.J. Closs
- School of Healthcare; University of Leeds; UK
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Convery E, Meyer C, Keidser G, Hickson L. Assessing hearing loss self-management in older adults. Int J Audiol 2017; 57:313-320. [DOI: 10.1080/14992027.2017.1390268] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Elizabeth Convery
- National Acoustic Laboratories, Sydney, Australia,
- HEARing Cooperative Research Centre, Melbourne, Australia, and
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Carly Meyer
- HEARing Cooperative Research Centre, Melbourne, Australia, and
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Gitte Keidser
- National Acoustic Laboratories, Sydney, Australia,
- HEARing Cooperative Research Centre, Melbourne, Australia, and
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
| | - Louise Hickson
- HEARing Cooperative Research Centre, Melbourne, Australia, and
- School of Health and Rehabilitation Sciences, University of Queensland, St. Lucia, Australia
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Evaluation of a Regional Australian Nurse-Led Parkinson's Service Using the Context, Input, Process, and Product Evaluation Model. CLIN NURSE SPEC 2017; 30:264-70. [PMID: 27509562 DOI: 10.1097/nur.0000000000000232] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE A nurse-led Parkinson's service was introduced at Canberra Hospital and Health Services in 2012 with the primary objective of improving the care and self-management of people with a diagnosis of Parkinson's disease (PD) and related movement disorders. Other objectives of the Service included improving the quality of life of patients with PD and reducing their caregiver burden, improving the knowledge and understanding of PD among healthcare professionals, and reducing unnecessary hospital admissions. This article evaluates the first 2 years of this Service. METHODS The Context, Input, Process, and Product Evaluation Model was used to evaluate the Parkinson's and Movement Disorder Service. CONTEXT The context evaluation was conducted through discussions with stakeholders, review of PD guidelines and care pathways, and assessment of service gaps. Input: The input evaluation was carried out by reviewing the resources and strategies used in the development of the Service. PROCESS The process evaluation was undertaken by reviewing the areas of the implementation that went well and identifying issues and ongoing gaps in service provision. Product: Finally, product evaluation was undertaken by conducting stakeholder interviews and surveying patients in order to assess their knowledge and perception of value, and the patient experience of the Service. Admission data before and after implementation of the Parkinson's and Movement Disorder Service were also compared for any notable trends. RESULTS CONTEXT Several gaps in service provision for patients with PD in the Australian Capital Territory were identified, prompting the development of a PD Service to address some of them. Input: Funding for a Parkinson's disease nurse specialist was made available, and existing resources were used to develop clinics, education sessions, and outreach services. PROCESS Clinics and education sessions were implemented successfully, with positive feedback from patients and healthcare professionals. However, outreach services were limited because of capacity constraints on the Parkinson's disease nurse specialist. Product: The Service has filled an important health need in the local context; 98.3% of patients surveyed reported that the Service met their needs and helped them understand their care plan, achieving the primary objective of improving patient self-management. Interviews with stakeholders provided positive feedback about the value and usefulness of the Service, and healthcare professionals reported improvement in their knowledge about PD management. The evaluation also identified ongoing gaps in service provision and highlighted areas for potential improvement. No discernible trends in admission rates before and after the implementation of the Service were identified. CONCLUSION The introduction of a nurse-led PD service has had a positive impact on the provision of care for patients with PD and is a valued service. The evaluation highlighted some ongoing gaps in service provision and has generated some recommendations to address these.
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Construct Validity of the Dutch Version of the 12-Item Partners in Health Scale: Measuring Patient Self-Management Behaviour and Knowledge in Patients with Chronic Obstructive Pulmonary Disease. PLoS One 2016; 11:e0161595. [PMID: 27564410 PMCID: PMC5001637 DOI: 10.1371/journal.pone.0161595] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Accepted: 08/08/2016] [Indexed: 01/23/2023] Open
Abstract
Objective The 12-item Partners in Health scale (PIH) was developed in Australia to measure self-management behaviour and knowledge in patients with chronic diseases, and has undergone several changes. Our aim was to assess the construct validity and reliability of the latest PIH version in Dutch COPD patients. Methods The 12 items of the PIH, scored on a self-rated 9-point Likert scale, are used to calculate total and subscale scores (knowledge; coping; recognition and management of symptoms; and adherence to treatment). We used forward-backward translation of the latest version of the Australian PIH to define a Dutch PIH (PIH(Du)). Mokken Scale Analysis and common Factor Analysis were performed on data from a Dutch COPD sample to investigate the psychometric properties of the Dutch PIH; and to determine whether the four-subscale solution previously found for the original Australian PIH could be replicated for the Dutch PIH. Results Two subscales were found for the Dutch PIH data (n = 118); 1) knowledge and coping; 2) recognition and management of symptoms, adherence to treatment. The correlation between the two Dutch subscales was 0.43. The lower-bound of the reliability of the total scale equalled 0.84. Factor analysis indicated that the first two factors explained a larger percentage of common variance (39.4% and 19.9%) than could be expected when using random data (17.5% and 15.1%). Conclusion We recommend using two PIH subscale scores when assessing self-management in Dutch COPD patients. Our results did not support the four-subscale structure as previously reported for the original Australian PIH.
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Jowsey T, Dennis S, Yen L, Mofizul Islam M, Parkinson A, Dawda P. Time to manage: patient strategies for coping with an absence of care coordination and continuity. SOCIOLOGY OF HEALTH & ILLNESS 2016; 38:854-873. [PMID: 26871716 DOI: 10.1111/1467-9566.12404] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
This paper examines how people with chronic illnesses respond to absences of continuity and coordination of care. Little work has been done on how the ill person might mitigate flaws in a less than optimal system. Our qualitative research, carried out among 91 participants in Australia, reveals that people with chronic illnesses create strategies to facilitate the management of their care. These strategies included efforts to improve communication between themselves and their health care practitioners; keeping personal up-to-date medication lists; and generating their own specific management plans. While we do not submit that it is patients' responsibility to attend to gaps in the health system, our data suggests that chronically ill people can, in and through such strategies, exert a measure of agency over their own care; making it effectively more continuous and coordinated. Participants crafted strategies according to the particular social and bodily rhythms that their ongoing illnesses had lent to their lives. Our analysis advances the view that the ill body itself is capable of enfolding the health system into the rhythms of illness - rather than the ill body always fitting into the overarching structural tempo. This entails an agent-centric view of time in illness experience. A Virtual Abstract of this paper can be found at: https://youtu.be/UwbxlEJOTx8.
