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McDermott K, Levey N, Brewer J, Ehmann M, Hooker JE, Pasinski R, Yousif N, Raju V, Gholston M, Greenberg J, Ritchie CS, Vranceanu AM. Improving Health for Older Adults With Pain Through Engagement: Protocol for Tailoring and Open Pilot Testing of a Mind-Body Activity Program Delivered Within Shared Medical Visits in an Underserved Community Clinic. JMIR Res Protoc 2023; 12:e52117. [PMID: 38157234 PMCID: PMC10787331 DOI: 10.2196/52117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Accepted: 08/25/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Chronic musculoskeletal pain is prevalent and disabling among older adults in underserved communities. Psychosocial pain management is more effective than pharmacological treatment in older adults. However, underserved community clinics often lack psychosocial treatments, in part because of a lack of trained providers. Shared medical appointments, in which patients undergo brief medical evaluation, monitoring, counseling, and group support, are an efficacious and cost-effective method for chronic disease management in underserved clinics, reducing the need for specialized providers. However, shared medical visits are often ineffective for chronic pain, possibly owing to lack of inclusion of skills most relevant for older adults (eg, pacing to increase engagement in daily activities). OBJECTIVE We have described the protocol for the development and initial pilot effectiveness testing of the GetActive+ mind-body activity intervention for older adults with chronic pain. GetActive+ was adapted from GetActive, an evidence-based intervention that improved pain outcomes among mostly affluent White adults. We aim to establish the initial feasibility, acceptability, fidelity, and effectiveness of GetActive+ when delivered as part of shared medical appointments in a community clinic. METHODS We conducted qualitative focus groups and individual interviews with providers (n=25) and English-speaking older adults (aged ≥55 y; n=18) with chronic pain to understand the pain experience in this population, perceptions about intervention content, and barriers to and facilitators of intervention participation and implementation in this setting. Qualitative interviews with Spanish-speaking older adults are in progress and will inform a future open pilot of the intervention in Spanish. We are currently conducting an open pilot study with exit interviews in English (n=30 individuals in total). Primary outcomes are feasibility (≥75% of patients who are approached agree to participate), acceptability (≥75% of patients who enrolled complete 8 out of 10 sessions; qualitative), and fidelity (≥75% of session components are delivered as intended). Secondary outcomes include physical function-self-reported, performance based (6-minute walk test), and objective (step count)-and emotional function (depression and anxiety). Other assessments include putative mechanisms (eg, mindfulness and pain catastrophizing). RESULTS We began enrolling participants for the qualitative phase in November 2022 and the open pilot phase in May 2023. We completed the qualitative phase with providers and English-speaking patients, and the results are being analyzed using a hybrid, inductive-deductive approach. We conducted rapid analysis of these data to develop GetActive+ before the open pilot in English, including increasing readability and clarity of language, reducing the number of skills taught to increase time for individual check-ins and group participation, and increasing experiential exercises for skill uptake. CONCLUSIONS We provide a blueprint for the refinement of a mind-body activity intervention for older adults with chronic pain in underserved community clinics and for incorporation within shared medical visits. It will inform a future, fully powered, effectiveness-implementation trial of GetActive+ to help address the chronic pain epidemic among older adults. TRIAL REGISTRATION ClinicalTrials.gov NCT05782231; https://clinicaltrials.gov/study/NCT05782231. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52117.
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Affiliation(s)
- Katherine McDermott
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Nadine Levey
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julie Brewer
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Madison Ehmann
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Julia E Hooker
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Roger Pasinski
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Neda Yousif
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Vidya Raju
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Milton Gholston
- Massachusetts General Hospital Revere HealthCare Center, Revere, MA, United States
| | - Jonathan Greenberg
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
| | - Christine S Ritchie
- Center for Aging and Serious Illness, Massachusetts General Hospital, Boston, MA, United States
| | - Ana-Maria Vranceanu
- Center for Health Outcomes and Interdisciplinary Research, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, United States
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Veroniki AA, Soobiah C, Nincic V, Lai Y, Rios P, MacDonald H, Khan PA, Ghassemi M, Yazdi F, Brownson RC, Chambers DA, Dolovich LR, Edwards A, Glasziou PP, Graham ID, Hemmelgarn BR, Holmes BJ, Isaranuwatchai W, Legare F, McGowan J, Presseau J, Squires JE, Stelfox HT, Strifler L, Van der Weijden T, Fahim C, Tricco AC, Straus SE. Efficacy of sustained knowledge translation (KT) interventions in chronic disease management in older adults: systematic review and meta-analysis of complex interventions. BMC Med 2023; 21:269. [PMID: 37488589 PMCID: PMC10367354 DOI: 10.1186/s12916-023-02966-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2022] [Accepted: 06/27/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Chronic disease management (CDM) through sustained knowledge translation (KT) interventions ensures long-term, high-quality care. We assessed implementation of KT interventions for supporting CDM and their efficacy when sustained in older adults. METHODS Design: Systematic review with meta-analysis engaging 17 knowledge users using integrated KT. ELIGIBILITY CRITERIA Randomized controlled trials (RCTs) including adults (> 65 years old) with chronic disease(s), their caregivers, health and/or policy-decision makers receiving a KT intervention to carry out a CDM intervention for at least 12 months (versus other KT interventions or usual care). INFORMATION SOURCES We searched MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials from each database's inception to March 2020. OUTCOME MEASURES Sustainability, fidelity, adherence of KT interventions for CDM practice, quality of life (QOL) and quality of care (QOC). Data extraction, risk of bias (ROB) assessment: We screened, abstracted and appraised articles (Effective Practice and Organisation of Care ROB tool) independently and in duplicate. DATA SYNTHESIS We performed both random-effects and fixed-effect meta-analyses and estimated mean differences (MDs) for continuous and odds ratios (ORs) for dichotomous data. RESULTS We included 158 RCTs (973,074 participants [961,745 patients, 5540 caregivers, 5789 providers]) and 39 companion reports comprising 329 KT interventions, involving patients (43.2%), healthcare providers (20.7%) or both (10.9%). We identified 16 studies described as assessing sustainability in 8.1% interventions, 67 studies as assessing adherence in 35.6% interventions and 20 studies as assessing fidelity in 8.7% of the interventions. Most meta-analyses suggested that KT interventions improved QOL, but imprecisely (36 item Short-Form mental [SF-36 mental]: MD 1.11, 95% confidence interval [CI] [- 1.25, 3.47], 14 RCTs, 5876 participants, I2 = 96%; European QOL-5 dimensions: MD 0.01, 95% CI [- 0.01, 0.02], 15 RCTs, 6628 participants, I2 = 25%; St George's Respiratory Questionnaire: MD - 2.12, 95% CI [- 3.72, - 0.51] 44 12 RCTs, 2893 participants, I2 = 44%). KT interventions improved QOC (OR 1.55, 95% CI [1.29, 1.85], 12 RCTS, 5271 participants, I2 = 21%). CONCLUSIONS KT intervention sustainability was infrequently defined and assessed. Sustained KT interventions have the potential to improve QOL and QOC in older adults with CDM. However, their overall efficacy remains uncertain and it varies by effect modifiers, including intervention type, chronic disease number, comorbidities, and participant age. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018084810.
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Affiliation(s)
- Areti Angeliki Veroniki
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
| | - Charlene Soobiah
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
| | - Vera Nincic
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Yonda Lai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Patricia Rios
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Heather MacDonald
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Paul A. Khan
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Marco Ghassemi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Fatemeh Yazdi
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Ross C. Brownson
- Prevention Research Center in St. Louis, Brown School, Washington University in St. Louis, St. Louis, MO USA
- Department of Surgery and Alvin J. Siteman Cancer Center, Washington University School of Medicine, Washington University in St. Louis, 660 S. Euclid Avenue, St. Louis, MO USA
| | - David A. Chambers
- National Cancer Institute, 9609 Medical Center Drive, Rockville, MD USA
| | - Lisa R. Dolovich
- Leslie Dan Faculty of Pharmacy, University of Toronto, 144 College Street, Toronto, ON Canada
- Department of Family Medicine David Braley Health Sciences Centre, McMaster University, 100 Main Street West, Hamilton, ON Canada
| | - Annemarie Edwards
- Canadian Partnership Against Cancer, 1 University Avenue, Toronto, ON Canada
| | - Paul P. Glasziou
- Faculty of Health Sciences and Medicine, Bond University, Robina, QLD 4226 Australia
| | - Ian D. Graham
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
| | - Brenda R. Hemmelgarn
- Department of Medicine, University of Alberta, C MacKenzie Health Sciences Centre, WalterEdmonton, AB 2J2.00 Canada
| | - Bev J. Holmes
- The Michael Smith Foundation for Health Research (MSFHR), 200 - 1285 West Broadway, Vancouver, BC Canada
| | - Wanrudee Isaranuwatchai
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - France Legare
- Département de Médecine Familiale Et Médecine d’urgenceFaculté de Médecine, Université Laval Pavillon Ferdinand-Vandry1050, Avenue de La Médecine, Local 2431, Québec, QC Canada
- Axe Santé Des Populations Et Pratiques Optimales en Santé, Centre de Recherche du CHU de Québec 1050, Chemin Sainte-Foy, Local K0-03, Québec, QC Canada
| | - Jessie McGowan
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
| | - Justin Presseau
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- The Ottawa Hospital Research Institute, 501 Smyth Road, Ottawa, ON Canada
| | - Janet E. Squires
- School of Epidemiology and Public Health, University of Ottawa, 600 Peter Morand Crescent, Ottawa, ON Canada
- School of Nursing, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Henry T. Stelfox
- Departments of Critical Care Medicine, Medicine and Community Health Sciences, O’Brien Institute for Public Health, University of Calgary and Alberta Health Services, Calgary, AB Canada
| | - Lisa Strifler
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Trudy Van der Weijden
- Department of Family Medicine, Maastricht University, CAPHRI Care and Public Health Research Institute, Debeyeplein 1, Maastricht, The Netherlands
| | - Christine Fahim
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
| | - Andrea C. Tricco
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Epidemiology Division & Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - Sharon E. Straus
- Knowledge Translation Program, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, 209 Victoria Street, East Building, Toronto, ON M5B 1T8 Canada
- Institute for Health Policy, Management, and Evaluation, University of Toronto, 155 College Street, Toronto, ON Canada
- Department of Geriatric Medicine, University of Toronto, Toronto, ON Canada
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Palay J, Bolton JM, Sareen J, Hensel JM. Increasing access to specialist care with group medical visits: summary of a pilot in a post-crisis psychiatric clinic. FRONTIERS IN HEALTH SERVICES 2023; 3:1127725. [PMID: 37435511 PMCID: PMC10332818 DOI: 10.3389/frhs.2023.1127725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 06/14/2023] [Indexed: 07/13/2023]
Abstract
Background Group medical visits (GMVs) have strong evidence of acceptability and effectiveness in the management of chronic medical diseases. Adaptation of GMVs for psychiatric care has potential to increase access, decrease stigma and save costs. Despite promise, this model has not been widely adopted. Methods A novel GMV pilot was implemented for psychiatric care post-crisis among patients with primary mood or anxiety disorders who required medication management. Participants filled out PHQ-9 and GAD-7 scales at each visit in order to track their progress. After discharge, charts were reviewed for demographics, medication changes and symptom changes. Patient characteristics were compared between those who attended and those who didn't. Changes in total PHQ-9 and GAD-7 scores among attendees were assessed with paired t-tests. Results Forty-eight patients were enrolled between October 2017 and the end of December 2018, 41 of whom consented to participate. Of those, 10 did not attend, 8 attended but did not complete, and 23 completed. Baseline PHQ-9 and GAD-7 scores did not differ significantly between groups. Significant and meaningful reductions in PHQ-9 and GAD-7 scores from baseline to last visit attended occurred among those who attended at least 1 visit (decrease of 5.13 and 5.26 points, respectively). Conclusions This GMV pilot demonstrated feasibility of the model as well as positive outcomes for patients recruited in a post-crisis setting. This model has the potential to increase access to psychiatric care in the face of limited resources, however the failure of the pilot to sustain highlights challenges to be addressed in future pivots.
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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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Psychosocial outcomes of group prenatal care. J Public Health (Oxf) 2022. [DOI: 10.1007/s10389-020-01441-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Group Medical Care: A Systematic Review of Health Service Performance. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312726. [PMID: 34886452 PMCID: PMC8657170 DOI: 10.3390/ijerph182312726] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 11/30/2021] [Accepted: 11/30/2021] [Indexed: 11/16/2022]
Abstract
Group care models, in which patients with similar health conditions receive medical services in a shared appointment, have increasingly been adopted in a variety of health care settings. Applying the Triple Aim framework, we examined the potential of group medical care to optimize health system performance through improved patient experience, better health outcomes, and the reduced cost of health care. A systematic review of English language articles was conducted using the Cochrane Controlled Trials Register (CENTRAL), MEDLINE/PubMed, Scopus, and Embase. Studies based on data from randomized control trials (RCTs) conducted in the US and analyzed using an intent-to-treat approach to test the effect of group visits versus standard individual care on at least one Triple Aim domain were included. Thirty-one studies met the inclusion criteria. These studies focused on pregnancy (n = 9), diabetes (n = 15), and other chronic health conditions (n = 7). Compared with individual care, group visits have the potential to improve patient experience, health outcomes, and costs for a diversity of health conditions. Although findings varied between studies, no adverse effects were associated with group health care delivery in these randomized controlled trials. Group care models may contribute to quality improvements, better health outcomes, and lower costs for select health conditions.
