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Neri M, Mewes JC, de Almeida FA, Stoychev S, Minarovic N, Charos A, Shea KM, Steuten LMG. Impact of including productivity costs in economic analyses of vaccines for C. difficile infections and infant respiratory syncytial virus, in a UK setting. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2024; 22:34. [PMID: 38689331 PMCID: PMC11059668 DOI: 10.1186/s12962-024-00533-4] [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: 12/14/2023] [Accepted: 03/21/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES It has been estimated that vaccines can accrue a relatively large part of their value from patient and carer productivity. Yet, productivity value is not commonly or consistently considered in health economic evaluations of vaccines in several high-income countries. To contribute to a better understanding of the potential impact of including productivity value on the expected cost-effectiveness of vaccination, we illustrate the extent to which the incremental costs would change with and without productivity value incorporated. METHODS For two vaccines currently under development, one against Cloistridioides difficile (C. difficile) infection and one against respiratory syncytial disease (RSV), we estimated their incremental costs with and without productivity value included and compared the results. RESULTS In this analysis, reflecting a UK context, a C. difficile vaccination programme would prevent £12.3 in productivity costs for every person vaccinated. An RSV vaccination programme would prevent £49 in productivity costs for every vaccinated person. CONCLUSIONS Considering productivity costs in future cost-effectiveness analyses of vaccines for C. difficile and RSV will contribute to better-informed reimbursement decisions from a societal perspective.
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Zhang X, Ho GWK, Mak YW. Effectiveness of a videoconferencing group-based dyad acceptance and commitment therapy on the quality of life of chronic heart failure patients and their family caregivers: A study protocol for a randomized controlled trial. PLoS One 2024; 19:e0298178. [PMID: 38635558 PMCID: PMC11025806 DOI: 10.1371/journal.pone.0298178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 01/03/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Chronic heart failure (CHF) poses a significant burden on both patients and their family caregivers (FCs), as it is associated with psychological distress and impaired quality of life (QOL). Acceptance and Commitment Therapy (ACT) supports QOL by focusing on value living and facilitates acceptance of psychological difficulties by cultivating psychological flexibility. A protocol is presented that evaluates the effectiveness of a dyad ACT-based intervention delivered via smartphone on QOL and other related health outcomes compared with CHF education only. METHODS This is a single-center, two-armed, single-blinded (rater), randomized controlled trial (RCT). One hundred and sixty dyads of CHF patients and their primary FCs will be recruited from the Cardiology Department of a hospital in China. The dyads will be stratified block randomized to either the intervention group experiencing the ACT-based intervention or the control group receiving CHF education only. Both groups will meet two hours per week for four consecutive weeks in videoconferencing sessions over smartphone. The primary outcomes are the QOL of patients and their FCs. Secondary outcomes include psychological flexibility, psychological symptoms, self-care behavior, and other related outcomes. All outcomes will be measured by blinded outcome assessors at baseline, immediately post-intervention, and at the three-month follow-up. Multilevel modeling will be conducted to assess the effects of the intervention. DISCUSSION This study is the first to adopt an ACT-based intervention for CHF patient-caregiver dyads delivered in groups via smartphone. If effective and feasible, the intervention strategy and deliverable approach could be incorporated into clinical policies and guidelines to support families with CHF without geographic and time constraints. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04917159. Registered on 08 June 2021.
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Affiliation(s)
- Xuelin Zhang
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Grace W. K. Ho
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Yim Wah Mak
- School of Nursing, The Hong Kong Polytechnic University, Hong Kong, China
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Cuoco A, Younas A, Boyne J, Juarez-Vela R, M Rice B, Vellone E, Durante A. Perception and Challenges of Time Management for Caregivers of People with Heart Failure: A Qualitative Study. J Cardiovasc Nurs 2023:00005082-990000000-00112. [PMID: 37550836 DOI: 10.1097/jcn.0000000000001027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/09/2023]
Abstract
BACKGROUND Informal caregivers contribute substantially to the self-care of people with heart failure (HF) by helping with concrete and interpersonal tasks. Time perception and management are essential issues among caregivers. However, investigators have not explored this topic in caregivers of people with HF. OBJECTIVES The aim of this study was to describe the perceptions and challenges of the time management experience among caregivers who support the self-care efforts of their relatives with HF. METHODS Adult informal caregivers of patients with HF, taking care of the patient for at least 3 months and without cognitive limitations, were recruited from Spain, Italy, and the Netherlands. Data were collected using semistructured interviews. Maryring's qualitative content analysis strategy with both a deductive and an inductive approach was used for analysis. RESULTS We enrolled 50 participants (20 Italians, 19 Spanish, and 11 Dutch). Caregivers had a mean (SD) age of 62.8 (12.8) years and were mostly female (84%). They dedicated 31.2 (SD, 21.7) hours per week to providing caring activities for their patients. After extracting 33 codes from their qualitative interview data, we summarized them into 8 categories and identified 4 main themes: (1) time for yourself, (2) house management, (3) time for the patient (dedicated to directing care), and (4) time for own socialization. CONCLUSION Caregivers navigate the complexity of time management by balancing dedicated time for supporting patients with HF and their own personal time.