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Affiliation(s)
- Tanisha Jowsey
- Centre for Medical and Health Sciences Education, The University of Auckland, New Zealand
- Australian Primary Health Care Research Institute, Australian National University, Australia
| | - Simone Dennis
- School of Archaeology and Anthropology, The Australian National University
| | - Laurann Yen
- Australian Primary Health Care Research Institute, Australian National University, Australia
| | - M Mofizul Islam
- Australian Primary Health Care Research Institute, Australian National University, Australia
| | - Anne Parkinson
- Australian Primary Health Care Research Institute, Australian National University, Australia
| | - Paresh Dawda
- Australian Primary Health Care Research Institute, Australian National University, Australia
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Chiu TML, Tam KTW, Siu CF, Chau PWP, Battersby M. Validation study of a Chinese version of Partners in Health in Hong Kong (C-PIH HK). Qual Life Res 2016; 26:199-203. [PMID: 27216940 DOI: 10.1007/s11136-016-1315-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/10/2016] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Partners in Health (PIH) scale is a measure designed to assess the generic knowledge, attitudes, behaviors, and impacts of self-management. A cross-cultural adaptation of the PIH for use in Hong Kong was evaluated in this study. This paper reports the validity and reliability of the Chinese version of PIH (C-PIH[HK]). METHOD A 12-item PIH was translated using forward-backward translation technique and reviewed by individuals with chronic diseases and health professionals. A total of 209 individuals with chronic diseases completed the scale. The construct validity, internal consistency, and test-retest reliability were evaluated in two waves. RESULTS The findings in Wave 1 (n = 73) provided acceptable psychometric properties of the C-PIH(HK) but supported the adaptation of question 5 to improve the cultural relevance, validity, and reliability of the scale. An adapted version of C-PIH(HK) was evaluated in Wave 2. The findings in Wave 2 (n = 136) demonstrated good construct validity and internal consistency of C-PIH(HK). A principal component analysis with Oblimin rotation yielded a 3-factor solution, and the Cronbach's alphas of the subscales ranged from 0.773 to 0.845. Participants were asked whether they perceived the self-management workshops they attended and education provided by health professionals as useful or not. The results showed that the C-PIH(HK) was able to discriminate those who agreed and those who disagreed related to the usefulness of individual health education (p < 0.0001 in all subscales) and workshops (p < 0.001 in the knowledge subscale) as hypothesized. The test-retest reliability was high (ICC = 0.818). CONCLUSION A culturally adapted version of PIH for use in Hong Kong was evaluated. The study supported good construct validity, discriminate validity, internal consistency, and test-retest reliability of the C-PIH(HK).
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Affiliation(s)
| | | | - Choi Fong Siu
- Hong Kong Society for Rehabilitation, Hong Kong, China
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Lê G, Morgan R, Bestall J, Featherstone I, Veale T, Ensor T. Can service integration work for universal health coverage? Evidence from around the globe. Health Policy 2016; 120:406-19. [DOI: 10.1016/j.healthpol.2016.02.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Revised: 01/12/2016] [Accepted: 02/16/2016] [Indexed: 11/15/2022]
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Harvey P. Effectiveness and efficiency in the treatment of gambling disorder: reflections on the Dodo Bird Conjecture. J Health Serv Res Policy 2016; 21:178-82. [PMID: 26791758 DOI: 10.1177/1355819615625430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
In the field of research into the treatment of problem gambling, researchers have been attempting to identify the treatment pathways that are effective in remediating gambling disorder among people seeking help. In spite of these efforts, research results remain equivocal in relation to which components of the various treatment options are effective, echoing the familiar claim that all psychotherapy treatments are effective, the Dodo Bird Conjecture.This recent tendency towards the revival of the Dodo Bird Conjecture in the field of gambling research is due to factors ranging from a continuing lack of clarity about the effective components of treatments, subjective therapist effects and the lack of validated repeated measures of outcome to assess changes in self-reported data on gambling urge: anxiety, depression and changes in the 'gambling disorder' diagnosis over time.
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Affiliation(s)
- Peter Harvey
- Director, Greater Green Triangle University Department of Rural Health, Flinders University, Australia Department of Psychiatry, Flinders University, Adelaide, Australia
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Lawn S, Zrim S, Leggett S, Miller M, Woodman R, Jones L, Kichenadasse G, Sukumaran S, Karapetis C, Koczwara B. Is self-management feasible and acceptable for addressing nutrition and physical activity needs of cancer survivors? Health Expect 2015; 18:3358-73. [PMID: 25545411 PMCID: PMC5810724 DOI: 10.1111/hex.12327] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Self-management is recommended for patients with chronic conditions, but its use with cancer survivors is underexplored. Optimal strategies for achieving lifestyle changes in cancer survivors are not known. OBJECTIVE We aimed to determine feasibility, acceptability and preliminary efficacy of self-management-based nutrition and physical activity interventions for cancer survivors. DESIGN, SETTING AND PARTICIPANTS Adult survivors (n = 25) during (Group 1 , n = 11) or post (Group 2, n = 14)-curative chemotherapy for solid tumours, most (n = 20, 80%) with breast cancer, were recruited prospectively from a single clinical centre. INTERVENTION The Flinders Living Well Self-Management Program, a generic self-management care planning programme, was utilized to establish patient-led nutrition and exercise goals within a tailored 12-week intervention. Fortnightly progress reviews occurred with assessments at baseline, 6 and 12 weeks. RESULTS Most participants (84%) found the intervention acceptable/very acceptable. Both groups showed a trend towards significant improvement in the self-management capability 'knowledge about changing risk factors' (P = 0.047); Group 2 showed a trend towards significantly improved 'psychological impacts' (P = 0.007). Goal ratings improved for both groups (P = 0.001). Quality of life improved for both groups for emotional functioning (P = 0.03). Physical functioning improved for Group 2 (P = 0.05); however, most symptom domains worsened for Group 1, as expected given their treatment stage. DISCUSSION AND CONCLUSIONS Self-management interventions are feasible for this population. In particular, building self-management capacity during the active phase of patients' cancer treatment provides health and psychosocial benefits. Larger randomized controlled trials are required to further determine efficacy. Further translational research is also needed to determine acceptability,feasibility, enablers and barriers for clinicians embedding this approach into routine cancer survivorship care.