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Wanni Arachchige Dona S, Angeles MR, Hall N, Watts JJ, Peeters A, Hensher M. Impacts of chronic disease prevention programs implemented by private health insurers: a systematic review. BMC Health Serv Res 2021; 21:1222. [PMID: 34763676 PMCID: PMC8582197 DOI: 10.1186/s12913-021-07212-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Accepted: 10/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Chronic diseases contribute to a significant proportion (71%) of all deaths each year worldwide. Governments and other stakeholders worldwide have taken various actions to tackle the key risk factors contributing to the prevalence and impact of chronic diseases. Private health insurers (PHI) are one key stakeholders, particularly in Australian health system, and their engagement in chronic disease prevention is growing. Therefore, we investigated the impacts of chronic disease prevention interventions implemented by PHI both in Australia and internationally. METHOD We searched multiple databases (Business Source Complete, CINAHL, Global Health, Health Business Elite, Medline, PsycINFO, and Scopus) and grey literature for studies/reports published in English until September 2020 using search terms on the impacts of chronic disease prevention interventions delivered by PHIs. Two reviewers assessed the risk of bias using a quality assessment tool developed by Effective Public Healthcare Panacea Project. After data extraction, the literature was synthesised thematically based on the types of the interventions reported across studies. The study protocol was registered in PROSPERO, CRD42020145644. RESULTS Of 7789 records, 29 studies were eligible for inclusion. There were predominantly four types of interventions implemented by PHIs: Financial incentives, health coaching, wellness programs, and group medical appointments. Outcome measures across studies were varied, making it challenging to compare the difference between the effectiveness of different intervention types. Most studies reported that the impacts of interventions, such as increase in healthy eating, physical activity, and lower hospital admissions, last for a shorter term if the length of the intervention is shorter. INTERPRETATION Although it is challenging to conclude which intervention type was the most effective, it appeared that, regardless of the intervention types, PHI interventions of longer duration (at least 2 years) were more beneficial and outcomes were more sustained than those PHI interventions that lasted for a shorter period. FUNDING Primary source of funding was Geelong Medical and Hospital Benefits Association (GMHBA), an Australian private health insurer.
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Affiliation(s)
- Sithara Wanni Arachchige Dona
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Mary Rose Angeles
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Natasha Hall
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Jennifer J Watts
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Anna Peeters
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia
| | - Martin Hensher
- Institute for Health Transformation, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia.
- Deakin Health Economics, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia.
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Saldivar P, Mira V, Duran P, Moldovan C, Ang G, Parikh N, Lee ML, Friedman TC. Implementing texting programs in the P.O.W.E.R. (preventing obesity with eating right) medical group visit for weight loss. Obes Sci Pract 2021; 7:583-590. [PMID: 34631136 PMCID: PMC8488446 DOI: 10.1002/osp4.513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 03/23/2021] [Accepted: 03/24/2021] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND The effect of incorporating mobile technology to support participants' lifestyle change and weight loss in medical group visits has not been well studied in a safety-net setting. RATIONALE AND DESIGN Thus, the rationale of the current study was to examine the effect of text messaging in a medical group visit, and test the effect of two texting programs (12 weeks and 20 weeks), compared to those who did not receive text-messaging in the Preventing Obesity With Eating Right (POWER) group visit program. The primary outcome was weight loss. RESULTS We found that those enrolled in the 20-week and 12-week texting programs attended more group visit sessions than those enrolled in the POWER group only (p < 0.001). Both POWER and POWER + 20-week texting groups had a significant reduction in weight at their final group visit compared to their baseline (POWER, 114 ± 27 kg vs. 112 ± 26 kg, p < 0.001; POWER + 20-week texting, 111 ± 28 kg vs. 109 ± 28 kg, p < 0.01), but not the 12-week texting group (114 ± 29 kg vs. 113 ± 29 kg, p = 0.22), with no differences between the groups. The number of group visits was correlated with a decrease in weight (rs = 0.12, p < 0.05). CONCLUSION In conclusion, text messaging programs led to more attendance in the medical group visits, but not greater weight loss or reduction in HbA1c than the POWER group obesity program alone. Further studies are needed to maximize the beneficial effects of texting programs in medical group visits in underserved minority populations.
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Affiliation(s)
- Perla Saldivar
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Valerie Mira
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Petra Duran
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Christina Moldovan
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Georgina Ang
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | | | - Martin L. Lee
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
| | - Theodore C. Friedman
- Division of Endocrinology, Metabolism, and Molecular Medicine, Department of Internal MedicineCharles R. Drew University of Medicine and ScienceLos AngelesCaliforniaUSA
- Martin Luther King Jr. Outpatient CenterLos AngelesCaliforniaUSA
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Ahluwalia SC, Bandini JI, Kogan AC, Bekelman DB, Olsen B, Phillips J, Sudore RL. Impact of group visits for older patients with heart failure on advance care planning outcomes: Preliminary data. J Am Geriatr Soc 2021; 69:2908-2915. [PMID: 34077563 PMCID: PMC8497395 DOI: 10.1111/jgs.17283] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 05/05/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Advance care planning (ACP) is critically important for heart failure patients, yet important challenges exist. Group visits can be a helpful way to engage patients and caregivers in identifying values and preferences for future care in a resource-efficient way. We sought to evaluate the impact of group visits for ACP among older adults with heart failure and their caregivers on ACP-related outcomes. METHODS We conducted a mixed-methods pilot study evaluating the impact of an ACP group visit for older adults with heart failure and their caregivers on ACP-related outcomes including readiness and self-efficacy. The evidence-based PREPARE for Your Care video-based intervention was used to guide the group visits. Twenty patients and 10 caregivers attended one of the five 90-min group visits led by a trained facilitator. Group visit participants completed pre-, post-, and 1-month follow-up surveys using validated 5-point ACP readiness and self-efficacy scales. Qualitative feedback obtained within 3 days of a group visit was analyzed using a directed content analysis. RESULTS Patient participants had a median age of 78 years. Approximately half were female while caregiver participants were mostly female. Participants were predominantly white. Patient readiness scores improved significantly pre-to-post (+0.53; p = 0.002) but was not sustained at 1-month follow-up. Patient and caregiver self-efficacy showed some improvement pre-to-post but was also not sustained at follow-up. Interviews revealed positive impacts of group visits across the three themes: encouraging reviewing or revisiting prior ACP activities, motivating patients to take direct steps towards ACP, and serving as a "wake-up" call to action. CONCLUSIONS Disease-focused group visits may have a short-term effect on ACP outcomes but ongoing touchpoints are likely necessary to sustain ACP over time. The results highlight a need for follow-up ACP conversations after a single group visit. Timing for follow-ups and the ideal person to follow-up ACP conversations needs to be explored.
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Affiliation(s)
- Sangeeta C. Ahluwalia
- RAND Corporation, Santa Monica, CA
- UCLA Fielding School of Public Health, Los Angeles, CA
| | | | - Alexis Coulourides Kogan
- Keck School of Medicine of USC, University of Southern California, Dept. of Family Medicine and Geriatrics, Alhambra, CA
| | - David B. Bekelman
- Department of Medicine, Eastern Colorado VA HCS and Division of General Internal Medicine, University of Colorado School of Medicine at the Anschutz Medical Campus
| | - Bonnie Olsen
- Keck School of Medicine of USC, University of Southern California, Dept. of Family Medicine and Geriatrics, Alhambra, CA
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Impfen gegen Influenza – Internationale Bestandsaufnahme und Perspektiven für Deutschland. ZEITSCHRIFT FÜR EVIDENZ, FORTBILDUNG UND QUALITÄT IM GESUNDHEITSWESEN 2021; 161:42-49. [PMID: 33640286 PMCID: PMC7903904 DOI: 10.1016/j.zefq.2021.01.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 01/21/2021] [Accepted: 01/24/2021] [Indexed: 11/23/2022]
Abstract
Hintergrund Die aktuelle SARS-CoV-2-Pandemie erfordert hohe Durchimpfungsraten von chronisch Kranken gegen Influenza, um das Gesundheitssystem nicht zusätzlich zu belasten. Trotz klarer Evidenz für Sicherheit und Wirksamkeit der Influenza-Impfung sind die Impfquoten in den vergangenen Jahren international auf insuffizientem Niveau verblieben. Der Hausarzt hat eine zentrale Bedeutung für die Versorgung dieser Population. Ziel dieser systematischen Übersichtsarbeit war daher die Evaluation verschiedener Maßnahmen in der Allgemeinmedizin zur Steigerung der saisonalen Influenza-Impfquoten bei chronisch Kranken unter Berücksichtigung verschiedener internationaler Gesundheitssysteme. Methoden Eine systematische Literaturrecherche wurde in MEDLINE, CENTRAL, EMBASE und ERIC sowie manuell in Studienregistern und Literaturlisten durchgeführt. Dabei wurden ausschließlich randomisierte kontrollierte Studien berücksichtigt. Die Methodik wurde im Vorfeld in einem Studienprotokoll festgelegt (PROSPERO CRD42018114163). Ergebnisse Insgesamt wurden 14 Studien im Rahmen eines nationalen Gesundheitsdienstes (Großbritannien), einer staatlichen (Australien) und sozialen (Schweiz) Krankenversicherung und eines privaten Gesundheitssystems (USA) in unsere Übersichtsarbeit eingeschlossen. Analoge Patientenerinnerungen und automatisierte Arzterinnerungen sowie Veränderungen der beruflichen Rollen führten ausschließlich im privaten Gesundheitssystem zu einem deutlichen Anstieg der Influenzaimpfquoten. Im nationalen Gesundheitsdienst konnte keine der analysierten Interventionen einen signifikanten Anstieg der Impfquoten erreichen, wobei im nationalen Gesundheitsdienst Großbritanniens verhältnismäßig gute Basisimpfraten gegen Influenza bereits vor Durchführung der Studien interventionsunabhängig vorlagen. Fortbildungsveranstaltungen für Praxisteams und Erinnerungs-SMS zeigten in den sozialen und staatlichen Krankenversicherungssystemen der Schweiz und in Australien gute Resultate. Schlussfolgerungen In Deutschland könnten vor allem Fortbildungsveranstaltungen für medizinische Teams und sowie zentral organisierte Einladungs- und Monitoringsysteme zur Verbesserung der Impfquoten bei chronisch Kranken geeignet sein. Eine staatliche Kostenübernahme der Impfkosten scheint in verschiedenen Gesundheitssystemen für eine gute Basisimpfquote gegen Influenza bei Indikationspatienten zu sorgen.
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Clinician Perspectives on Group Visits for Advance Care Planning Among Caregivers and Older Adult Patients With Heart Failure. J Am Board Fam Med 2021; 34:375-386. [PMID: 33833006 PMCID: PMC8108709 DOI: 10.3122/jabfm.2021.02.200270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Advance care planning (ACP) is critical for older adults with heart failure; however, patient-level and clinician-level barriers exist. Although a group visit (GV) approach to engage patients in ACP has proven effective among general geriatric populations, little is known about clinician perceptions/likelihood of referral. METHODS Qualitative study to understand clinician perspectives on GVs for ACP among older adult patients with heart failure and caregivers. Twenty physicians and advance practice providers participated in telephone-based interviews guided by a semistructured research protocol. Transcripts were analyzed using a grounded theory approach. RESULTS Results highlight variability in clinician engagement in ACP but greater agreement around the factors that prompt discussions. Qualitative themes included (1) inherent properties of GVs (characteristics that make GVs ideal for most but less ideal for some, risk-to-benefit ratio); (2) purpose of GVs (general education, "priming the pump" for subsequent discussions, providing tools for action); and (3) format and procedures for GVs (inclusion/exclusion considerations, organizing by unifying characteristic, link back to clinicians). CONCLUSIONS This is the first study to gain clinician insights into ACP GVs specific to patients and caregivers affected by heart failure. Results shed light on an important topic and suggest key considerations for conducting GVs for ACP.