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Urwin S, Lau YS, Grande G, Sutton M. The Challenges of Measuring Informal Care Time: A Review of the Literature. PHARMACOECONOMICS 2021; 39:1209-1223. [PMID: 34324174 PMCID: PMC8516777 DOI: 10.1007/s40273-021-01053-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 06/13/2023]
Abstract
Economic evaluations increasingly include the value of informal care, for example, in terms of caregiver health effects or time costs. If an economic evaluation uses caregiving time costs, appropriate measurement of caregiving time is an important first step prior to its valuation. There is no comprehensive overview of the measurement challenges for caregiving time. In this literature review, we searched Medline, Embase, Econlit and Scopus to identify measurement issues and associated studies which reported informal care time that addressed them. The search identified 27 studies that addressed nine measurement issues. There is limited evidence on how to address these issues, although some have received relatively more attention, including incremental time (considered in 16 studies), time measurement method comparisons (six studies) and the inclusion of intangible tasks (four studies). Non-response (considered in only one study) and carer and recipient identification (two studies) were the most wide-reaching measurement concerns, as these determine who is identified as carers. There was no evidence on the consequences of these measurement challenges in terms of impacts on cost-effectiveness ratios and on the total cost of health conditions, which would be a crucial next step. Future research on these issues should consider a range of different settings, as informal care is highly heterogeneous. The measurement of informal care is key for its inclusion in economic evaluations but there is little consensus on how to appropriately measure this type of care.
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Affiliation(s)
- Sean Urwin
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK.
| | - Yiu-Shing Lau
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
| | - Gunn Grande
- Division of Nursing, Midwifery and Social Care, University of Manchester, Manchester, UK
| | - Matt Sutton
- Health Organisation, Policy and Economics, School of Health Sciences, University of Manchester, Williamson Building, Oxford Road, Manchester, M13 9PL, UK
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Psychosocial Factors Related to Adverse Outcomes in Heart Failure Caregivers: A Structural Equation Modeling Analysis. J Cardiovasc Nurs 2021; 35:137-148. [PMID: 31985703 DOI: 10.1097/jcn.0000000000000634] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Heart failure (HF) caregivers experience increased demands and burden. Social support and problem solving may influence the effect of these variables on caregiver outcomes. OBJECTIVE The aim of this study was to examine whether social support and problem solving mediate relationships among caregiver demands and burden, self-care, depression, and life changes in heart failure caregivers. METHODS Using a cross-sectional, exploratory design, heart failure caregivers (n = 530) completed online questionnaires on caregiver demands and burden, social support, problem solving, depression, self-care, and life changes. Path analysis examined a hypothesized mediating role of social support and problem solving in the relationships among caregiver demands and burden and caregiver outcomes. The analysis included (1) a model-development phase (n = 329) to make data-based decisions on measurement indicators and model structure and (2) a confirmatory phase (n = 201) to provide unbiased inference on the model structure resulting from the initial phase. RESULTS Participants were 41.39 (±10.38) years old and primarily white (78.3%) men (50.9%) caring for a spouse (44.9%). Per the magnitudes of the estimated path coefficients, social support mediated the relationship between caregiver burden and depression but did not relevantly mediate the relationship between caregiver burden and self-care or caregiver life changes. In the presence of social support as a parallel mediator, problem solving was not a relevant mediator between caregiver burden and demands and caregiver outcomes. CONCLUSIONS Social support mediates the effects of caregiver burden on depression but has little effect on self-care or life changes. In the presence of social support, problem solving does not mediate the effects of caregiver demands and burden on caregiver outcomes.