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Affiliation(s)
- Sharon Lawn
- Flinders Human Behaviour & Health Research UnitMargaret Tobin Centre (Room 4T306)Flinders UniversityAdelaideSAAustralia
| | - Stephanie Zrim
- Medical OncologyFlinders UniversityAdelaideSAAustralia
- Present address:
Australian Research Centre for Health of Women and Babies (ARCH)The University of AdelaideWomen's & Children's HospitalLevel 1Queen Victoria Building72 King William StreetNorth Adelaide5006SAAustralia
| | - Stephanie Leggett
- Department of Nutrition and DieteticsFlinders UniversityAdelaideSAAustralia
| | - Michelle Miller
- Department of Nutrition and DieteticsFlinders UniversityAdelaideSAAustralia
| | - Richard Woodman
- Flinders Centre of Epidemiology and BiostatisticsFlinders UniversityAdelaideSAAustralia
| | - Lynnette Jones
- School of Physical EducationUniversity of OtagoDunedinNew Zealand
| | | | | | | | - Bogda Koczwara
- Medical OncologyFlinders UniversityAdelaideSAAustralia
- Flinders Centre for Innovation in CancerFlinders Medical Centre/Flinders UniversityAdelaideSAAustralia
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Zimbudzi E, Lo C, Misso M, Ranasinha S, Zoungas S. Effectiveness of management models for facilitating self-management and patient outcomes in adults with diabetes and chronic kidney disease. Syst Rev 2015; 4:81. [PMID: 26059649 PMCID: PMC4489399 DOI: 10.1186/s13643-015-0072-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/02/2015] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Self-management models can be a very powerful resource in the health system provided they are well tailored to a particular disease and setting. Patient outcomes have been demonstrated to improve when self-management practices are embedded in the care of people with certain diseases. However, it remains unclear whether self-management models and specific components of these programmes can be implemented in order to effectively improve the care of people with diabetes and/or chronic kidney disease. METHODS/DESIGN Medline (including Medline in-process), Excerpta medica database (EMBASE), Cumulative Index to Nursing and Allied Health (CINAHL) and all evidence-based medicine (EBM) will be systematically searched for randomised controlled studies comparing self-management models with usual care in patients with diabetes or chronic kidney disease. Two reviewers will independently assess articles for eligibility: extract data, evaluate risk of bias and complete quality assessment of included studies. The data will be tabulated and narratively synthesised. Meta-analyses will be performed if there is sufficient homogenous data. DISCUSSION This protocol utilises rigorous methodology as well as pre-specified eligibility criteria to comprehensively search for diabetes and kidney disease self-management models which have been compared with usual care in randomised controlled trials. The review is likely to provide insight into the effectiveness of current models for improving patient self-management, and this may address the key translational issue of how to integrate and tailor these self-management practices for patients with diabetes and chronic kidney disease. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015017316.
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Affiliation(s)
- Edward Zimbudzi
- Department of Nephrology, Monash Health, Clayton, Melbourne, VIC, Australia. .,Monash Centre for Health Research and Implementation-MCHRI, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, VIC, Australia.
| | - Clement Lo
- Monash Centre for Health Research and Implementation-MCHRI, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, VIC, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Melbourne, VIC, Australia
| | - Marie Misso
- Monash Centre for Health Research and Implementation-MCHRI, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, VIC, Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation-MCHRI, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, VIC, Australia
| | - Sophia Zoungas
- Monash Centre for Health Research and Implementation-MCHRI, School of Public Health and Preventive Medicine, Monash University, Clayton, Melbourne, VIC, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Melbourne, VIC, Australia.,The George Institute for Global Health, University of Sydney, Sydney, NSW, Australia
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Does it matter who organises your health care? Int J Integr Care 2015; 15:e022. [PMID: 26150760 PMCID: PMC4491326 DOI: 10.5334/ijic.1598] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 04/14/2015] [Accepted: 04/14/2015] [Indexed: 11/30/2022] Open
Abstract
Background As the prevalence of long-term and multimorbid conditions is increasing, patients increasingly require consultations with multiple health care professionals and coordination of their care needs. Methods This study is based on a 2011 survey of older Australians which draws on sub-populations of people with diabetes aged 50 years or over, people with chronic obstructive pulmonary disease, and members of Nationals Seniors Australia. We develop a composite coordination measure and examine differences in the measure with different care coordination indicators using both descriptive and regression methods. Three categories of respondent-perceived care organisers are used: health care professionals; “no one”; and patients, their partner, relative or friend. Results Of the 2,540 survey respondents (an overall response rate of 24%), 1,865 provided information on who organised their health care, and composite coordination measures were calculated for 1,614. Multivariate analysis showed the composite score was highest where a health care professional coordinated care, followed by care organised by self or a carer, and then the group reporting no organiser. Conclusion In moving towards care coordination there are opportunities to improve the care coordination process itself, and the key enablers to improving care coordination appear to be the availability and communication of clinical information and the role of the clinical team.
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Coulter A, Entwistle VA, Eccles A, Ryan S, Shepperd S, Perera R. Personalised care planning for adults with chronic or long-term health conditions. Cochrane Database Syst Rev 2015; 2015:CD010523. [PMID: 25733495 PMCID: PMC6486144 DOI: 10.1002/14651858.cd010523.pub2] [Citation(s) in RCA: 275] [Impact Index Per Article: 30.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Personalised care planning is a collaborative process used in chronic condition management in which patients and clinicians identify and discuss problems caused by or related to the patient's condition, and develop a plan for tackling these. In essence it is a conversation, or series of conversations, in which they jointly agree goals and actions for managing the patient's condition. OBJECTIVES To assess the effects of personalised care planning for adults with long-term health conditions compared to usual care (i.e. forms of care in which active involvement of patients in treatment and management decisions is not explicitly attempted or achieved). SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, PsycINFO, ProQuest, clinicaltrials.gov and WHO International Clinical Trials Registry Platform to July 2013. SELECTION CRITERIA We included randomised controlled trials and cluster-randomised trials involving adults with long-term conditions where the intervention included collaborative (between individual patients and clinicians) goal setting and action planning. We excluded studies where there was little or no opportunity for the patient to have meaningful influence on goal selection, choice of treatment or support package, or both. DATA COLLECTION AND ANALYSIS Two of three review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. The primary outcomes were effects on physical health, psychological health, subjective health status, and capabilities for self management. Secondary outcomes included effects on health-related behaviours, resource use and costs, and type of intervention. A patient advisory group of people with experience of living with long-term conditions advised on various aspects of the review, including the protocol, selection of outcome measures and emerging findings. MAIN RESULTS We included 19 studies involving a total of 10,856 participants. Twelve of these studies focused on diabetes, three on mental health, one on heart failure, one on end-stage renal disease, one on asthma, and one on various chronic conditions. All 19 studies included components that were intended to support behaviour change among patients, involving either face-to-face or telephone support. All but three of the personalised care planning interventions took place in primary care or community settings; the remaining three were located in hospital clinics. There was some concern about risk of bias for each of the included studies in respect of one or more criteria, usually due to inadequate or unclear descriptions of research methods. Physical healthNine studies measured glycated haemoglobin (HbA1c), giving a combined mean difference (MD) between intervention and control of -0.24% (95% confidence interval (CI) -0.35 to -0.14), a small positive effect in favour of personalised care planning compared to usual care (moderate quality evidence).Six studies measured systolic blood pressure, a combined mean difference of -2.64 mm/Hg (95% CI -4.47 to -0.82) favouring personalised care (moderate quality evidence). The pooled results from four studies showed no significant effect on diastolic blood pressure, MD -0.71 mm/Hg (95% CI -2.26 to 0.84).We found no evidence of an effect on cholesterol (LDL-C), standardised mean difference (SMD) 0.01 (95% CI -0.09 to 0.11) (five studies) or body mass index, MD -0.11 (95% CI -0.35 to 0.13) (four studies).A single study of people with asthma reported that personalised care planning led to improvements in lung function and asthma control. Psychological healthSix studies measured depression. We were able to pool results from five of these, giving an SMD of -0.36 (95% CI -0.52 to -0.20), a small effect in favour of personalised care (moderate quality evidence). The remaining study found greater improvement in the control group than the intervention group.Four other studies used a variety of psychological measures that were conceptually different so could not be pooled. Of these, three found greater improvement for the personalised care group than the usual care group and one was too small to detect differences in outcomes. Subjective health statusTen studies used various patient-reported measures of health status (or health-related quality of life), including both generic health status measures and condition-specific ones. We were able to pool data from three studies that used the SF-36 or SF-12, but found no effect on the physical component summary score SMD 0.16 (95% CI -0.05 to 0.38) or the mental component summary score SMD 0.07 (95% CI -0.15 to 0.28) (moderate quality evidence). Of the three other studies that measured generic health status, two found improvements related to personalised care and one did not.Four studies measured condition-specific health status. The combined results showed no difference between the intervention and control groups, SMD -0.01 (95% CI -0.11 to 0.10) (moderate quality evidence). Self-management capabilitiesNine studies looked at the effect of personalised care on self-management capabilities using a variety of outcome measures, but they focused primarily on self efficacy. We were able to pool results from five studies that measured self efficacy, giving a small positive result in favour of personalised care planning: SMD 0.25 (95% CI 0.07 to 0.43) (moderate quality evidence).A further five studies measured other attributes that contribute to self-management capabilities. The results from these were mixed: two studies found evidence of an effect on patient activation, one found an effect on empowerment, and one found improvements in perceived interpersonal support. Other outcomesPooled data from five studies on exercise levels showed no effect due to personalised care planning, but there was a positive effect on people's self-reported ability to carry out self-care activities: SMD 0.35 (95% CI 0.17 to 0.52).We found no evidence of adverse effects due to personalised care planning.The effects of personalised care planning were greater when more stages of the care planning cycle were completed, when contacts between patients and health professionals were more frequent, and when the patient's usual clinician was involved in the process. AUTHORS' CONCLUSIONS Personalised care planning leads to improvements in certain indicators of physical and psychological health status, and people's capability to self-manage their condition when compared to usual care. The effects are not large, but they appear greater when the intervention is more comprehensive, more intensive, and better integrated into routine care.