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Smith SM, Wallace E, O'Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev 2021; 1:CD006560. [PMID: 33448337 PMCID: PMC8092473 DOI: 10.1002/14651858.cd006560.pub4] [Citation(s) in RCA: 57] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions to improve outcomes for people with multimorbidity. OBJECTIVES To determine the effectiveness of health-service or patient-oriented interventions designed to improve outcomes in people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. SEARCH METHODS We searched MEDLINE, EMBASE, CINAHL and seven other databases to 28 September 2015. We also searched grey literature and consulted experts in the field for completed or ongoing studies. SELECTION CRITERIA Two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised clinical trials (NRCTs), controlled before-after studies (CBAs), and interrupted time series analyses (ITS) evaluating interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. This includes studies where participants can have combinations of any condition or have combinations of pre-specified common conditions (comorbidity), for example, hypertension and cardiovascular disease. The comparison was usual care as delivered in that setting. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included studies, evaluated study quality, and judged the certainty of the evidence using the GRADE approach. We conducted a meta-analysis of the results where possible and carried out a narrative synthesis for the remainder of the results. We present the results in a 'Summary of findings' table and tabular format to show effect sizes across all outcome types. MAIN RESULTS We identified 17 RCTs examining a range of complex interventions for people with multimorbidity. Nine studies focused on defined comorbid conditions with an emphasis on depression, diabetes and cardiovascular disease. The remaining studies focused on multimorbidity, generally in older people. In 11 studies, the predominant intervention element was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In six studies, the interventions were predominantly patient-oriented, for example, educational or self-management support-type interventions delivered directly to participants. Overall our confidence in the results regarding the effectiveness of interventions ranged from low to high certainty. There was little or no difference in clinical outcomes (based on moderate certainty evidence). Mental health outcomes improved (based on high certainty evidence) and there were modest reductions in mean depression scores for the comorbidity studies that targeted participants with depression (standardized mean difference (SMD) -0.41, 95% confidence interval (CI) -0.63 to -0.2). There was probably a small improvement in patient-reported outcomes (moderate certainty evidence). The intervention may make little or no difference to health service use (low certainty evidence), may slightly improve medication adherence (low certainty evidence), probably slightly improves patient-related health behaviours (moderate certainty evidence), and probably improves provider behaviour in terms of prescribing behaviour and quality of care (moderate certainty evidence). Cost data were limited. AUTHORS' CONCLUSIONS This review identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities in primary care and community settings. There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity in general due to the relatively small number of RCTs conducted in this area to date, with mixed findings overall. It is possible that the findings may change with the inclusion of large ongoing well-organised trials in future updates. The results suggest an improvement in health outcomes if interventions can be targeted at risk factors such as depression in people with co-morbidity.
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Affiliation(s)
- Susan M Smith
- HRB Centre for Primary Care Research, Department of General Practice, RCSI Medical School, Dublin 2, Ireland
| | - Emma Wallace
- HRB Centre for Primary Care Research, Department of General Practice, RCSI Medical School, Dublin 2, Ireland
| | - Tom O'Dowd
- Department of Public Health and Primary Care, Trinity College Centre for Health Sciences, Dublin, Ireland
| | - Martin Fortin
- Department of Family Medicine, University of Sherbrooke, Quebec, Canada
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Akmatov MK, Holstiege J, Steffen A, Bätzing J. Utilization of influenza vaccination among chronically ill individuals in Germany: A nationwide claims-based analysis. Vaccine 2021; 39:952-960. [PMID: 33451775 DOI: 10.1016/j.vaccine.2020.12.081] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 12/18/2020] [Accepted: 12/23/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Individuals with chronic diseases have a higher risk of serious complications or even death in case of influenza infection. The European Union (EU) set a goal to reach a vaccination coverage of 75% in seniors and chronically ill individuals. The aim of this study was to assess influenza vaccination uptake among individuals with a wide spectrum of chronic diseases and examine its regional variations and temporal trends over a period of the last ten years. METHODS We used nationwide SHI-physician outpatient claims data from the years 2009 to 2018 covering 87% of the total German population to assess influenza vaccination uptake among individuals over 1 year of age with at least one of the following chronic diseases: pulmonary, cardiovascular, liver, kidney, metabolic, neurological and musculoskeletal diseases, as well as immune deficiency disorders, including HIV infection. RESULTS Influenza vaccination coverage varied across patient populations between 19% (multiple sclerosis) and 44% (chronic kidney disease) in the influenza season 2017/18. Vaccination coverage was slightly higher among females than males, except for HIV/AIDS patients. Among HIV-patients vaccination coverage was higher by 7 percent points among males (43%) than females (37%). The coverage was higher nearly for all patient groups in the eastern than western federal states. Over the observation period vaccination uptake showed decreasing trends in most of the target groups. Among patients with HIV/AIDS and immune deficiency disorders a stagnating trend was observed. CONCLUSIONS Vaccination uptake among chronically ill individuals is suboptimal and far from the EU-defined target of 75%. There were substantial variations in coverage by disease groups, individual factors and regions. The disease-specific evaluation of the current study allows identification of populations at higher risk with considerable vaccination gaps. Further efforts are needed to improve vaccination uptake in these vulnerable population groups.
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Affiliation(s)
- Manas K Akmatov
- Central Research Institute of Ambulatory Health Care in the Federal Republic of Germany, Berlin, Germany.
| | - Jakob Holstiege
- Central Research Institute of Ambulatory Health Care in the Federal Republic of Germany, Berlin, Germany
| | - Annika Steffen
- Central Research Institute of Ambulatory Health Care in the Federal Republic of Germany, Berlin, Germany
| | - Jörg Bätzing
- Central Research Institute of Ambulatory Health Care in the Federal Republic of Germany, Berlin, Germany
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Baqir W, Gray WK, Blair A, Haining S, Birrell F. Osteoporosis group consultations are as effective as usual care: Results from a non‐inferiority randomized trial. LIFESTYLE MEDICINE 2020. [DOI: 10.1002/lim2.3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Wasim Baqir
- Northumbria Healthcare NHS Foundation Trust Wansbeck General Hospital Ashington United Kingdom
| | - William K. Gray
- Northumbria Healthcare NHS Foundation Trust Wansbeck General Hospital Ashington United Kingdom
| | | | - Shona Haining
- North of England Commissioning Support (NECS) Newcastle United Kingdom
| | - Fraser Birrell
- Centre for Integrated Research into Musculoskeletal Ageing Newcastle University Newcastle upon Tyne United Kingdom
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Sanftenberg L, Brombacher F, Schelling J, Klug SJ, Gensichen J. Increasing Influenza Vaccination Rates in People With Chronic Illness. DEUTSCHES ARZTEBLATT INTERNATIONAL 2020; 116:645-652. [PMID: 31617479 DOI: 10.3238/arztebl.2019.0645] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 04/02/2019] [Accepted: 06/28/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND The safety and efficacy of influenza vaccination for the chronically ill are clearly supported by the evidence, yet vaccination rates in this vulnerable popu- lation remain low. This leads to many avoidable hospitalizations and deaths in Germany every year. The goal of this systematic review is to identify measures in primary care medicine that can be used to increase influenza vaccination rates among the chronically ill. METHODS This review was carried out as recommended in the PRISMA statement. A systematic literature search was performed. Only randomized, controlled trials were included in the analysis. Details can be found in the study protocol (PROSPERO, CRD42018114163). RESULTS 15 trials were included in the analysis. Training sessions for medical practice teams focusing on a particular disease raised the vaccination rates by as much as 22%. A financial incentive had the greatest effect (relative risk [RR]: 2.79; 95% confidence interval: [1.18; 6.62]). Reminders via text message yielded a maximum 3.8% absolute increase in vaccination rates. Complex interventions were not found to be of any greater benefit than simple ones. CONCLUSION A variety of approaches can be effective. Focusing training sessions for medical practice teams on certain diseases may be of greater benefit than vacci- nation-centered training sessions. Reminder systems for doctors should be more reliably implemented. Simple strategies are perhaps the most suitable ones in the heterogeneous population of chronically ill persons. The limitations of this system- atic review include the heterogeneity of the studies that we examined and the small number of studies in each category.
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Zhang X, Foo S, Majid S, Chang YK, Dumaual HTJ, Suri VR. Self-Care and Health-Information-Seeking Behaviours of Diabetic Patients in Singapore. HEALTH COMMUNICATION 2020; 35:994-1003. [PMID: 31303050 DOI: 10.1080/10410236.2019.1606134] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patients in Singapore with chronic conditions such as diabetes are encouraged to participate in patient-professional partnership activities because of rising health care costs and a shortage of infrastructure and human resources. This study explores the self-care and health information seeking behaviors of diabetic patients in Singapore, as well as factors related to health and information carriers that might influence those behaviors. A pilot-tested online survey was developed based on the Comprehensive Model of Information Seeking (CMIS) and notified to the members of the Diabetic Society of Singapore (DSS) through their newsletter in January 2016. In total, 60 usable responses from the DSS members were collected. The survey revealed that more than 30% of the patients did not strictly follow doctors' instructions to regularly exercise, self-monitor blood sugar, and pay attention to type of food prepared at home. However, it was found that the majority of them had consciously limited their sugar intake. It was also revealed that respondents' most frequently used sources of health information were authoritative sources such as doctors/nurses and pamphlets/leaflets from hospitals/clinics. Understandably, respondents experiencing less distress caused by diabetes tended to report better health status, less worries, and stronger beliefs in the efficacy of their methods for diabetes control.
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Affiliation(s)
- Xue Zhang
- Wee Kim Wee School of Communication & Information', Nanyang Technological University
| | - Schubert Foo
- Wee Kim Wee School of Communication & Information', Nanyang Technological University
| | - Shaheen Majid
- Wee Kim Wee School of Communication & Information', Nanyang Technological University
| | - Yun-Ke Chang
- Computer Information Sciences Division, Higher College of Technology
| | | | - Venkata Ratnadeep Suri
- Department of Social Sciences and Humanities, Indraprastha Institute of Information Technology Delhi
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Ee C, de Courten B, Avard N, de Manincor M, Al-Dabbas MA, Hao J, McBride K, Dubois S, White RL, Fleming C, Egger G, Blair A, Stevens J, MacMillan F, Deed G, Grant S, Templeman K, Chang D. Shared Medical Appointments and Mindfulness for Type 2 Diabetes-A Mixed-Methods Feasibility Study. Front Endocrinol (Lausanne) 2020; 11:570777. [PMID: 33123089 PMCID: PMC7573307 DOI: 10.3389/fendo.2020.570777] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 09/10/2020] [Indexed: 01/22/2023] Open
Abstract
INTRODUCTION Type 2 diabetes (T2DM) is a major health concern with significant personal and healthcare system costs. There is growing interest in using shared medical appointments (SMAs) for management of T2DM. We hypothesize that adding mindfulness to SMAs may be beneficial. This study aimed to assess the feasibility and acceptability of SMAs with mindfulness for T2DM within primary care in Australia. MATERIALS AND METHODS We conducted a single-blind randomized controlled feasibility study of SMAs within primary care for people with T2DM living in Western Sydney, Australia. People with T2DM, age 21 years and over, with HbA1c > 6.5% or fasting glucose >7.00 mmol/L within the past 3 months were eligible to enroll. The intervention group attended six 2-h programmed SMAs (pSMAs) which were held fortnightly. pSMAs included a structured education program and mindfulness component. The control group received usual care from their healthcare providers. We collected quantitative and qualitative data on acceptability as well as glycemic control (glycated hemoglobin and continuous glucose monitoring), lipids, anthropometric measures, blood pressure, self-reported psychological outcomes, quality of life, diet, and physical activity using an ActiGraph accelerometer. RESULTS Over a 2-month period, we enrolled 18 participants (10 females, 8 males) with a mean age of 58 years (standard deviation 9.8). We had 94.4% retention. All participants in the intervention group completed at least four pSMAs. Participants reported that attending pSMAs had been a positive experience that allowed them to accept their diagnosis and empowered them to make changes, which led to beneficial effects including weight loss and better glycemic control. Four pSMA participants found the mindfulness component helpful while two did not. All of the seven participants who contributed to qualitative evaluation reported improved psychosocial wellbeing and found the group setting beneficial. There was a significant difference in total cholesterol levels at 12 weeks between groups (3.86 mmol/L in intervention group vs. 4.15 mmol/L in the control group; p = 0.025) as well as pain intensity levels as measured by the PROMIS-29 (2.11 vs. 2.38; p = 0.034). CONCLUSION pSMAs are feasible and acceptable to people with T2DM and may result in clinical improvement. A follow-up fully-powered randomized controlled trial is warranted. CLINICAL TRIAL REGISTRATION Australia and New Zealand Clinical Trial Registry, identifier ACTRN12619000892112.