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Timonet-Andreu E, Morales-Asencio JM, Alcalá Gutierrez P, Cruzado Alvarez C, López-Moyano G, Mora Banderas A, López-Leiva I, Canca-Sanchez JC. Health-Related Quality of Life and Use of Hospital Services by Patients with Heart Failure and Their Family Caregivers: A Multicenter Case-Control Study. J Nurs Scholarsh 2020; 52:217-228. [PMID: 32141224 DOI: 10.1111/jnu.12545] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/27/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Heart failure (HF) causes high rates of hospital admissions. It is known that disease progression impacts the health-related quality of life (HRQoL) of both patients and caregivers, yet to date, this finding is based on cross-sectional studies with limited samples. OBJECTIVES The study aim is to analyze the relationship between HF patients' use of hospital services (a proxy for disease progression) and the HRQoL of their family caregivers. METHODS This work is a multicenter nested case-control study on a population of patients admitted to hospitals in southern Spain due to heart failure. The sample comprised 530 patient-caregiver dyads. Hospital admission data were retrospectively collected for the 5 years prior to inclusion in the study. Bivariate analyses and multivariate logistic regression were used to determine associations between patient deterioration and caregivers' quality of life. RESULTS Patients' use of hospital services was associated with worsened quality of life for family caregivers, with an overall OR of 1.48 (95% CI: 1.23-1.79). A positive correlation was found between patients' perceptions of their physical health and the perceived mental health of caregivers (r = 0.127, p = 0.004) and between the perceived mental health of both (r = 0.291; p <0.0001). CONCLUSIONS Greater use of hospital services by patients with HF is an independent predictor of deterioration of family caregivers' HRQoL. The physical and mental components of patients' and their family caregivers' HRQoL interact and influence each other. Additional factors, such as the nature and intensity of care provided, also determine the worsening of a family caregiver's HRQoL. CLINICAL RELEVANCE These results can be used to identify family caregivers of people with heart failure at risk of suffering a deterioration in their health-related quality of life. Increased use of hospital services is an independent predictor of the deterioration of the family caregivers' health-related quality of life. Since clinical nurses are the main provider who gives support and education to family caregivers, they should be alert to this situation and individualize interventions to prevent this deterioration.
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Affiliation(s)
- Eva Timonet-Andreu
- Clinical Nursing Supervisor of Cardiology, Costa del Sol Public Health Agency, Marbella, Spain; Instituto de Investigación Biomédica de Málaga, IBIMA
| | - José Miguel Morales-Asencio
- Professor. Instituto de Investigación Biomédica de Málaga, IBIMA, Universidad de Málaga, Faculty of Health Sciences, Spain
| | | | | | | | - Ana Mora Banderas
- Clinical Nursing Supervisor, Costa del Sol Public Health Agency, Marbella, Spain
| | - Inmaculada López-Leiva
- Assistant Professor, Universidad de Málaga, Faculty of Health Sciences, Spain; Instituto de Investigación Biomédica de Málaga, IBIMA
| | - José Carlos Canca-Sanchez
- Costa del Sol Public Health Agency. Associate Professor, Universidad de Málaga, Faculty of Health Sciences, Marbella, Spain; Instituto de Investigación Biomédica de Málaga, IBIMA
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Teixeira MJC, Abreu W, Costa N, Maddocks M. Understanding family caregivers' needs to support relatives with advanced progressive disease at home: an ethnographic study in rural Portugal. BMC Palliat Care 2020; 19:73. [PMID: 32450848 PMCID: PMC7249372 DOI: 10.1186/s12904-020-00583-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 05/20/2020] [Indexed: 11/17/2022] Open
Abstract
Background Family caregivers play an important role supporting their relatives with advanced progressive disease to live at home. There is limited research to understand family caregiver needs over time, particularly outside of high-income settings. The aim of this study was to explore family caregivers’ experiences of caring for a relative living with advanced progressive disease at home, and their perceptions of met and unmet care needs over time. Methods An ethnographic study comprising observations and interviews. A purposive sample of 10 family caregivers and 10 relatives was recruited within a rural area in the north of Portugal. Data were collected between 2014 and 16 using serial participant observations (n = 33) and in-depth interviews (n = 11). Thematic content analysis was used to analyse the data. Results Five overarching themes were yielded: (1) provision of care towards independence and prevention of complications; (2) perceived and (3) unknown caregiver needs; (4) caregivers’ physical and emotional impairments; and (5) balancing limited time. An imbalance towards any one of these aspects may lead to reduced capability and performance of the family caregiver, with increased risk of complications for their relative. However, with balance, family caregivers embraced their role over time. Conclusions These findings enhance understanding around the needs of family caregivers, which are optimally met when professionals and family caregivers work together with a collaborative approach over time. Patients and their families should be seen as equal partners. Family-focused care would enhance nursing practice in this context and this research can inform nursing training and educational programs.