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Affiliation(s)
- Angela Coulter
- University of OxfordHealth Services Research Unit, Nuffield Department of Population HealthOld Road Campus, HeadingtonOxfordUKOX3 7LF
| | - Vikki A Entwistle
- University of AberdeenHealth Services Research UnitHealth Services Building Level 3ForesterhillAberdeenUKAB25 2ZD
| | - Abi Eccles
- University of OxfordDepartment of Primary Care Health Sciences23‐28 Hythe Bridge StreetOxfordUKOX1 2ET
| | - Sara Ryan
- University of OxfordQuality and Outcomes Research Unit and Health Experiences Research Group23‐28 Hythe Bridge StreetOxfordUKOX1 2ET
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordUKOX3 7LF
| | - Rafael Perera
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory QuarterWoodstock RoadOxfordUKOX2 6GG
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Gage H, Grainger L, Ting S, Williams P, Chorley C, Carey G, Borg N, Bryan K, Castleton B, Trend P, Kaye J, Jordan J, Wade D. Specialist rehabilitation for people with Parkinson’s disease in the community: a randomised controlled trial. HEALTH SERVICES AND DELIVERY RESEARCH 2014. [DOI: 10.3310/hsdr02510] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundMultidisciplinary rehabilitation is recommended for Parkinson’s disease, but evidence suggests that benefit is not sustained.Objectives(1) Implement a specialist domiciliary rehabilitation service for people with Parkinson’s and carers. (2) Provide continuing support from trained care assistants to half receiving the rehabilitation. (3) Evaluate the clinical effectiveness of the service, and the value added by the care assistants, compared with usual care. (4) Assess the costs of the interventions. (5) Investigate the acceptability of the service. (6) Deliver guidance for commissioners.DesignPragmatic three-parallel group randomised controlled trial.SettingCommunity, county of Surrey, England, 2010–11.ParticipantsPeople with Parkinson’s, at all stages of the disease, and live-in carers.InterventionsGroups A and B received specialist rehabilitation from a multidisciplinary team (MDT) – comprising Parkinson’s nurse specialists, physiotherapists, occupational therapists, and speech and language therapists – delivered at home, tailored to individual needs, over 6 weeks (about 9 hours’ individual therapy per patient). In addition to the MDT, participants in group B received ongoing support for a further 4 months from a care assistant trained in Parkinson’s (PCA), embedded in the MDT (1 hour per week per patient). Participants in control group (C) received care as usual (no co-ordinated MDT or ongoing support).Main outcome measuresFollow-up assessments were conducted in participants’ homes at 6, 24 and 36 weeks after baseline. Primary outcomes: Self-Assessment Parkinson’s Disease Disability Scale (patients); the Modified Caregiver Strain Index (carers). Secondary outcomes included: for patients, disease-specific and generic health-related quality of life, psychological well-being, self-efficacy, mobility, falls and speech; for carers, strain, stress, health-related quality of life, psychological well-being and functioning.ResultsA total of 306 people with Parkinson’s (and 182 live-in carers) were randomised [group A,n = 102 (n = 61); group B,n = 101 (n = 60); group C,n = 103 (n = 61)], of whom 269 (155) were analysed at baseline, pilot cohort excluded. Attrition occurred at all stages. A per-protocol analysis [people with Parkinson’s,n = 227 (live-in carers,n = 125)] [group A,n = 75 (n = 45); group B,n = 69 (n = 37); group C,n = 83 (n = 43)] showed that, at the end of the MDT intervention, people with Parkinson’s in groups A and B, compared with group C, had reduced anxiety (p = 0.02); their carers had improved psychological well-being (p = 0.02). People with Parkinson’s in groups A and B also had marginally reduced disability (primary outcome,p = 0.09), and improved non-motor symptoms (p = 0.06) and health-related quality of life (p = 0.07), compared with C. There were significant differences in change scores between week 6 (end of MDT) and week 24 (end of PCA for group B) in favour of group B, owing to worsening in group A (no PCA support) in posture (p = 0.001); non-motor symptoms (p = 0.05); health-related quality of life (p = 0.07); and self-efficacy (p = 0.09). Carers in group B (vs. group A) reported a tendency for reduced strain (p = 0.06). At 36 weeks post recruitment, 3 months after the end of PCA support for group B, there were few differences between the groups. Participants reported learning about Parkinson’s, and valued individual attention. The MDT cost £833; PCA support was £600 extra, per patient (2011 Great British pounds).ConclusionsFurther research is needed into ways of sustaining benefits from rehabilitation including the use of care assistants.Study registrationCurrent Controlled Trials: ISRCTN44577970.FundingThis project was funded by the National Institute for Health Research Health Services and Delivery Research programme and the South East Coast Dementias and Neurodegenerative Disease Research Network (DeNDRoN), and the NHS South East Coast. The report will be published in full inHealth Services and Delivery Research; Vol. 2, No. 51. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Heather Gage
- School of Economics, University of Surrey, Guildford, UK
| | - Linda Grainger
- School of Economics, University of Surrey, Guildford, UK
| | - Sharlene Ting
- School of Economics, University of Surrey, Guildford, UK
| | - Peter Williams
- Department of Mathematics, University of Surrey, Guildford, UK
| | | | - Gillian Carey
- School of Economics, University of Surrey, Guildford, UK
| | - Neville Borg
- School of Economics, University of Surrey, Guildford, UK
| | - Karen Bryan
- Division of Health and Social Care, University of Surrey, Guildford, UK
| | | | - Patrick Trend
- Department of Neurology, Royal Surrey County Hospital, Guildford, UK
| | - Julie Kaye
- Division of Health and Social Care, University of Surrey, Guildford, UK
| | - Jake Jordan
- School of Economics, University of Surrey, Guildford, UK
| | - Derick Wade
- Oxford Centre for Enablement, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