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Affiliation(s)
- Carolyn Ee
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- *Correspondence: Carolyn Ee, ; Dennis Chang,
| | - Barbora de Courten
- Department of Medicine, School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
| | - Nicole Avard
- Next Practice Health, Erina, Sydney, NSW, Australia
| | - Michael de Manincor
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Mahmoud A. Al-Dabbas
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Jie Hao
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kate McBride
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- School of Medicine, Western Sydney University, Penrith, NSW, Australia
| | - Shamieka Dubois
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Rhiannon Lee White
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Catharine Fleming
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Garry Egger
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | | | - John Stevens
- School of Health and Human Sciences, Southern Cross University, Lismore, NSW, Australia
| | - Freya MacMillan
- Translational Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- School of Health Sciences, Western Sydney University, Penrith, NSW, Australia
| | - Gary Deed
- Mediwell Clinic, Brisbane, QLD, Australia
| | - Suzanne Grant
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Kate Templeman
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
| | - Dennis Chang
- NICM Health Research Institute, Western Sydney University, Penrith, NSW, Australia
- *Correspondence: Carolyn Ee, ; Dennis Chang,
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Kakareka R, Stone TA, Plsek P, Imamura A, Hwang E. Fresh and Savory: Integrating Teaching Kitchens with Shared Medical Appointments. J Altern Complement Med 2019; 25:709-718. [PMID: 31314556 DOI: 10.1089/acm.2019.0091] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Objectives: In the fall of 2017, Fresh and Savory, a Culinary and Lifestyle Medicine Teaching Kitchen (TK) program proved systematically feasible as a Shared Medical Appointment (SMA). A portable TK complemented physician consultations, interactive didactic presentations, nutritious cooking, and mind-body exercises. A series of SMAs were launched to develop a system for physicians to address patients' nutritional and lifestyle needs. Interventions: MedStar Health implemented three TK SMA programs to improve patients culinary and lifestyle skills and improve relevant habits. Two cohorts were recruited from Internal Medicine and Cardiology (Internal Medicine/Cardiology I and II) and completed an 8-week program leveraging a culinary and lifestyle medicine curriculum. One cohort (Sports Performance) was held with young, elite athletes completing a 4-week program regarding athlete's nutrition and lifestyle. Feasibility was assessed through patient surveys, staff program operation assessments, and reimbursement. Results: Fifty-three unique patients attended SMA programs, 4-18 patients per weekly session; 223 appointments billed in 2018. E&M code 99213 was billed at $157 and reimbursed, on average, at $116 per patient encounter. During a 4- to 8-week SMA program, changes in patient vitals were statistically insignificant, yet habit changes showed clinical significance. Patients noted increased knowledge of plant-based meals, importance of sleep, and adding mindfulness and exercise to their weekly routine. Conclusions: This exploration investigated the feasibility to implement TK SMA programs at MedStar Health. Developing financial and operational infrastructure for TK SMAs requires financial, staffing, location, and population considerations. TK SMAs proved patient demand for opportunities to develop healthy behaviors. However, sufficient time is required to recruit patients. Vital signs may not acutely improve over an 8-week period, however, small habit changes may improve health outcomes longitudinally and additional exploration is required to assess longitudinal patient outcomes. Financially, SMAs suggest a sustainable and effective approach to integrative medicine in health care.
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Affiliation(s)
- Renee Kakareka
- 1MedStar Health, MedStar Institute for Innovation, Washington, D.C
| | - Theresa A Stone
- 2MedStar Health, MedStar Lafayette Center Internal Medicine, Washington, D.C
| | - Paul Plsek
- 1MedStar Health, MedStar Institute for Innovation, Washington, D.C
| | - Anthony Imamura
- 1MedStar Health, MedStar Institute for Innovation, Washington, D.C
| | - Ellie Hwang
- 1MedStar Health, MedStar Institute for Innovation, Washington, D.C
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Effectiveness of group visits for elderly patients with type 2 diabetes in an urban community in China. Geriatr Nurs 2019; 41:229-235. [PMID: 31679812 DOI: 10.1016/j.gerinurse.2019.10.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2019] [Revised: 10/05/2019] [Accepted: 10/08/2019] [Indexed: 10/25/2022]
Abstract
The purpose of this study is to evaluate the effectiveness of a group visit intervention in comparison with the usual care for elderly patients with type 2 diabetes in a community. We randomized 109 community elderly patients with type 2 diabetes to the intervention group (n = 55) of monthly group visits sessions or to a control group (n = 54) of usual care. Repeated measures analysis of variance was used to compare the changes in HbA1C, diabetes knowledge, self-efficacy, and self-management behavior in both groups. At the 6-month follow-up, although no significant difference was observed between the groups regarding HbA1C (p = 0.272). Diabetes knowledge, self-efficacy and self-management scores were higher in patients in the intervention group than that in the control group (p < 0.05). The group visits model increased diabetes knowledge and self-efficacy and improved patients' self-management behavior. The model was found suitable for helping these elderly patients with type 2 diabetes achieve effective self-management.
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Butterworth JE, Hays R, McDonagh STJ, Richards SH, Bower P, Campbell J. Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations. Cochrane Database Syst Rev 2019; 2019:CD013124. [PMID: 31684697 PMCID: PMC6815935 DOI: 10.1002/14651858.cd013124.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Older patients with multiple health problems (multi-morbidity) value being involved in decision-making about their health care. However, they are less frequently involved than younger patients. To maximise quality of life, day-to-day function, and patient safety, older patients require support to identify unmet healthcare needs and to prioritise treatment options. OBJECTIVES To assess the effects of interventions for older patients with multi-morbidity aiming to involve them in decision-making about their health care during primary care consultations. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; all years to August 2018), in the Cochrane Library; MEDLINE (OvidSP) (1966 to August 2018); Embase (OvidSP) (1988 to August 2018); PsycINFO (OvidSP) (1806 to August 2018); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Ovid) (1982 to September 2008), then in Ebsco (2009 to August 2018); Centre for Reviews and Dissemination Databases (Database of Abstracts and Reviews of Effects (DARE)) (all years to August 2018); the Health Technology Assessment (HTA) Database (all years to August 2018); the Ongoing Reviews Database (all years to August 2018); and Dissertation Abstracts International (1861 to August 2018). SELECTION CRITERIA We sought randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs of interventions to involve patients in decision-making about their health care versus usual care/control/another intervention, for patients aged 65 years and older with multi-morbidity in primary care. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Meta-analysis was not possible; therefore we prepared a narrative synthesis. MAIN RESULTS We included three studies involving 1879 participants: two RCTs and one cluster-RCT. Interventions consisted of: · patient workshop and individual coaching using behaviour change techniques; · individual patient coaching utilising cognitive-behavioural therapy and motivational interviewing; and · holistic patient review, multi-disciplinary practitioner training, and organisational change. No studies reported the primary outcome 'patient involvement in decision-making' or the primary adverse outcome 'less patient involvement as a result of the intervention'. Comparing interventions (patient workshop and individual coaching, holistic patient review plus practitioner training, and organisational change) to usual care: we are uncertain whether interventions had any effect on patient reports of high self-rated health (risk ratio (RR) 1.40, 95% confidence interval (CI) 0.36 to 5.49; very low-certainty evidence) or on patient enablement (mean difference (MD) 0.60, 95% CI -9.23 to 10.43; very low-certainty evidence) compared with usual care. Interventions probably had no effect on health-related quality of life (adjusted difference in means 0.00, 95% CI -0.02 to 0.02; moderate-certainty evidence) or on medication adherence (MD 0.06, 95% CI -0.05 to 0.17; moderate-certainty evidence) but probably improved the number of patients discussing their priorities (adjusted odds ratio 1.85, 95% CI 1.44 to 2.38; moderate-certainty evidence) and probably increased the number of nurse consultations (incident rate ratio from adjusted multi-level Poisson model 1.37, 95% CI 1.17 to 1.61; moderate-certainty evidence) compared with usual care. Practitioner outcomes were not measured. Interventions were not reported to adversely affect rates of participant death or anxiety, emergency department attendance, or hospital admission compared with usual care. Comparing interventions (patient workshop and coaching, individual patient coaching) to attention-control conditions: we are uncertain whether interventions affect patient-reported high self-rated health (RR 0.38, 95% CI 0.15 to 1.00, favouring attention control, with very low-certainty evidence; RR 2.17, 95% CI 0.85 to 5.52, favouring the intervention, with very low-certainty evidence). We are uncertain whether interventions affect patient enablement and engagement by increasing either patient activation (MD 1.20, 95% CI -8.21 to 10.61; very low-certainty evidence) or self-efficacy (MD 0.29, 95% CI -0.21 to 0.79; very low-certainty evidence); or whether interventions affect the number of general practice visits (MD 0.51, 95% CI -0.34 to 1.36; very low-certainty evidence), compared to attention-control conditions. The intervention may however lead to more patient-reported changes in management of their health conditions (RR 1.82, 95% CI 1.35 to 2.44; low-certainty evidence). Practitioner outcomes were not measured. Interventions were not reported to adversely affect emergency department attendance nor hospital admission when compared with attention control. Comparing one form of intervention with another: not measured. There was 'unclear' risk across studies for performance bias, detection bias, and reporting bias; however, no aspects were 'high' risk. Evidence was downgraded via GRADE, most often because of 'small sample size' and 'evidence from a single study'. AUTHORS' CONCLUSIONS Limited available evidence does not allow a robust conclusion regarding the objectives of this review. Whilst patient involvement in decision-making is seen as a key mechanism for improving care, it is rarely examined as an intervention and was not measured by included studies. Consistency in design, analysis, and evaluation of interventions would enable a greater likelihood of robust conclusions in future reviews.
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Affiliation(s)
- Joanne E Butterworth
- University of Exeter Medical SchoolUniversity of Exeter Collaboration for Academic Primary Care (APEx)Smeall BuildingSt Luke's CampusExeterDevonUKEX1 2LU
| | - Rebecca Hays
- University of ManchesterNIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care5th Floor, Williamson BuildingOxford RoadManchesterUKM13 9PL
| | - Sinead TJ McDonagh
- University of Exeter Medical SchoolUniversity of Exeter Collaboration for Academic Primary Care (APEx)Smeall BuildingSt Luke's CampusExeterDevonUKEX1 2LU
| | - Suzanne H Richards
- University of LeedsLeeds Institute of Health SciencesCharles Thackrah Building101 Clarendon RoadLeedsUKLS2 9LJ
| | - Peter Bower
- University of ManchesterNIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care5th Floor, Williamson BuildingOxford RoadManchesterUKM13 9PL
| | - John Campbell
- University of Exeter Medical SchoolUniversity of Exeter Collaboration for Academic Primary Care (APEx)Smeall BuildingSt Luke's CampusExeterDevonUKEX1 2LU
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Zijlstra WT, Os‐Medendorp H, Fieten KB, Sinnema G, Bruijnzeel‐Koomen CAFM, Zuithoff NPA, L'Hoir MP, Pasmans SGMA. Effects of shared medical appointments compared to individual appointments in children with atopic dermatitis: A pragmatic randomized controlled trial. Clin Exp Allergy 2019; 49:1095-1106. [DOI: 10.1111/cea.13416] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 04/02/2019] [Accepted: 04/10/2019] [Indexed: 01/09/2023]
Affiliation(s)
- Wieneke T. Zijlstra
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
- Department of Pediatrics OLVG Amsterdam Amsterdam The Netherlands
| | - Harmieke Os‐Medendorp
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
| | - Karin B. Fieten
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
| | - Gerben Sinnema
- Department of Pediatric Psychology and Social Work, Wilhelmina Children's Hospital University Medical Center Utrecht Utrecht The Netherlands
| | | | - Nicolaas P. A. Zuithoff
- Julius Center for Health Sciences and Primary Care University Medical Center Utrecht Utrecht The Netherlands
| | - Monique P. L'Hoir
- Human Nutrition Wageningen University & Research (WUR) Wageningen The Netherlands
| | - Suzanne G. M. A. Pasmans
- Department of Dermatology and Allergology University Medical Centre Utrecht Utrecht The Netherlands
- Department of Pediatric Dermatology, Sophia Children's Hospital Erasmus University Medical Centre Rotterdam The Netherlands
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Wadsworth KH, Archibald TG, Payne AE, Cleary AK, Haney BL, Hoverman AS. Shared medical appointments and patient-centered experience: a mixed-methods systematic review. BMC FAMILY PRACTICE 2019; 20:97. [PMID: 31286876 PMCID: PMC6615093 DOI: 10.1186/s12875-019-0972-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Accepted: 05/31/2019] [Indexed: 12/25/2022]
Abstract
Background Shared medical appointments (SMAs), or group visits, are a healthcare delivery method with the potential to improve chronic disease management and preventive care. In this review, we sought to better understand opportunities, barriers, and limitations to SMAs based on patient experience in the primary care context. Methods An experienced biomedical librarian conducted literature searches of PubMed, Cochrane Library, PsycINFO, CINAHL, Web of Science, ClinicalTrials.gov, and SSRN for peer-reviewed publications published 1997 or after. We searched grey literature, nonempirical reports, social science publications, and citations from published systematic reviews. The search yielded 1359 papers, including qualitative, quantitative, and mixed method studies. Categorization of the extracted data informed a thematic synthesis. We did not perform a formal meta-analysis. Results Screening and quality assessment yielded 13 quantitative controlled trials, 11 qualitative papers, and two mixed methods studies that met inclusion criteria. We identified three consistent models of care: cooperative health care clinic (five articles), shared medical appointment / group visit (10 articles) and group prenatal care / CenteringPregnancy® (11 articles). Conclusions SMAs in a variety of formats are increasingly employed in primary care settings, with no singular gold standard. Accepting and implementing this nontraditional approach by both patients and clinicians can yield measurable improvements in patient trust, patient perception of quality of care and quality of life, and relevant biophysical measurements of clinical parameters. Further refinement of this healthcare delivery model will be best driven by standardizing measures of patient satisfaction and clinical outcomes. Electronic supplementary material The online version of this article (10.1186/s12875-019-0972-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kim H Wadsworth
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA.