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Affiliation(s)
- Maria João Cardoso Teixeira
- Royal National Orthopaedic Hospital NHS Foundation Trust & National Institute for Health Research (NIHR), Brockley Hill Road, Stanmore, Middlesex, HA7 4LP, UK.
| | - Wilson Abreu
- School of Nursing & Research Centre "Centre for Health Technology and Services Research / ESEP -CINTESIS", Porto, Portugal
| | - Nilza Costa
- University of Aveiro - Research Centre "Didactic and Technology in the Education of Educators/CIDTFF", Aveiro, Portugal
| | - Matthew Maddocks
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, King's College of London, London, UK
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Guilabert M, Amil P, González-Mestre A, Gil-Sánchez E, Vila A, Contel JC, Ansotegui JC, Solas O, Bacigalupe MT, Fernández-Cano P, Arteagoitia M, Mira JJ. The Measure of the Family Caregivers' Experience. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15092040. [PMID: 30231535 PMCID: PMC6165505 DOI: 10.3390/ijerph15092040] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 08/31/2018] [Accepted: 09/15/2018] [Indexed: 12/31/2022]
Abstract
Objective: Design and validate a measure of the experience of family caregivers with the integrated care that receive the persons they care for. Methods: The new instrument for measuring the experience of caregivers is based on the Instrument to Evaluate the EXperience of PAtients with Chronic Diseases (acronym in Spanish: IEXPAC) scale instrument. With the qualitative technique of the discussion group, nine professionals and eight caregivers assessed the face validity of the instrument and they advised on issues to explore and the measuring scale to use. The instrument’s items were analyzed individually, as well as its consistency, reliability, and construct and empirical validity. Results: 235 caregivers responded, of which 186 (79%) were women. The average age of the persons under their care was 83.9 years (SD 9.7). The scale’s score when eliminating its items one by one ranged between 38.6 and 41.1. The factorial saturations of the items ranged between 0.53 and 0.82. Cronbach’s alpha (12 elements) was 0.88 and the Kuder-Richardson coefficient was 0.91. The factorial solution explained 64.3% of the total variance and allowed isolating two factors (with 11 items with saturations greater than 0.65): care for the patient, and care for the caregiver. The internal consistency of both factors was greater than 0.80. The scale’s score was 41.1 (SD 9.7). Conclusions: The Caregivers Experience Instrument combines acceptability, ease of comprehension, and perceived usefulness for the caregivers. It has adequate internal consistency, reliability, and construct and empirical validity.
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Affiliation(s)
- Mercedes Guilabert
- Health Psychology Department, Universidad Miguel Hernández de Elche, Comunidad Valenciana, 03202 Elche, Spain.
| | - Paloma Amil
- Programa Pacient Expert Catalunya®, Programa de Prevenció i Atenció a la Cronicitat Direcció General de Planificació i en Salut, Departament de Salut, Cataluña, 08028 Barcelona, Spain.
| | - Asunción González-Mestre
- Programa Pacient Expert Catalunya®, Programa de Prevenció i Atenció a la Cronicitat Direcció General de Planificació i en Salut, Departament de Salut, Cataluña, 08028 Barcelona, Spain.
| | - Esther Gil-Sánchez
- Programa Pacient Expert Catalunya®, Programa de Prevenció i Atenció a la Cronicitat Direcció General de Planificació i en Salut, Departament de Salut, Cataluña, 08028 Barcelona, Spain.
| | - Anna Vila
- Servei de Valoracions, Sub-Direcció General d'Atenció i de Promoció de l'Autonomia Personal Direcció general de Protecció Social, Departament de Treball, Afers Socials i Famílies, Cataluña, 08019 Barcelona, Spain.
| | - Joan Carles Contel
- Programa Pacient Expert Catalunya®, Programa de Prevenció i Atenció a la Cronicitat Direcció General de Planificació i en Salut, Departament de Salut, Cataluña, 08028 Barcelona, Spain.
| | | | - Olga Solas
- Consultora de Políticas Públicas y Gestión de Organizaciones, Castilla la Mancha, 45112 Toledo, Spain.
| | | | | | - Marisa Arteagoitia
- Fundación Vasca de Innovación Sanitaria, País Vasco, 48902 Bilbao, Spain.
| | - José Joaquín Mira
- Health Psychology Department, Universidad Miguel Hernández de Elche, Comunidad Valenciana, 03202 Elche, Spain.
- Alicante-Sant Joan Health District, Comunidad Valenciana, 03550 Alicante, Spain.
- REDISSEC, Red de Investigación en Servicios de Salud en Enfermedades Crónicas, Comunidad Valenciana, 46020 Valencia, Spain.
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