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van der Klauw D, Molema H, Grooten L, Vrijhoef H. Identification of mechanisms enabling integrated care for patients with chronic diseases: a literature review. Int J Integr Care 2014; 14:e024. [PMID: 25114665 PMCID: PMC4109400 DOI: 10.5334/ijic.1127] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Revised: 03/31/2014] [Accepted: 05/08/2014] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Notwithstanding care for chronically ill patients requires a shift towards care that is well coordinated and focused on prevention and self-care, the concept of integrated care lacks specificity and clarity. This article presents a literature review to identify mechanisms for achieving integrated care objectives. THEORY AND METHODS Existing models often present a large variety of dimensions, archetypes and categories of integration without specifying them. Models and programmes describing integrated care for chronic diseases were reviewed. Data were extracted related to objectives and clusters of mechanisms of integration. RESULTS Thirty-four studies presented four objectives: functional, organisational, professional and service integration. We categorised approaches and interventions to achieve these objectives by strategy and clusters of 'mechanisms of integration': degree, patient centredness and normative aspects. CONCLUSIONS AND DISCUSSION The clarification of mechanisms to achieve objectives of integrated care as presented may be used as starting point for the development and refinement of integrated care programmes, including methodological grounding of their evaluation. Given that most studies reviewed lack both empirical data and descriptions of the methods used, future research needs to close these gaps. Validation of the findings by a large panel of experts is suggested as recommendation to work towards a grounded framework.
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Affiliation(s)
| | | | | | - Hubertus Vrijhoef
- MD3, National University of Singapore, 16 Medical Drive, 117597 Singapore
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Harvey P. The provision of integrated care for people with gambling disorders and co-occurring mental health conditions. Aust N Z J Public Health 2014; 37:588. [PMID: 24892160 DOI: 10.1111/1753-6405.12125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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Phillips RL, Short A, Dugdale P, Nugus P, Greenfield D. Supporting patients to self-manage chronic disease: clinicians’ perspectives and current practices. Aust J Prim Health 2014; 20:257-65. [DOI: 10.1071/py13002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 04/23/2013] [Indexed: 11/23/2022]
Abstract
This study investigated: clinicians’ perspectives of the scope of self-management, which self-management support initiatives are used, and the factors clinicians consider when deciding which initiative to use with individual patients. Three phases of data collection were used. First, clinicians were interviewed about their attitudes toward self-management (n = 14). Second, clinicians and managers completed a survey about the support initiatives they use (n = 38). Third, in interviews clinicians described the applications of initiatives (n = 6). Data were descriptively and thematically analysed. Clinicians believed that supporting self-management involved a holistic approach. However, some also thought that not all patients had the capacity to self-manage. This idea may be at odds with the underlying notion of self-management and impact on the support provided. Clinicians reported using 54 initiatives to support self-management and identified a range of situations when each initiative may or may not be suitable. This suggests that clinicians need to be familiar with a range of support initiatives as one will not suit everyone. Deciding which initiative is most appropriate may be aided by the development of guidelines.
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Parker V, McNeil K, Higgins I, Mitchell R, Paliadelis P, Giles M, Parmenter G. How health professionals conceive and construct interprofessional practice in rural settings: a qualitative study. BMC Health Serv Res 2013; 13:500. [PMID: 24289815 PMCID: PMC4220626 DOI: 10.1186/1472-6963-13-500] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2013] [Accepted: 11/25/2013] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Although interprofessional practice (IPP) offers the potential to enhance rural health services and provide support to rural clinicians, IPP may itself be problematic due to workforce limitations and service fragmentation. Differing socioeconomic and geographic characteristics of rural communities means that the way that IPP occurs in rural contexts will necessarily differ from that occurring in metropolitan contexts. The aim of this study was to investigate the factors contributing to effective IPP in rural contexts, to examine how IPP happens and to identify barriers and enablers. METHODS Using Realistic Evaluation as a framework, semi-structured interviews were conducted with health professionals in a range of rural healthcare contexts in NSW, Australia. Independent thematic analysis was undertaken by individual research team members, which was then integrated through consensus to achieve a qualitative description of rural IPP practice. RESULTS There was clear evidence of diversity and complexity associated with IPP in the rural settings that was supported by descriptions of collaborative integrated practice. There were instances where IPP doesn't and could happen. There were a number of characteristics identified that significantly impacted on IPP including the presence of a shared philosophical position and valuing of IPP and recognition of the benefits, funding to support IPP, pivotal roles, proximity and workforce resources. CONCLUSIONS The nature of IPP in rural contexts is diverse and determined by a number of critical factors. This study goes some of the way towards unravelling the complexity of IPP in rural contexts, highlighting the strong motivating factors that drive IPP. However, it has also identified significant structural and relational barriers related to workload, workforce, entrenched hierarchies and ways of working and service fragmentation. Further research is required to explicate the mechanisms that drive successful IPP across a range of diverse rural contexts in order to inform the implementation of robust flexible strategies that will support sustainable models of rural IPP.