| | - Trevor G Archibald
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA
| | - Allison E Payne
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA
| | - Anita K Cleary
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA
| | - Byron L Haney
- Pacific Northwest University of Health Sciences, College of Osteopathic Medicine, Yakima, WA, USA.,Family Health Care of Ellensburg, Ellensburg, WA, USA
| | - Adam S Hoverman
- Multnomah County Health Department, Oregon Health and Science University-Portland State University School of Public Health, Portland, OR, USA
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Fallon M, Haynes L, Cadet T, Petrosino S, Cazeau E, Solis J, Cox J, Wu AC, Holder-Niles FF. A Group Visit for High-Risk Pediatric Asthma Patients: A Quality Improvement Initiative to Improve Asthma Care. Clin Pediatr (Phila) 2019; 58:746-751. [PMID: 30938184 DOI: 10.1177/0009922819839238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Asthma disproportionately affects poor and minority children. Limited parental knowledge and confidence in asthma management, as well as stress from chronic illness, may contribute to poor outcomes. Novel approaches for providing care are essential for this vulnerable population. Our objective was to evaluate the feasibility and impact of an asthma group visit for high-risk children. METHODS Our primary care practice cares for more than 2600 children with asthma. The majority have public insurance. Children classified as high risk (≥1 asthma-related emergency department visit/hospitalization in the preceding 2 years) were eligible. Children received brief physical examinations, medication review, and updated Asthma Action Plans. Educational sessions were held for children and parents. Pre and post surveys were used to assess parents' experience and changes in confidence in asthma management. RESULTS Twenty children and their parents participated. Mean parent confidence scores (5-point Likert-type scale, 5 indicating greatest confidence) improved in managing their child's asthma symptoms (3.60, 4.40, P ≤ .005), managing their child's asthma medications (3.85, 4.30, P ≤ .005), using their child's Asthma Action Plan (3.79, 4.45, P ≤ .02), communicating with the school about their child's food allergies (4.32, 4.72, P ≤ .03), and helping their child relax to reduce emotional triggers of asthma (3.25, 4.47, P ≤ .01). All families reported that they would return to a group visit. CONCLUSION Group visits are feasible for providing care, education, and peer support to a vulnerable population. Parents expressed satisfaction and improved confidence in aspects of asthma management. Group visits have the potential to improve asthma outcomes for high-risk families.
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Affiliation(s)
- Margaret Fallon
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | | | | | | | | | | | - Joanne Cox
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
| | - Ann Chen Wu
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA.,3 Center for Healthcare Research in Pediatrics (CHeRP), Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Faye F Holder-Niles
- 1 Boston Children's Hospital, Boston, MA, USA.,2 Harvard Medical School, Boston, MA, USA
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Jones T, Darzi A, Egger G, Ickovics J, Noffsinger E, Ramdas K, Stevens J, Sumego M, Birrell F. PROCESS AND SYSTEMS: A systems approach to embedding group consultations in the NHS. Future Healthc J 2019; 6:8-16. [PMID: 31098579 PMCID: PMC6520080 DOI: 10.7861/futurehosp.6-1-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Group consultations are an important care option that is -starting to gain traction in the USA and Australia. This review summarises the likely benefits accruing from a systems -approach to implementing group consultations widely in the NHS and other socialised healthcare systems. Existing evidence is mapped to five distinct systems approaches: (1) development; (2) different age groups; (3) patient-centred pathway of care; (4) NHS system changes; and (5) education. Implications are discussed for patients and staff, who both benefit from group consultations once embedded; ranging from improved access and efficiency to more enjoyable multidisciplinary team working, improved resource management, and maintained/better outcomes. Moreover, even patients who don't attend group consultations can benefit from system effects of long-term implementation. Changing behaviour and health systems is challenging, but change requires systematic experimentation and documentation of evidence. We conclude that group consultations have unique potential for delivering system-wide benefits across the NHS.
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Affiliation(s)
- Tania Jones
- Institute of Health & Society, Newcastle University, Newcastle upon Tyne
| | | | | | | | | | | | | | | | - Fraser Birrell
- Newcastle University, Newcastle, UK
- Northumbria Healthcare NHS Foundation Trust, Northumberland, UK
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25
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Thomas RE, Lorenzetti DL. Interventions to increase influenza vaccination rates of those 60 years and older in the community. Cochrane Database Syst Rev 2018; 5:CD005188. [PMID: 29845606 PMCID: PMC6494593 DOI: 10.1002/14651858.cd005188.pub4] [Citation(s) in RCA: 60] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The effectiveness of interventions to increase influenza vaccination uptake in people aged 60 years and older varies by country and participant characteristics. This review updates versions published in 2010 and 2014. OBJECTIVES To assess access, provider, system, and societal interventions to increase the uptake of influenza vaccination in people aged 60 years and older in the community. SEARCH METHODS We searched CENTRAL, which includes the Cochrane Acute Respiratory Infections Group's Specialised Register, MEDLINE, Embase, CINAHL, and ERIC for this update, as well as WHO ICTRP and ClinicalTrials.gov for ongoing studies to 7 December 2017. We also searched the reference lists of included studies. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-randomised trials of interventions to increase influenza vaccination in people aged 60 years or older in the community. DATA COLLECTION AND ANALYSIS We used standard methodological procedures as specified by Cochrane. MAIN RESULTS We included three new RCTs for this update (total 61 RCTs; 1,055,337 participants). Trials involved people aged 60 years and older living in the community in high-income countries. Heterogeneity limited some meta-analyses. We assessed studies as at low risk of bias for randomisation (38%), allocation concealment (11%), blinding (44%), and selective reporting (100%). Half (51%) had missing data. We assessed the evidence as low-quality. We identified three levels of intervention intensity: low (e.g. postcards), medium (e.g. personalised phone calls), and high (e.g. home visits, facilitators).Increasing community demand (12 strategies, 41 trials, 53 study arms, 767,460 participants)One successful intervention that could be meta-analysed was client reminders or recalls by letter plus leaflet or postcard compared to reminder (odds ratio (OR) 1.11, 95% confidence interval (CI) 1.07 to 1.15; 3 studies; 64,200 participants). Successful interventions tested by single studies were patient outreach by retired teachers (OR 3.33, 95% CI 1.79 to 6.22); invitations by clinic receptionists (OR 2.72, 95% CI 1.55 to 4.76); nurses or pharmacists educating and nurses vaccinating patients (OR 152.95, 95% CI 9.39 to 2490.67); medical students counselling patients (OR 1.62, 95% CI 1.11 to 2.35); and multiple recall questionnaires (OR 1.13, 95% CI 1.03 to 1.24).Some interventions could not be meta-analysed due to significant heterogeneity: 17 studies tested simple reminders (11 with 95% CI entirely above unity); 16 tested personalised reminders (12 with 95% CI entirely above unity); two investigated customised compared to form letters (both 95% CI above unity); and four studies examined the impact of health risk appraisals (all had 95% CI above unity). One study of a lottery for free groceries was not effective.Enhancing vaccination access (6 strategies, 8 trials, 10 arms, 9353 participants)We meta-analysed results from two studies of home visits (OR 1.30, 95% CI 1.05 to 1.61) and two studies that tested free vaccine compared to patient payment for vaccine (OR 2.36, 95% CI 1.98 to 2.82). We were unable to conduct meta-analyses of two studies of home visits by nurses plus a physician care plan (both with 95% CI above unity) and two studies of free vaccine compared to no intervention (both with 95% CI above unity). One study of group visits (OR 27.2, 95% CI 1.60 to 463.3) was effective, and one study of home visits compared to safety interventions was not.Provider- or system-based interventions (11 strategies, 15 trials, 17 arms, 278,524 participants)One successful intervention that could be meta-analysed focused on payments to physicians (OR 2.22, 95% CI 1.77 to 2.77). Successful interventions tested by individual studies were: reminding physicians to vaccinate all patients (OR 2.47, 95% CI 1.53 to 3.99); posters in clinics presenting vaccination rates and encouraging competition between doctors (OR 2.03, 95% CI 1.86 to 2.22); and chart reviews and benchmarking to the rates achieved by the top 10% of physicians (OR 3.43, 95% CI 2.37 to 4.97).We were unable to meta-analyse four studies that looked at physician reminders (three studies with 95% CI above unity) and three studies of facilitator encouragement of vaccination (two studies with 95% CI above unity). Interventions that were not effective were: comparing letters on discharge from hospital to letters to general practitioners; posters plus postcards versus posters alone; educational reminders, academic detailing, and peer comparisons compared to mailed educational materials; educational outreach plus feedback to teams versus written feedback; and an intervention to increase staff vaccination rates.Interventions at the societal levelNo studies reported on societal-level interventions.Study funding sourcesStudies were funded by government health organisations (n = 33), foundations (n = 9), organisations that provided healthcare services in the studies (n = 3), and a pharmaceutical company offering free vaccines (n = 1). Fifteen studies did not report study funding sources. AUTHORS' CONCLUSIONS We identified interventions that demonstrated significant positive effects of low (postcards), medium (personalised phone calls), and high (home visits, facilitators) intensity that increase community demand for vaccination, enhance access, and improve provider/system response. The overall GRADE assessment of the evidence was moderate quality. Conclusions are unchanged from the 2014 review.
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Affiliation(s)
- Roger E Thomas
- University of CalgaryDepartment of Family Medicine, Faculty of MedicineHealth Sciences Centre3330 Hospital Drive NWCalgaryABCanadaT2N 4N1
| | - Diane L Lorenzetti
- Faculty of Medicine, University of CalgaryDepartment of Community Health Sciences3rd Floor TRW3280 Hospital Drive NWCalgaryABCanadaT2N 4Z6
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Rasmussen GS, Kragballe K, Maindal HT, Lomborg K. Experience of Being Young With Psoriasis: Self-Management Support Needs. QUALITATIVE HEALTH RESEARCH 2018; 28:73-86. [PMID: 29192872 DOI: 10.1177/1049732317737311] [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: 06/07/2023]
Abstract
Psoriasis is a long-term condition with a possibly cumulative life course impairment. Young people struggle to minimize its effects on appearance and functioning. To date, the self-management needs of adolescents suffering from psoriasis have been underinvestigated. Using focus groups and individual interviews, we present an interpretive description of young people's experiences of living with psoriasis, the challenges they face, and the support they need to relieve suffering and come to terms with their condition. This process is characterized by loneliness, the self-imposition of limitations, and the lack of personalized knowledge and communication skills to manage the impact of disease and society's reactions. Our study provides insight into needs of early interventions tailored to address condition, role, and emotional management, involving parent education, peer support, storytelling, and roles for professionals. We argue that further research should involve young people, their parents, and professionals in the development and evaluation of interventions.
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Affiliation(s)
| | | | | | - Kirsten Lomborg
- 2 Aarhus University, Aarhus, Denmark
- 4 Metropolitan University College, Copenhagen, Denmark
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Affiliation(s)
- Valerie S. Ganetsky
- Philadelphia College of Pharmacy, University of the Sciences, Philadelphia, PA
| | | | - Steven T. Kaufman
- Cooper University Hospital Urban Health Institute, Camden, NJ
- Cooper Medical School of Rowan University, Camden, NJ
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Domek GJ, Macdonald B, Cooper C, Cunningham M, Abdel-Maksoud M, Berman S. Group based learning among caregivers: assessing mothers' knowledge before and after an early childhood intervention in rural Guatemala. Glob Health Promot 2017; 26:61-69. [PMID: 28805505 DOI: 10.1177/1757975917714287] [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: 11/17/2022]
Abstract
BACKGROUND The first three years of a child's life are a critical period for brain growth and development. Caregiver interventions during this period that improve early childhood health and development have the potential to enhance a child's physical, mental, and social well-being. METHODS This was a pretest/posttest quasi experimental program evaluation. Early childhood education materials were adapted to create two separate interventions consisting of 30-page interactive flipchart talks to educate mothers on health and development topics relevant to 0-6 and 6-12 month old children. Three community health workers performed the talks with groups of 5-8 mothers. Short learning assessments were given individually to each mother pre-intervention (pretest), immediately post-intervention (posttest 1), and two weeks post-intervention (posttest 2). Demographic surveys and focus group discussions were conducted with all participants. RESULTS Mothers (n = 77) had an average age of 33.6 years and had an average of 3.6 living children. Most of the mothers (71%) had received some primary education, but 23% had received no formal schooling. For the 0-6 months flipchart learning assessment (n = 38), the mean pretest score was 77% correct. The mean posttest 1 score improved to 87% (p < 0.0001), and the mean posttest 2 score improved further from the mean posttest 1 score to 90% (p = 0.01). For the 6-12 months flipchart learning assessment (n = 39), the mean pretest score was 78%. The mean posttest 1 score improved to 89% (p < 0.0001), and the mean posttest 2 score improved further from the mean posttest 1 score to 92% (p = 0.03). CONCLUSIONS Mothers in an impoverished region of southwestern Guatemala significantly increased their knowledge about child health topics following a short interactive group talk. Mothers further increased their knowledge two weeks after the intervention, without specific re-exposure to the intervention materials, suggesting assimilation and informal reinforcement through group based learning with other mothers in their community.