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Affiliation(s)
- Vicki Parker
- School of Health, University of New England, Armidale, NSW, Australia
- Hunter New England Nursing and Midwifery Research Centre, Hunter New England Area Health District, Newcastle, NSW 2300, Australia
- School of Nursing, University of Newcastle, Newcastle, NSW, Australia
| | - Karen McNeil
- Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | - Isabel Higgins
- School of Nursing, University of Newcastle, Newcastle, NSW, Australia
| | - Rebecca Mitchell
- Newcastle Business School, University of Newcastle, Newcastle, NSW, Australia
| | | | - Michelle Giles
- Hunter New England Nursing and Midwifery Research Centre, Hunter New England Area Health District, Newcastle, NSW 2300, Australia
| | - Glenda Parmenter
- School of Health, University of New England, Armidale, NSW, Australia
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Heatley EM, Harris M, Battersby M, McEvoy RD, Chai-Coetzer CL, Antic NA. Obstructive sleep apnoea in adults: A common chronic condition in need of a comprehensive chronic condition management approach. Sleep Med Rev 2013; 17:349-55. [DOI: 10.1016/j.smrv.2012.09.004] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 09/20/2012] [Accepted: 09/21/2012] [Indexed: 12/21/2022]
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Rotter T, Kinsman L, Machotta A, Zhao FL, van der Weijden T, Ronellenfitsch U, Scott SD. Clinical pathways for primary care: effects on professional practice, patient outcomes, and costs. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2013. [DOI: 10.1002/14651858.cd010706] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Thomas Rotter
- University of Saskatchewan; College of Pharmacy and Nutrition; 110 Science Place Saskatoon Saskatchewan Canada S7N 5C9
| | - Leigh Kinsman
- Monash University; School of Rural Health; Rowan Street Bendigo VIC 3550 Australia
| | - Andreas Machotta
- Erasmus MC - Sophia Children's Hospital; Department of Anesthesiology; PO Box 2060 Rotterdam Netherlands 3000 CB
| | - Fei-Li Zhao
- University of Newcastle; School of Medicine and Public Health; Newcastle Australia 2308
| | - Trudy van der Weijden
- School for Public Health and Primary Care; Department of General Practice; Maastricht University Maastricht Netherlands 6200 MD
| | - Ulrich Ronellenfitsch
- University Medical Centre Mannheim, University of Heidelberg; Department of Surgery; Theodor-Kutzer-Ufer 1-3 Mannheim Germany 68167 Mannheim
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McMillan SS, Kendall E, Sav A, King MA, Whitty JA, Kelly F, Wheeler AJ. Patient-centered approaches to health care: a systematic review of randomized controlled trials. Med Care Res Rev 2013; 70:567-96. [PMID: 23894060 DOI: 10.1177/1077558713496318] [Citation(s) in RCA: 209] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
There is growing interest in patient-centered care, but there is little guidance about the interventions required for its delivery and whether it leads to better health outcomes. This systematic review evaluates the efficacy of patient-centered care interventions for people with chronic conditions. Thirty randomized controlled trials were identified from health-related databases. The findings indicated that most interventions were based on the notion of empowering care and included attempts to educate consumers or prompt them about how to manage a health consultation. Other common interventions focused on training providers in delivering empowering care. Although it was difficult to draw firm conclusions because of the moderate to high risk of bias of the research designs, this review has shown some promising findings from implementing a patient-centered care approach. There appeared to be benefits associated with this model of care in terms of patient satisfaction and perceived quality of care.
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Wigg AJ, McCormick R, Wundke R, Woodman RJ. Efficacy of a chronic disease management model for patients with chronic liver failure. Clin Gastroenterol Hepatol 2013; 11:850-8.e1-4. [PMID: 23375997 DOI: 10.1016/j.cgh.2013.01.014] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 01/04/2013] [Accepted: 01/11/2013] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Despite the economic impacts of chronic liver failure (CLF) and the success of chronic disease management (CDM) programs in routine clinical practice, there have been no randomized controlled trials of CDM for CLF. We investigated the efficacy of CDM programs for CLF patients in a prospective, controlled trial. METHODS Sixty consecutive patients with cirrhosis and complications from CLF were assigned randomly to groups given intervention (n = 40) or usual care (n = 20), from 2009 to 2010. The 12-month intervention comprised 4 CDM components: delivery system redesign, self-management support, decision support, and clinical information systems. The primary outcome was the number of days spent in a hospital bed for liver-related reasons. Secondary outcomes were rates of other hospital use measures, rate of attendance at planned outpatient care, disease severity, quality of life, and quality of care. RESULTS The intervention did not reduce the number of days patients spent in hospital beds for liver-related reasons, compared with usual care (17.8 vs 11.0 bed days/person/y, respectively; incidence rate ratio, 1.6; 95% confidence interval, 0.5-4.8; P = .39), or affect other measures of hospitalization. Patients given the intervention had a 30% higher rate of attendance at outpatient care (incidence rate ratio, 1.3; 95% confidence interval, 1.1-1.5; P = .004) and significant increases in quality of care, based on adherence to hepatoma screening, osteoporosis and vaccination guidelines, and referral to transplant centers (P < .05 for all). CONCLUSIONS In a pilot study to determine the efficacy of CDM for patients with CLF, patients receiving CDM had significant increases in attendance at outpatient centers and quality of care, compared with patients who did not receive CDM. However, CDM did not appear to reduce hospital admission rates or disease severity or improve patient quality of life. Larger trials with longer follow-up periods are required to confirm these findings and assess cost effectiveness.
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Affiliation(s)
- Alan J Wigg
- Hepatology and Liver Transplant Medicine Unit, Flinders Medical Centre, Adelaide, Australia.
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Battersby MW, Beattie J, Pols RG, Smith DP, Condon J, Blunden S. A randomised controlled trial of the Flinders Program™ of chronic condition management in Vietnam veterans with co-morbid alcohol misuse, and psychiatric and medical conditions. Aust N Z J Psychiatry 2013; 47:451-62. [PMID: 23307806 DOI: 10.1177/0004867412471977] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate the efficacy of the Flinders Program™ of chronic condition management on alcohol use, psychosocial well-being and quality of life in Vietnam veterans with alcohol misuse. METHOD This 9-month wait-list, randomised controlled trial used the Alcohol Use Disorders Identification Test (AUDIT) score ≥ 8 as the entry criterion. Intervention veterans received the Flinders Program plus usual care and controls received usual care. The primary outcome measure was AUDIT score at baseline, 3, 6 and 9 months. Secondary measures included quality of life, alcohol dependence (DSM-IV), anxiety and depression. All measures were repeated at variable trial end dates between 9 and 18 months in the intervention group. RESULTS Randomisation resulted in 46 intervention and 31 control participants. Intent-to-treat analyses showed AUDIT scores improved significantly from baseline to 9-month follow-up (p = 0.039) in the intervention group compared to control group. The control group had 1.46 times the risk of alcohol dependence than the intervention group at 9 months (p = 0.027). There were no significant differences between groups for secondary measures. Within-group analyses showed that both groups significantly improved in AUDIT (p < 0.001), anxiety and depression (p < 0.01), anger (p < 0.001), and post-traumatic stress (p < 0.01). Improvements in AUDIT (p < 0.001) and alcohol dependence were maintained in the intervention group to 18 months. CONCLUSIONS Use of the Flinders Program in addition to usual care resulted in reduced alcohol use, reduced alcohol dependence, and global clinical improvement in Vietnam veterans with risky alcohol behaviours and chronic mental health problems. The findings demonstrate that the Flinders Program provides a structured framework for delivering self-management support, case management and coordinated care for people with chronic conditions. This clinical approach has the potential to bridge the gap between physical and mental illness service delivery for people with long-term conditions in Australia.
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Affiliation(s)
- Malcolm W Battersby
- Department of Psychiatry, Flinders University, Adelaide, SA 5001, Australia.
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Masters S, Oliver-Baxter J, Barton C, Summers M, Howard S, Roeger L, Reed R. Programmes to support chronic disease self-management: should we be concerned about the impact on spouses? HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:315-326. [PMID: 23441887 DOI: 10.1111/hsc.12020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/08/2012] [Indexed: 06/01/2023]
Abstract
Chronic disease self-management support (CDSMS) programmes are widely advocated as an essential element of chronic disease care and have demonstrated increased engagement with self-care activities such as improving diet but may place additional strain on spouses. This study used an embedded mixed methods approach to explore the impact of CDSMS on spouses. Spouses were recruited as part of a larger randomised controlled trial to assess the efficacy of a health professional-led CDSMS programme (the Flinders Program) in older adults with multiple chronic conditions, compared with an attention control group. Spouses were recruited from the general community through General Practitioners located in the southern areas of Adelaide, Australia. Quantitative and qualitative data were collected between September 2009 and March 2011; a total of 25 spouses from each of the CDSMS and control groups provided data. Spousal strain was measured by the Caregiver Risk Screen (CRS). Few spouses had CRS scores indicative of moderate or high strain at baseline or upon completion of the study and CRS scores did not differ by programme allocation. Spouses of participants with poorer self-management (r = 0.34, P = 0.016) and more illness intrusiveness (r = 0.35, P = 0.013) had higher CRS scores at baseline (quantitative) and spousal strain was found to increase as a partner's well-being and capacity to self-manage decreased (qualitative). Spouse presence at CDSMS sessions (20%) frequently signalled a reduced level of partner well-being. Overall, our findings suggest that CDSMS programmes in many cases will have little impact (either positive or negative) on spousal strain. A significant increase in spousal strain may occur, however, if there is deterioration in the health status of a CDSMS participant. The impact of decline in participant health status on carer strain needs to be considered in CDSMS programmes.
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Affiliation(s)
- Stacey Masters
- Discipline of General Practice, Flinders University, Adelaide, SA, Australia.
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Jowsey T, McRae IS, Valderas JM, Dugdale P, Phillips R, Bunton R, Gillespie J, Banfield M, Jones L, Kljakovic M, Yen L. Time's up. descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey. PLoS One 2013; 8:e59379. [PMID: 23560046 PMCID: PMC3613388 DOI: 10.1371/journal.pone.0059379] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 02/14/2013] [Indexed: 11/18/2022] Open
Abstract
Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5-16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.
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Affiliation(s)
- Tanisha Jowsey
- Australian Primary Health Care Research Institute, Australian National University, Canberra, Australian Capital Territory, Australia.
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Trivedi D, Goodman C, Gage H, Baron N, Scheibl F, Iliffe S, Manthorpe J, Bunn F, Drennan V. The effectiveness of inter-professional working for older people living in the community: a systematic review. HEALTH & SOCIAL CARE IN THE COMMUNITY 2013; 21:113-28. [PMID: 22891915 DOI: 10.1111/j.1365-2524.2012.01067.x] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Health and social care policy in the UK advocates inter-professional working (IPW) to support older people with complex and multiple needs. Whilst there is a growing understanding of what supports IPW, there is a lack of evidence linking IPW to explicit outcomes for older people living in the community. This review aimed to identify the models of IPW that provide the strongest evidence base for practice with community dwelling older people. We searched electronic databases from 1 January 1990-31 March 2008. In December 2010 we updated the findings from relevant systematic reviews identified since 2008. We selected papers describing interventions that involved IPW for community dwelling older people and randomised controlled trials (RCT) reporting user-relevant outcomes. Included studies were classified by IPW models (Case Management, Collaboration and Integrated Team) and assessed for risk of bias. We conducted a narrative synthesis of the evidence according to the type of care (interventions delivering acute, chronic, palliative and preventive care) identified within each model of IPW. We retrieved 3211 records and included 37 RCTs which were mapped onto the IPW models: Overall, there is weak evidence of effectiveness and cost-effectiveness for IPW, although well-integrated and shared care models improved processes of care and have the potential to reduce hospital or nursing/care home use. Study quality varied considerably and high quality evaluations as well as observational studies are needed to identify the key components of effective IPW in relation to user-defined outcomes. Differences in local contexts raise questions about the applicability of the findings and their implications for practice. We need more information on the outcomes of the process of IPW and evaluations of the effectiveness of different configurations of health and social care professionals for the care of community dwelling older people.
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Affiliation(s)
- Daksha Trivedi
- Centre for Research in Primary and Community Care, University of Hertfordshire, Hatfield, UK.
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Warren J, Gu Y, Humphrey G. Usage analysis of a shared care planning system. AMIA ... ANNUAL SYMPOSIUM PROCEEDINGS. AMIA SYMPOSIUM 2012; 2012:950-959. [PMID: 23304370 PMCID: PMC3540434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We examined the content of electronically mediated communications in a trial of shared care planning (SCP) for long-term condition management. Software supports SCP by sharing patient records and care plans among members of the multidisciplinary care team (with patient access). Our analysis focuses on a three-month period with 73 enrolled patients, 149 provider-assigned tasks, 64 clinical notes and 48 care plans with 162 plan elements. Results show that content of notes entries is often related to task assignment and that nurses are the most active users. Directions for refinement of the SCP technology are indicated, including better integration of notes, tasks and care team notifications, as well as the central role of nurses for design use cases. Broader issues are raised about workforce roles and responsibilities for SCP, integrating patient-provider and provider-provider communications, and the centrality of care plans as the key entity in mediation of the care team.
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Affiliation(s)
- Jim Warren
- University of Auckland, Auckland, New Zealand
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Tung HH, Lien RY, Wei J, Clinciu DL, Lee JY, Huang HC. The role of adherence in the relationship between self-efficacy and self-management in diabetic patients undergoing CABG in Taiwan. HEART ASIA 2012; 4:114-9. [PMID: 27326045 DOI: 10.1136/heartasia-2012-010155] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2012] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To determine the role of adherence and its significance in the relationship between self-efficacy and self-management of diabetic patients undergoing coronary artery bypass graft (CABG) in Taiwan. DESIGN Descriptive and correlational survey design. SETTING Three outpatient clinics in Taiwan. PARTICIPANTS Patients diagnosed with diabetes undergoing CABG at least 6 months before the study, 18 years of age or older, able to communicate verbally without any psychiatric problems, and with a life expectancy longer than 1 year. MAIN OUTCOME MEASURES Self-management assessment (self-efficacy for managing disease and adherence to guidelines and medication measured on a scale of 0-8), the higher aspects of self-management (keeping appointments, taking medication properly and keeping follow-up appointments) and the lower aspects of self-management (inability to share decisions with primary physician, inability to take correct actions when symptoms worsen and inability to adapt habits to improve health). RESULTS The mean score obtained for self-management among the 166 participants was 6.48, with 57 (34.3%) of them showing non-adherent behaviour. Self-efficacy accounts for 38% (R(2)=0.380, F(1,103)=63.124, p < 0.001), and 54% of good self-management was explained by self-efficacy and adherence in managing disease (R(2)=0.540, F(2,102)=56.937, p<0.001). Adherence accounts for 16% of better self-management, age and education combined account for 4.9% (R(2)=0.589, F(6.98)=23.399, p<0.001), and lifestyle items account for 5.2% (R(2)=0.641, F(14,90)=11.457, p<0.001). Disease-related variables contribute 3.4% (R(2)=0.674, F(17,87)=10.599, p<0.001). Thus self-efficacy, adherence, age, education, primary care provider and systolic pressure are considered significant predictors of self-management. With the exception of adherence, none of the variables had a statistically significant mediating effect. CONCLUSIONS The results confirm strong relationships between self-efficacy, adherence and self-management, with adherence having a significant mediating effect in post-CABG patients with diabetes in Taiwan.