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Affiliation(s)
- Gretchen J Domek
- 1 Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,2 Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | | | | | - Maureen Cunningham
- 1 Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,2 Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
| | - Madiha Abdel-Maksoud
- 1 Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,2 Center for Global Health, Colorado School of Public Health, Aurora, CO, USA.,4 Department of Epidemiology, Colorado School of Public Health, Aurora, CO, USA
| | - Stephen Berman
- 1 Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.,2 Center for Global Health, Colorado School of Public Health, Aurora, CO, USA
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Vedanthan R, Kamano JH, Lee H, Andama B, Bloomfield GS, DeLong AK, Edelman D, Finkelstein EA, Hogan JW, Horowitz CR, Manyara S, Menya D, Naanyu V, Pastakia SD, Valente TW, Wanyonyi CC, Fuster V. Bridging Income Generation with Group Integrated Care for cardiovascular risk reduction: Rationale and design of the BIGPIC study. Am Heart J 2017; 188:175-185. [PMID: 28577673 DOI: 10.1016/j.ahj.2017.03.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Accepted: 03/17/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with >80% of CVD deaths occurring in low and middle income countries (LMICs). Diabetes mellitus and pre-diabetes are risk factors for CVD, and CVD is the major cause of morbidity and mortality among individuals with DM. There is a critical period now during which reducing CVD risk among individuals with diabetes and pre-diabetes may have a major impact. Cost-effective, culturally appropriate, and context-specific approaches are required. Two promising strategies to improve health outcomes are group medical visits and microfinance. METHODS/DESIGN This study tests whether group medical visits integrated into microfinance groups are effective and cost-effective in reducing CVD risk among individuals with diabetes or at increased risk for diabetes in western Kenya. An initial phase of qualitative inquiry will assess contextual factors, facilitators, and barriers that may impact integration of group medical visits and microfinance for CVD risk reduction. Subsequently, we will conduct a four-arm cluster randomized trial comparing: (1) usual clinical care, (2) usual clinical care plus microfinance groups only, (3) group medical visits only, and (4) group medical visits integrated into microfinance groups. The primary outcome measure will be 1-year change in systolic blood pressure, and a key secondary outcome measure is 1-year change in overall CVD risk as measured by the QRISK2 score. We will conduct mediation analysis to evaluate the influence of changes in social network characteristics on intervention outcomes, as well as moderation analysis to evaluate the influence of baseline social network characteristics on effectiveness of the interventions. Cost-effectiveness analysis will be conducted in terms of cost per unit change in systolic blood pressure, percent change in CVD risk score, and per disability-adjusted life year saved. DISCUSSION This study will provide evidence regarding effectiveness and cost-effectiveness of interventions to reduce CVD risk. We aim to produce generalizable methods and results that can provide a model for adoption in low-resource settings worldwide.
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Abstract
Heart failure presents unique challenges to the clinician who desires to provide excellent and humane care near the end of life. Accurate prediction of mortality in the individual patient is complicated by a chronic disease that is punctuated by recurrent acute episodes and sudden death. Health care providers continue to have difficulty communicating effectively with terminally ill patients and their caregivers regarding end-of-life care preferences, all of which needs to occur earlier rather than later. This article also discusses various means of providing palliative care, and specific issues regarding device therapy, cardiopulmonary resuscitation, and palliative sedation with concurrent discussion of the ethical ramifications and pitfalls of each.
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Affiliation(s)
- John Arthur McClung
- Division of Cardiology, Westchester Medical Center, New York Medical College, 100 Woods Road, Valhalla, NY 10595, USA.
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Kirsh SR, Aron DC, Johnson KD, Santurri LE, Stevenson LD, Jones KR, Jagosh J. A realist review of shared medical appointments: How, for whom, and under what circumstances do they work? BMC Health Serv Res 2017; 17:113. [PMID: 28160771 PMCID: PMC5291948 DOI: 10.1186/s12913-017-2064-z] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2015] [Accepted: 01/31/2017] [Indexed: 12/22/2022] Open
Abstract
Background Shared medical appointments (SMAs) are doctor-patient visits in which groups of patients are seen by one or more health care providers in a concurrent session. There is a growing interest in understanding the potential benefits of SMAs in various contexts to improve clinical outcomes and reduce healthcare costs. This study builds upon the existing evidence base that suggests SMAs are indeed effective. In this study, we explored how they are effective in terms of the underlying mechanisms of action and under what circumstances. Methods Realist review methodology was used to synthesize the literature on SMAs, which included a broad search of 800+ published articles. 71 high quality primary research articles were retained to build a conceptual model of SMAs and 20 of those were selected for an in depth analysis using realist methodology (i.e.,middle-range theories and and context-mechanism-outcome configurations). Results Nine main mechanisms that serve to explain how SMAs work were theorized from the data immersion process and configured in a series of context-mechanism-outcome configurations (CMOs). These are: (1) Group exposure in SMAs combats isolation, which in turn helps to remove doubts about one’s ability to manage illness; (2) Patients learn about disease self-management vicariously by witnessing others’ illness experiences; (3) Patients feel inspired by seeing others who are coping well; (4) Group dynamics lead patients and providers to developing more equitable relationships; (5) Providers feel increased appreciation and rapport toward colleagues leading to increased efficiency; (6) Providers learn from the patients how better to meet their patients’ needs; (7) Adequate time allotment of the SMA leads patients to feel supported; (8) Patients receive professional expertise from the provider in combination with first-hand information from peers, resulting in more robust health knowledge; and (9) Patients have the opportunity to see how the physicians interact with fellow patients, which allows them to get to know the physician and better determine their level of trust. Conclusions Nine overarching mechanisms were configured in CMO configurations and discussed as a set of complementary middle-range programme theories to explain how SMAs work. It is anticipated that this innovative work in theorizing SMAs using realist review methodology will provide policy makers and SMA program planners adequate conceptual grounding to design contextually sensitive SMA programs in a wide variety of settings and advance an SMA research agenda for varied contexts.
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Affiliation(s)
- Susan R Kirsh
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Aron
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA. .,School of Medicine, Case Western Reserve University, Cleveland, OH, USA. .,Weatherhead School of Management, Case Western Reserve University, Cleveland, OH, USA.
| | - Kimberly D Johnson
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,College of Nursing, University of Cincinnati, Cincinnati, OH, USA
| | - Laura E Santurri
- Louis Stokes Cleveland VA Medical Center, Cleveland, OH, USA.,School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | | | - Katherine R Jones
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Justin Jagosh
- Centre for the Advancement of Realist Evaluation and Synthesis, University of Liverpool, Liverpool, UK
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Shamliyan TA, Khalil DH, Middleton M. Interventions for Community-dwelling Patients with Multiple Chronic Illnesses. Am J Med 2017; 130:148-152. [PMID: 27838377 DOI: 10.1016/j.amjmed.2016.10.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Accepted: 10/19/2016] [Indexed: 11/25/2022]
Affiliation(s)
- Tatyana A Shamliyan
- Senior Director, Evidence-Based Medicine Quality Assurance, Elsevier, 1600 JFK Blvd 20(th) floor, Philadelphia, PA 19103.
| | - Dr Hanan Khalil
- Senior Lecturer/Pharmacist Academic, Faculty of Medicine, Nursing and Health Sciences, Monash Rural Heath, Monash University; Editor-in-Chief- International Journal of Evidence-Based Healthcare
| | - Maria Middleton
- Project Coordinator, Evidence-Based Medicine Center, Elsevier, 1600 JFK Blvd 20(th) floor, Philadelphia, PA 19103
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Martin OJ, Wu WC, Taveira TH, Eaton CB, Sharma SC. Multidisciplinary Group Behavioral and Pharmacologic Intervention for Cardiac Risk Reduction in Diabetes. DIABETES EDUCATOR 2017; 33:118-27. [PMID: 17272798 DOI: 10.1177/0145721706297456] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the effectiveness of a multidisciplinary team providing both education and medication management in a group setting for cardiac risk reduction in patients with diabetes mellitus. METHODS The electronic medical records of patients with diabetes who participated in group behavioral and pharmacologic interventions for cardiac risk reduction during May to October 2002 at the Providence VA Medical Center were reviewed. Forty-one veterans with diabetes mellitus attended the weekly sessions of a diabetes education and intervention program directed by pharmacists for 1 month. Two groups of 15 to 20 patients received four 1.5-hour diabetes self-management education classes provided by a multidisciplinary team consisting of a pharmacist (leader), nurse educator, dietician, physical therapist, and social worker and four 1-hour group medication adjustment sessions provided by the pharmacist. Pharmacists followed medication adjustment algorithms for blood pressure, diabetes, and cholesterol management previously developed in collaboration with physician specialists in the field. Baseline and 3-month after-intervention data were collected for glycosylated hemoglobin A1C (A1C), systolic and diastolic blood pressure (SBP and DBP, respectively), low-density lipoprotein cholesterol, and body mass index. RESULTS Thirty-six patients attended 4 sessions, and 5 patients attended 3 sessions. All parameters improved after the intervention, with significant reductions in A1C (-1.5% +/- 1.0%) and DBP (-5 mm Hg). Reductions were further accentuated when baseline values were abnormal, with significant improvement in A1C (-2.0% +/- 0.5%), SBP (-14 +/- 3 mm Hg), and DBP (-13 +/- 3 mm Hg). CONCLUSIONS Short-term multidisciplinary group behavioral and pharmacologic intervention programs may be effective in improving cardiac risk factors in patients with diabetes.
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Affiliation(s)
- Oanh J Martin
- Pharmacy Service, Veterans Affairs Medical Center, and the Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Providence VA Medical Center, Providence, Rhode Island (Dr Martin)
| | - Wen-Chih Wu
- Medical Service, Veterans Affairs Medical Center, Providence VA Medical Center, and Brown Medical School, Brown University, Providence, Rhode Island (Dr Wu, Dr Sharma)
| | - Tracey H Taveira
- Pharmacy Service, Veterans Affairs Medical Center, and the Department of Pharmacy Practice, University of Rhode Island, College of Pharmacy (Dr Taveira)
| | - Charles B Eaton
- The Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, Rhode Island, and the Department of Family Medicine, Brown Medical School, Brown University, Providence, Rhode Island (Dr Eaton)
| | - Satish C Sharma
- Medical Service, Veterans Affairs Medical Center, Providence VA Medical Center, and Brown Medical School, Brown University, Providence, Rhode Island (Dr Wu, Dr Sharma)
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Goldring AE, Ashok AP, Casey EK, Mulcahey MK. Key components and potential benefits of a comprehensive approach to women's musculoskeletal health. PHYSICIAN SPORTSMED 2016; 44:417-424. [PMID: 27548840 DOI: 10.1080/00913847.2016.1222854] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Over the last 40 years there has been a significant increase in the number of female athletes, as well as a rise in musculoskeletal injuries observed in women. There is sufficient evidence from past medical research identifying various musculoskeletal injuries and conditions that more commonly affect women, such as osteoarthritis, osteoporosis, stress fractures, and anterior cruciate ligament tears. Several women's sports medicine and musculoskeletal health programs have been developed throughout the United States in an attempt to provide more tailored care to the female athlete. The goal of a comprehensive approach to women's musculoskeletal health is to create an interdisciplinary team to facilitate treatment for a variety of injuries and related conditions. This manuscript outlines the musculoskeletal conditions that commonly affect women and highlights the various etiologies of these sex disparities. We discuss the role of interdisciplinary women's musculoskeletal health and sports medicine programs, and define the potential benefits of such an approach. Future studies should focus on assessing the outcomes of multidisciplinary women's sports medicine programs as current literature in this area is lacking.
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Affiliation(s)
- Anne E Goldring
- a Drexel University College of Medicine , Philadelphia , PA , USA
| | - Annie P Ashok
- b Drexel University College of Medicine , Department of Orthopaedic Surgery , Philadelphia , PA , USA
| | - Ellen K Casey
- c Department of Physical Medicine and Rehabilitation , University of Pennsylvania , Philadelphia , PA , USA
| | - Mary K Mulcahey
- b Drexel University College of Medicine , Department of Orthopaedic Surgery , Philadelphia , PA , USA
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Housden L, Wong ST, Browne AJ, Dawes M. Complexities of Introducing Group Medical Visits With Nurse Practitioners in British Columbia. Policy Polit Nurs Pract 2016; 17:198-207. [PMID: 27777335 DOI: 10.1177/1527154416675224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In Canada, increasing numbers of people with chronic conditions have prompted calls for innovative approaches to delivering primary care. These approaches may include group medical visits (GMVs) and the introduction of nurse practitioners (NPs). We examined why NPs in the province of British Columbia were not using GMVs. This case study is part of a larger research project that examined the impact of GMVs with NPs for patients with chronic conditions. We completed open-ended interviews with seven NPs working in primary care. Interviews were audiotaped and transcribed. Data were analyzed using interpretive descriptive approaches. Three major themes emerged: (a) advantages of GMVs, (b) questioning the fit of GMVs in current practice contexts, and (c) navigating scope of practice and role constraints that affect NPs' ability to use GMVs. Power dynamics and hierarchies may influence NPs' ability to adapt to GMVs. Consideration of practice environments and structures that enable the NPs ability to diffuse and utilize health-care innovative care delivery methods is needed.