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Affiliation(s)
- Heng-Hsin Tung
- Nursing School, National Taipei University of Nursing and Health Science, Taiwan, ROC; Nursing Department, Tungs' Taichung MetroHabor Hospital, Taiwan, ROC
| | - Ru-Yu Lien
- Nursing Department of Taipei Veterans General Hospital, Taipei, Taiwan, ROC
| | - Jeng Wei
- Heart Center of Chen-Hsin Hospital, Taipei, Taiwan, ROC
| | - Daniel L Clinciu
- Feng Chia University, National Taipei University of Nursing and Health Science, Taichung City, Taiwan, ROC
| | - Jyun-Yi Lee
- Cardiovascular Department, Mackay Memorial Hospital, Taipei City, Taiwan, ROC
| | - Hui-Chuan Huang
- Nursing Department, Cardinal Tien College of Healthcare & Management, Taipei, Taiwan, ROC
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HUNT E, MOORE JA, SHERRIFF J. Community health-care planning in Western Australian Country Health Service-South West: An evaluation of patient views. Nutr Diet 2012. [DOI: 10.1111/j.1747-0080.2011.01571.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Béland F, Hollander MJ. Integrated models of care delivery for the frail elderly: international perspectives. GACETA SANITARIA 2011; 25 Suppl 2:138-46. [DOI: 10.1016/j.gaceta.2011.09.003] [Citation(s) in RCA: 67] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Revised: 08/31/2011] [Accepted: 09/04/2011] [Indexed: 11/26/2022]
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Gage H, Ting S, Williams P, Bryan K, Kaye J, Castleton B, Trend P, Wade D. A comparison of specialist rehabilitation and care assistant support with specialist rehabilitation alone and usual care for people with Parkinson's living in the community: study protocol for a randomised controlled trial. Trials 2011; 12:250. [PMID: 22112960 PMCID: PMC3261836 DOI: 10.1186/1745-6215-12-250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2011] [Accepted: 11/23/2011] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Parkinson's Disease is a degenerative neurological condition that causes movement problems and other distressing symptoms. People with Parkinson's disease gradually lose their independence and strain is placed on family members. A multidisciplinary approach to rehabilitation for people with Parkinson's is recommended but has not been widely researched. Studies are needed that investigate cost-effective community-based service delivery models to reduce disability and dependency and admission to long term care, and improve quality of life. METHODS A pragmatic three parallel group randomised controlled trial involving people with Parkinson's Disease and live-in carers (family friends or paid carers), and comparing: management by a specialist multidisciplinary team for six weeks, according to a care plan agreed between the professionals and the patient and carer (Group A); multidisciplinary team management and additional support for four months from a trained care assistant (Group B); usual care, no coordinated team care planning or ongoing support (Group C). Follow up will be for six months to determine the impact and relative cost-effectiveness of the two interventions, compared to usual care. The primary outcomes are disability (patients) and strain (carers). Secondary outcomes include patient mobility, falls, speech, pain, self efficacy, health and social care use; carer general health; patient and carer social functioning, psychological wellbeing, health related quality of life. Semi structured interviews will be undertaken with providers (team members, care assistants), service commissioners, and patients and carers in groups A and B, to gain feedback about the acceptability of the interventions. A cost - effectiveness evaluation is embedded in the trial. DISCUSSION The trial investigates components of recent national policy recommendations for people with long term conditions, and Parkinson's Disease in particular, and will provide guidance to inform local service planning and commissioning. TRIAL REGISTRATION ISRCTN: ISRCTN44577970.
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Affiliation(s)
- Heather Gage
- Dept of Economics, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Sharlene Ting
- Dept of Economics, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Peter Williams
- Dept of Mathematics, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Karen Bryan
- Division of Health and Social Care, University of Surrey, Guildford, Surrey GU2 7TE, UK
| | - Julie Kaye
- NHS Surrey, Cedar Court, Guildford Road, Leatherhead, Surrey, KT22 9AE, UK
| | - Beverly Castleton
- Movement Disorders Service, Ashford St Peter's Hospital, Guildford Road, Chertsey, Surrey, KT16 9BN, UK
| | - Patrick Trend
- Department of Neurology, Royal Surrey County Hospital, Egerton Road, Guildford, Surrey, GU2 7XX, UK
| | - Derick Wade
- Oxford Centre for Enablement, Windmill Road, Oxford, Oxfordshire, OX3 7LD, UK
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Mills D. Re It's not just about the HbA1c. Aust J Rural Health 2011; 19:329. [PMID: 22098218 DOI: 10.1111/j.1440-1584.2011.01233.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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Darkwah V, Ross C, Williams B, Madill H. Undergraduate Nursing Student Self-Efficacy in Patient Education in a Context-Based Learning Program. J Nurs Educ 2011; 50:579-82. [DOI: 10.3928/01484834-20110630-01] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 05/11/2011] [Indexed: 11/20/2022]
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Reed RL, Battersby M, Osborne RH, Bond MJ, Howard SL, Roeger L. Protocol for a randomised controlled trial of chronic disease self-management support for older Australians with multiple chronic diseases. Contemp Clin Trials 2011; 32:946-52. [PMID: 21864719 DOI: 10.1016/j.cct.2011.08.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2011] [Revised: 07/08/2011] [Accepted: 08/09/2011] [Indexed: 12/21/2022]
Abstract
The prevalence of older Australians with multiple chronic diseases is increasing and now accounts for a large proportion of total health care utilisation. Chronic disease self-management support (CDSMS) has become a core service component of many community based health programs because it is considered a useful tool in improving population health outcomes and reducing the financial burden of chronic disease care. However, the evidence base to justify these support programs is limited, particularly for older people with multiple chronic diseases. We describe an ongoing trial examining the effectiveness of a particular CDSMS approach called the Flinders Program. The Flinders Program is a clinician-led generic self-management intervention that provides a set of tools and a structured process that enables health workers and patients to collaboratively assess self-management behaviours, identify problems, set goals, and develop individual care plans covering key self-care, medical, psychosocial and carer issues. A sample of 252 older Australians that have two or more chronic conditions will be randomly assigned to receive either CDSMS or an attention control intervention (health information only) for 6 months. Outcomes will be assessed using self-reported health measures taken at baseline and post-intervention. This project will be the first comprehensive evaluation of CDSMS in this population. Findings are expected to guide consumers, clinicians and policymakers in the use of CDSMS, as well as facilitate prioritisation of public monies towards evidence-based services.
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Affiliation(s)
- Richard L Reed
- Discipline of General Practice, Flinders University. Health Sciences Building, Level 3, Registry Road, Bedford Park, South Australia, 5042, Australia.
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