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Affiliation(s)
- Laura Housden
- 1 School of Nursing, University of British Columbia, Port Moody, Canada
| | - Sabrina T Wong
- 2 School of Nursing and Centre for Health Services and Policy Research, University of British Columbia, Vancouver, Canada
| | - Annette J Browne
- 3 School of Nursing, University of British Columbia, Vancouver, Canada
| | - Martin Dawes
- 4 Department of Family Practice, University Boulevard, Vancouver, BC, Canada
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Lynch M, Estes CL, Hernandez M. Chronic Care Initiatives for the Elderly: Can They Bridge the Gerontology-Medicine Gap? J Appl Gerontol 2016. [DOI: 10.1177/0733464804271455] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The authors describe initiatives designed to meet the chronic health needs of the elderly. These programs include demonstration programs such as Program of All-Inclusive Care for Elderly, Social Health Maintenance Organization, and state programs for Medicare-Medicaid-eligible elders that focus on integrating medical care with home and community-based services, disease- or disability-focused care management/coordination initiatives, and recent population-based disease management programs focused on improving adherence to evidence-based protocols, self-care management, and the use of innovative practices such as group visits to improve health outcomes. These initiatives have the potential to improve outcomes and reduce costs, but also highlight tensions between medical model disease management and functionally oriented home and community service programs. The authors suggest that optimal chronic care for elders would require the integration of advances in medically oriented disease management with the best of home and community-based service programs. Medicare policy should promote such integration.
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Smith SM, Wallace E, O'Dowd T, Fortin M. Interventions for improving outcomes in patients with multimorbidity in primary care and community settings. Cochrane Database Syst Rev 2016; 3:CD006560. [PMID: 26976529 PMCID: PMC6703144 DOI: 10.1002/14651858.cd006560.pub3] [Citation(s) in RCA: 282] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions to improve outcomes for people with multimorbidity. OBJECTIVES To determine the effectiveness of health-service or patient-oriented interventions designed to improve outcomes in people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. SEARCH METHODS We searched MEDLINE, EMBASE, CINAHL and seven other databases to 28 September 2015. We also searched grey literature and consulted experts in the field for completed or ongoing studies. SELECTION CRITERIA Two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised clinical trials (NRCTs), controlled before-after studies (CBAs), and interrupted time series analyses (ITS) evaluating interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. This includes studies where participants can have combinations of any condition or have combinations of pre-specified common conditions (comorbidity), for example, hypertension and cardiovascular disease. The comparison was usual care as delivered in that setting. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data from the included studies, evaluated study quality, and judged the certainty of the evidence using the GRADE approach. We conducted a meta-analysis of the results where possible and carried out a narrative synthesis for the remainder of the results. We present the results in a 'Summary of findings' table and tabular format to show effect sizes across all outcome types. MAIN RESULTS We identified 18 RCTs examining a range of complex interventions for people with multimorbidity. Nine studies focused on defined comorbid conditions with an emphasis on depression, diabetes and cardiovascular disease. The remaining studies focused on multimorbidity, generally in older people. In 12 studies, the predominant intervention element was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In six studies, the interventions were predominantly patient-oriented, for example, educational or self-management support-type interventions delivered directly to participants. Overall our confidence in the results regarding the effectiveness of interventions ranged from low to high certainty. There was little or no difference in clinical outcomes (based on moderate certainty evidence). Mental health outcomes improved (based on high certainty evidence) and there were modest reductions in mean depression scores for the comorbidity studies that targeted participants with depression (standardized mean difference (SMD) -2.23, 95% confidence interval (CI) -2.52 to -1.95). There was probably a small improvement in patient-reported outcomes (moderate certainty evidence) although two studies that specifically targeted functional difficulties in participants had positive effects on functional outcomes with one of these studies also reporting a reduction in mortality at four year follow-up (Int 6%, Con 13%, absolute difference 7%). The intervention may make little or no difference to health service use (low certainty evidence), may slightly improve medication adherence (low certainty evidence), probably slightly improves patient-related health behaviours (moderate certainty evidence), and probably improves provider behaviour in terms of prescribing behaviour and quality of care (moderate certainty evidence). Cost data were limited. AUTHORS' CONCLUSIONS This review identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities in primary care and community settings. There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity in general due to the relatively small number of RCTs conducted in this area to date, with mixed findings overall. It is possible that the findings may change with the inclusion of large ongoing well-organised trials in future updates. The results suggest an improvement in health outcomes if interventions can be targeted at risk factors such as depression, or specific functional difficulties in people with multimorbidity.
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Affiliation(s)
- Susan M Smith
- RCSI Medical SchoolHRB Centre for Primary Care Research, Department of General Practice123 St Stephens GreenDublin 2Ireland
| | - Emma Wallace
- RCSI Medical SchoolHRB Centre for Primary Care Research, Department of General Practice123 St Stephens GreenDublin 2Ireland
| | - Tom O'Dowd
- Trinity College Centre for Health SciencesDepartment of Public Health and Primary CareAdelaide and Meath Hosptials, Incorporating the National Children's HospitalTallaghtDublinIreland24
| | - Martin Fortin
- University of SherbrookeDepartment of Family MedicineUnite de Medicine de famille de Chicoutimi305, St‐Vallier ChicoutimiQuebecCanadaG7H 5H6
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Nurse-Led Multidisciplinary Heart Failure Group Clinic Appointments: Methods, Materials, and Outcomes Used in the Clinical Trial. J Cardiovasc Nurs 2016; 30:S25-34. [PMID: 25774836 DOI: 10.1097/jcn.0000000000000255] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The Self-management and Care of Heart Failure through Group Clinics Trial evaluated the effects of multidisciplinary group clinic appointments on self-care skills and rehospitalizations in high-risk heart failure (HF) patients. OBJECTIVE The purpose of this article is to (1) describe key Self-management and Care of Heart Failure through Group Clinics Trial group clinic interactive learning strategies, (2) describe resources and materials used in the group clinic appointment, and (3) present results supporting this patient-centered group intervention. METHODS This clinical trial included 198 HF patients (randomized to either group clinical appointments or to standard care). Data were collected from 72 group clinic appointments via patients' (1) group clinic session evaluations, (2) HF self-care behaviors skills, (3) HF-related discouragement and quality of life scores, and (4) HF-related reshopitalizations during the 12-month follow-up. Also, the costs of delivery of the group clinical appointments were tabulated. RESULTS Overall, patients rated group appointments as 4.8 of 5 on the "helpfulness" in managing HF score. The statistical model showed a 33% decrease in the rate of rehospitalizations (incidence rate ratio, 0.67) associated with the intervention over the 12-month follow-up period when compared with control patients (χ(2)1=3.9, P=.04). The total cost for implementing 5 group appointments was $243.58 per patient. CONCLUSION The intervention was associated with improvements in HF self-care knowledge and home care behavior skills and managing their for HF care. In turn, better self-care was associated with reductions in HF-related hospitalizations.
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Rémond MGW, Coyle ME, Mills JE, Maguire GP. Approaches to Improving Adherence to Secondary Prophylaxis for Rheumatic Fever and Rheumatic Heart Disease. Cardiol Rev 2016; 24:94-8. [DOI: 10.1097/crd.0000000000000065] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Lum HD, Jones J, Matlock DD, Glasgow RE, Lobo I, Levy CR, Schwartz RS, Sudore RL, Kutner JS. Advance Care Planning Meets Group Medical Visits: The Feasibility of Promoting Conversations. Ann Fam Med 2016; 14:125-32. [PMID: 26951587 PMCID: PMC4781515 DOI: 10.1370/afm.1906] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Revised: 11/11/2015] [Accepted: 11/24/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Primary care needs new models to facilitate advance care planning conversations. These conversations focus on preferences regarding serious illness and may involve patients, decision makers, and health care providers. We describe the feasibility of the first primary care-based group visit model focused on advance care planning. METHODS We conducted a pilot demonstration of an advance care planning group visit in a geriatrics clinic. Patients were aged at least 65 years. Groups of patients met in 2 sessions of 2 hours each facilitated by a geriatrician and a social worker. Activities included considering personal values, discussing advance care planning, choosing surrogate decision-makers, and completing advance directives. We used the RE-AIM framework to evaluate the project. RESULTS Ten of 11 clinicians referred patients for participation. Of 80 patients approached, 32 participated in 5 group visit cohorts (a 40% participation rate) and 27 participated in both sessions (an 84% retention rate). Mean age was 79 years; 59% of participants were female and 72% white. Most evaluated the group visit as better than usual clinic visits for discussing advance care planning. Patients reported increases in detailed advance care planning conversations after participating (19% to 41%, P = .02). Qualitative analysis found that older adults were willing to share personal values and challenges related to advance care planning and that they initiated discussions about a broad range of relevant topics. CONCLUSION A group visit to facilitate discussions about advance care planning and increase patient engagement is feasible. This model warrants further evaluation for effectiveness in improving advance care planning outcomes for patients, clinicians, and the system.
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Affiliation(s)
- Hillary D Lum
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado
| | - Jacqueline Jones
- College of Nursing, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Daniel D Matlock
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Russell E Glasgow
- VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado Colorado Research in Implementation Science Program, Adult and Child Center for Health Outcomes Research and Delivery Science, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Ingrid Lobo
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
| | - Cari R Levy
- Denver-Seattle Center for Veteran-centered and Value-Driven Care, Denver, Colorado
| | - Robert S Schwartz
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, Colorado
| | - Rebecca L Sudore
- University of California, San Francisco Division of Geriatrics, VA Medical Center, University of California, San Francisco, California
| | - Jean S Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colorado
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Careyva BA, Johnson MB, Goodrich SA, Shaak K, Stello B. Clinician-Reported Barriers to Group Visit Implementation. J Prim Care Community Health 2016; 7:188-93. [PMID: 26883437 DOI: 10.1177/2150131916631924] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Group visits have been shown to improve disease-oriented outcomes and satisfaction, yet many clinicians have not incorporated them into practice. We aimed to identify clinician-reported barriers that preclude clinicians from implementing group visits. METHODS Primary care physicians from one practice-based research network were surveyed regarding their experience with and barriers to group visits. The survey, developed for this study, was mailed to 246 clinicians. RESULTS Of 107 respondents (44% response rate), those in practice <10 years were significantly more likely to have had group visit experience than those with >10 years of experience. For those without prior group visit experience, training was named as the top barrier to incorporating group visits. Those with group visit experience named staffing concerns and recruitment as the top barriers to group visit implementation. CONCLUSIONS Primary care clinicians without prior group visit experience were less likely to endorse group visits. Addressing the modifiable barriers may enhance the incorporation of group visits into practice.
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Affiliation(s)
| | | | | | - Kyle Shaak
- Lehigh Valley Health Network, Allentown, PA, USA
| | - Brian Stello
- Lehigh Valley Health Network, Allentown, PA, USA
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Baptista DR, Wiens A, Pontarolo R, Regis L, Reis WCT, Correr CJ. The chronic care model for type 2 diabetes: a systematic review. Diabetol Metab Syndr 2016; 8:7. [PMID: 26807158 PMCID: PMC4722715 DOI: 10.1186/s13098-015-0119-z] [Citation(s) in RCA: 73] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Accepted: 12/23/2015] [Indexed: 01/19/2023] Open
Abstract
The chronic care model (CCM) uses a systematic approach to restructure health care systems. The aim of this systematic review was to examine studies that evaluated different elements of the CCM in patients with type 2 diabetes mellitus (T2DM) and to assess the influence of the CCM on different clinical outcomes. There view was performed in the Medline and Cochrane Library electronic databases. The search was limited to randomized controlled trials conducted with T2DM patients. Studies were eligible for inclusion if they compared usual care with interventions that use done or more elements of the CCM and assessed the impact on clinical outcomes. After applying the eligibility criteria, 12 studies were included for data extraction. Of these, six showed evidence of effectiveness of the CCM for T2DM management in primary care as well as significant improvements in clinical outcomes. In the other six studies, no improvements regarding clinical outcomes were observed when comparing the intervention and control groups. Some limitations, such as a short follow-up period and a low number of patients, were observed. Some studies showed that the reorganization of health systems can improveT2DM care. However, it is possible that greater benefits could be obtained through combing all 6 elements of CCM.
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Affiliation(s)
| | - Astrid Wiens
- Universidade Federal do Parana, Curitiba, Paraná Brazil
| | | | - Lara Regis
- Universidade Federal do Parana, Curitiba, Paraná Brazil
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Affiliation(s)
- Katherine Gergen Barnett
- Boston Medical Center, Massachusetts. Dr Gergen Barnett blogs for The Huffington Post and Health Affairs and is a contributor to The Boston Globe
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Booth A, Cantrell A, Preston L, Chambers D, Goyder E. What is the evidence for the effectiveness, appropriateness and feasibility of group clinics for patients with chronic conditions? A systematic review. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03460] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundGroup clinics are a form of delivering specialist-led care in groups rather than in individual consultations.ObjectiveTo examine the evidence for the use of group clinics for patients with chronic health conditions.DesignA systematic review of evidence from randomised controlled trials (RCTs) supplemented by qualitative studies, cost studies and UK initiatives.Data sourcesWe searched MEDLINE, EMBASE, The Cochrane Library, Web of Science and Cumulative Index to Nursing and Allied Health Literature from 1999 to 2014. Systematic reviews and RCTs were eligible for inclusion. Additional searches were performed to identify qualitative studies, studies reporting costs and evidence specific to UK settings.Review methodsData were extracted for all included systematic reviews, RCTs and qualitative studies using a standardised form. Quality assessment was performed for systematic reviews, RCTs and qualitative studies. UK studies were included regardless of the quality or level of reporting. Tabulation of the extracted data informed a narrative synthesis. We did not attempt to synthesise quantitative data through formal meta-analysis. However, given the predominance of studies of group clinics for diabetes, using common biomedical outcomes, this subset was subject to quantitative analysis.ResultsThirteen systematic reviews and 22 RCT studies met the inclusion criteria. These were supplemented by 12 qualitative papers (10 studies), four surveys and eight papers examining costs. Thirteen papers reported on 12 UK initiatives. With 82 papers covering 69 different studies, this constituted the most comprehensive coverage of the evidence base to date. Disease-specific outcomes – the large majority of RCTs examined group clinic approaches to diabetes. Other conditions included hypertension/heart failure and neuromuscular conditions. The most commonly measured outcomes for diabetes were glycated haemoglobin A1c(HbA1c), blood pressure and cholesterol. Group clinic approaches improved HbA1cand improved systolic blood pressure but did not improve low-density lipoprotein cholesterol. A significant effect was found for disease-specific quality of life in a few studies. No other outcome measure showed a consistent effect in favour of group clinics. Recent RCTs largely confirm previous findings. Health services outcomes – the evidence on costs and feasibility was equivocal. No rigorous evaluation of group clinics has been conducted in a UK setting. A good-quality qualitative study from the UK highlighted factors such as the physical space and a flexible appointment system as being important to patients. The views and attitudes of those who dislike group clinic provision are poorly represented. Little attention has been directed at the needs of people from ethnic minorities. The review team identified significant weaknesses in the included research. Potential selection bias limits the generalisability of the results. Many patients who could potentially be included do not consent to the group approach. Attendance is often interpreted liberally.LimitationsThis telescoped review, conducted within half the time period of a conventional systematic review, sought breadth in covering feasibility, appropriateness and meaningfulness in addition to effectiveness and cost-effectiveness and utilised several rapid-review methods. It focused on the contribution of recently published evidence from RCTs to the existing evidence base. It did not reanalyse trials covered in previous reviews. Following rapid review methods, we did not perform independent double data extraction and quality assessment.ConclusionsAlthough there is consistent and promising evidence for an effect of group clinics for some biomedical measures, this effect does not extend across all outcomes. Much of the evidence was derived from the USA. It is important to engage with UK stakeholders to identify NHS considerations relating to the implementation of group clinic approaches.Future workThe review team identified three research priorities: (1) more UK-centred evaluations using rigorous research designs and economic models with robust components; (2) clearer delineation of individual components within different models of group clinic delivery; and (3) clarification of the circumstances under which group clinics present an appropriate alternative to an individual consultation.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
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Affiliation(s)
- Andrew Booth
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Anna Cantrell
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Louise Preston
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Duncan Chambers
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
| | - Elizabeth Goyder
- School for Health and Related Research (ScHARR), University of Sheffield, Sheffield, UK
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Abstract
This article provides an overview of shared medical appointments, an innovative approach to managing patients with chronic conditions. The Diabetes Shared Medical Appointment of the Veterans Affairs Loma Linda Healthcare System, conducted by an interprofessional team and led by a nurse practitioner, is described.
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Hollander SA, McDonald N, Lee D, May LJ, Doan LN, Kaufman BD, Rosenthal DN. Group visits in the pediatric heart transplant outpatient clinic. Pediatr Transplant 2015; 19:730-6. [PMID: 26250489 DOI: 10.1111/petr.12574] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/22/2015] [Indexed: 11/30/2022]
Abstract
The "GVM" has emerged as an alternative to traditional individualized appointments in the ambulatory care setting. We hypothesized that group visits could successfully be utilized in a PHtx clinic. Seven patients, ages 1-18 yr old, and their families participated in a total of 11 group visits in lieu of individualized appointments. Patients were divided into two groups based on whether they were greater or less than one yr post-transplant. Patient/provider satisfaction, medication adherence, and content retention were ascertained via questionnaires and free-response tests. Total clinic throughput time, including per-patient clinic utilization time, was compared to historical data. Six of seven patients completed the study with one dropout. Overall satisfaction ratings were 3.98 of 4 with all patients reporting that they would "strongly recommend" group visits to others. Health information retention tests demonstrated improvement between pre- and post-tests in eight of nine (89%) of the group visits. Overall clinic utilization decreased by nearly 50% while providing 70 min of face-to-face time with the provider. Medication adherence neared 100% for all patients. The GVM can be successfully applied to the PHtx population with high patient and provider satisfaction, more face-to-face time, excellent content retention, and greatly improved clinic efficiency.
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Affiliation(s)
- Seth A Hollander
- Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, CA, USA
| | - Nancy McDonald
- Transplantation Services, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Donna Lee
- Transplantation Services, Lucile Packard Children's Hospital, Stanford, CA, USA
| | - Lindsay J May
- Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, CA, USA
| | - Lan N Doan
- Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, CA, USA.,Spectrum Child Health, Lucile Packard Foundation for Children's Health & Child Health Research, Palo Alto, CA, USA
| | - Beth D Kaufman
- Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, CA, USA
| | - David N Rosenthal
- Department of Pediatrics (Cardiology), Stanford University Medical Center, Palo Alto, CA, USA
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Holliday HV, Jenstad LM, Grosjean G, Purves B. "You Can Lead a Horse to Water …": Focus Group Perspectives on Initiating and Supporting Hearing Health Change in Older Adults. Am J Audiol 2015; 24:360-76. [PMID: 25812995 DOI: 10.1044/2015_aja-14-0073] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 03/22/2015] [Indexed: 11/09/2022] Open
Abstract
PURPOSE The aim of this study was to use focus group discussions to (a) evaluate the use of an educational presentation as an impetus for hearing health change and (b) investigate hearing health from the perspective of older adults. METHOD Twenty-seven (4 men, 23 women) community-dwelling older adults attended 4 data collection events. Participants attended a presentation titled Hearing Health in Older Adults, which was delivered by a trained presenter in a peer-teaching-peer format. Following each presentation, a focus group discussion took place. Digital audio recordings, field notes, and memos of the discussions were used to create verbatim transcripts. Data were analyzed using qualitative description and thematic analysis techniques. RESULTS Five central themes emerged when older adult focus groups discussed the presentation and hearing health change: recognizing and admitting, understanding the options, sharing stories and experiences, barriers and facilitators, and the presentation. CONCLUSION Facilitators to hearing health change identified by participants include widespread education about hearing health; clarification about roles, professional motivation, and cost in hearing care; and opportunities to learn from and share personal stories with peers.
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Mallow JA, Theeke LA, Long DM, Whetsel T, Theeke E, Mallow BK. Study protocol: mobile improvement of self-management ability through rural technology (mI SMART). SPRINGERPLUS 2015; 4:423. [PMID: 26301170 PMCID: PMC4537468 DOI: 10.1186/s40064-015-1209-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Accepted: 08/03/2015] [Indexed: 11/16/2022]
Abstract
Background There are 62 million Americans currently residing in rural areas who are more likely to have multiple chronic conditions
and be economically disadvantaged, and in poor health, receive less recommended preventive services and attend fewer visits to health care providers. Recent advances in mobile healthcare (mHealth) offer a promising new approach to solving health disparities and improving chronic illness care. It is now possible and affordable to transmit health information, including values from glucometers, automated blood pressure monitors, and scales, through Bluetooth-enabled devices. Additionally, audio and video communications technologies can allow healthcare providers to conduct many parts of a physical exam remotely from varied settings. These technologies could remove geographical distance as a barrier to care and diminish the access to care issues faced by patients who live rurally. However, currently there is lack of studies that provide evidence of feasibility, acceptability, and effectiveness of mHealth initiatives on improved outcomes of care, a needed step to make the translation to implementation studies in healthcare systems. The purpose of this paper is to present the protocol for the first study of mI SMART (mobile Improvement of Self-Management Ability through Rural Technology), a new integrated mHealth intervention. Methods Our objective is to provide evidence of feasibility and acceptability for the use of mI SMART in an underserved population and establish evidence for the refinement of mI SMART. The proposed study will take place at Milan Puskar Health Right, a free primary care clinic in the state of West Virginia. The clinic provides health care at no cost to uninsured, low income; adults aged 18–64 living in West Virginia. We will enroll 30 participants into this feasibility study with plans of implementing a longitudinal randomized, comparative effectiveness design in the future. Data collection will include tracking of barriers and facilitators to using mI SMART on patient and provider feedback surveys, tracking of patient-provider communications, self-reports from patients on quality of life, adherence, and self-management ability, and capture of health record data on chronic illness measures. Discussion We expect that the mI SMART intervention, refined from participant and provider feedback, will be acceptable and feasible. We anticipate high patient-provider satisfaction, enhanced patient-provider communication, and improved health related quality of life, adherence to treatment, and self-management ability. In addition, we hypothesize that patients who use mI SMART will demonstrate improved physical outcomes such as blood glucose, blood pressure, and weight.
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Affiliation(s)
| | - Laurie A Theeke
- West Virginia University Health Sciences Center, Mortantown, WV USA
| | - Dustin M Long
- West Virginia University Health Sciences Center, Mortantown, WV USA
| | - Tara Whetsel
- West Virginia University Health Sciences Center, Mortantown, WV USA
| | - Elliott Theeke
- West Virginia University Health Sciences Center, Mortantown, WV USA
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Catling CJ, Medley N, Foureur M, Ryan C, Leap N, Teate A, Homer CSE. Group versus conventional antenatal care for women. Cochrane Database Syst Rev 2015; 2015:CD007622. [PMID: 25922865 PMCID: PMC6465187 DOI: 10.1002/14651858.cd007622.pub3] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Antenatal care is one of the key preventive health services used around the world. In most Western countries, antenatal care traditionally involves a schedule of one-to-one visits with a care provider. A different way of providing antenatal care involves use of a group model. OBJECTIVES 1. To compare the effects of group antenatal care versus conventional antenatal care on psychosocial, physiological, labour and birth outcomes for women and their babies.2. To compare the effects of group antenatal care versus conventional antenatal care on care provider satisfaction. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2014), contacted experts in the field and reviewed the reference lists of retrieved studies. SELECTION CRITERIA All identified published, unpublished and ongoing randomised and quasi-randomised controlled trials comparing group antenatal care with conventional antenatal care were included. Cluster-randomised trials were eligible, and one has been included. Cross-over trials were not eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias and extracted data; all review authors checked data for accuracy. MAIN RESULTS We included four studies (2350 women). The overall risk of bias for the included studies was assessed as acceptable in two studies and good in two studies. No statistically significant differences were observed between women who received group antenatal care and those given standard individual antenatal care for the primary outcome of preterm birth (risk ratio (RR) 0.75, 95% confidence interval (CI) 0.57 to 1.00; three trials; N = 1888). The proportion of low-birthweight (less than 2500 g) babies was similar between groups (RR 0.92, 95% CI 0.68 to 1.23; three trials; N = 1935). No group differences were noted for the primary outcomes small-for-gestational age (RR 0.92, 95% CI 0.68 to 1.24; two trials; N = 1473) and perinatal mortality (RR 0.63, 95% CI 0.32 to 1.25; three trials; N = 1943).Satisfaction was rated as high among women who were allocated to group antenatal care, but this outcome was measured in only one trial. In this trial, mean satisfaction with care in the group given antenatal care was almost five times greater than that reported by those allocated to standard care (mean difference 4.90, 95% CI 3.10 to 6.70; one study; N = 993). No differences in neonatal intensive care admission, initiation of breastfeeding or spontaneous vaginal birth were observed between groups. Several outcomes related to stress and depression were reported in one trial. No differences between groups were observed for any of these outcomes.No data were available on the effects of group antenatal care on care provider satisfaction.We used the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach to assess evidence for seven prespecified outcomes; results ranged from low quality (perinatal mortality) to moderate quality (preterm birth, low birthweight, neonatal intensive care unit admission, breastfeeding initiation) to high quality (satisfaction with antenatal care, spontaneous vaginal birth). AUTHORS' CONCLUSIONS Available evidence suggests that group antenatal care is positively viewed by women and is associated with no adverse outcomes for them or for their babies. No differences in the rate of preterm birth were reported when women received group antenatal care. This review is limited because of the small numbers of studies and women, and because one study contributed 42% of the women. Most of the analyses are based on a single study. Additional research is required to determine whether group antenatal care is associated with significant benefit in terms of preterm birth or birthweight.
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Affiliation(s)
- Christine J Catling
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
| | - Nancy Medley
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
| | - Maralyn Foureur
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
| | - Clare Ryan
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
| | - Nicky Leap
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
| | - Alison Teate
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
| | - Caroline SE Homer
- University of Technology SydneyCentre for Midwifery, Child and Family HealthFaculty of HealthBroadwayNSWAustralia2007
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