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Endalamaw A, Zewdie A, Wolka E, Assefa Y. Care models for individuals with chronic multimorbidity: lessons for low- and middle-income countries. BMC Health Serv Res 2024; 24:895. [PMID: 39103802 DOI: 10.1186/s12913-024-11351-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/23/2024] [Indexed: 08/07/2024] Open
Abstract
BACKGROUND Patients with multiple long-term conditions requires understanding the existing care models to address their complex and multifaceted health needs. However, current literature lacks a comprehensive overview of the essential components, impacts, challenges, and facilitators of these care models, prompting this scoping review. METHODS A scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Review and Meta-analysis Extension for Scoping Reviews guideline. Our search encompassed articles from PubMed, Web of Science, EMBASE, SCOPUS, and Google Scholar. The World Health Organization's health system framework was utilized to synthesis the findings. This framework comprises six building blocks (service delivery, health workforce, health information systems, access to essential medicines, financing, and leadership/governance) and eight key characteristics of good service delivery models (access, coverage, quality, safety, improved health, responsiveness, social and financial risk protection, and improved efficiency). Findings were synthesized qualitatively to identify components, impacts, barriers, and facilitators of care models. RESULTS A care model represents various collective interventions in the healthcare delivery aimed at achieving desired outcomes. The names of these care models are derived from core activities or major responsibilities, involved healthcare teams, diseases conditions, eligible clients, purposes, and care settings. Notable care models include the Integrated, Collaborative, Integrated-Collaborative, Guided, Nurse-led, Geriatric, and Chronic care models, as well as All-inclusive Care Model for the Elderly, IMPACT clinic, and Geriatric Patient-Aligned Care Teams (GeriPACT). Other care models (include Care Management Plus, Value Stream Mapping, Preventive Home Visits, Transition Care, Self-Management, and Care Coordination) have supplemented the main ones. Care models improved quality of care (such as access, patient-centeredness, timeliness, safety, efficiency), cost of care, and quality of life for patients that were facilitated by presence of shared mission, system and function integration, availability of resources, and supportive tools. CONCLUSIONS Care models were implemented for the purpose of enhancing quality of care, health outcomes, cost efficiency, and patient satisfaction by considering careful recruitment of eligible clients, appropriate selection of service delivery settings, and robust organizational arrangements involving leadership roles, healthcare teams, financial support, and health information systems. The distinct team compositions and their roles in service provision processes differentiate care models.
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Affiliation(s)
- Aklilu Endalamaw
- School of Public Health, The University of Queensland, Brisbane, Australia.
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia.
| | - Anteneh Zewdie
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Eskinder Wolka
- International Institute for Primary Health Care in Ethiopia, Addis Ababa, Ethiopia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, Australia
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Sumner J, Ng CWT, Teo KEL, Peh ALT, Lim YW. Co-designing care for multimorbidity: a systematic review. BMC Med 2024; 22:58. [PMID: 38321495 PMCID: PMC10848537 DOI: 10.1186/s12916-024-03263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/18/2024] [Indexed: 02/08/2024] Open
Abstract
BACKGROUND The co-design of health care enables patient-centredness by partnering patients, clinicians and other stakeholders together to create services. METHODS We conducted a systematic review of co-designed health interventions for people living with multimorbidity and assessed (a) their effectiveness in improving health outcomes, (b) the co-design approaches used and (c) barriers and facilitators to the co-design process with people living with multimorbidity. We searched MEDLINE, EMBASE, CINAHL, Scopus and PsycINFO between 2000 and March 2022. Included experimental studies were quality assessed using the Cochrane risk of bias tool (ROB-2 and ROBINS-I). RESULTS We screened 14,376 reports, with 13 reports meeting the eligibility criteria. Two reported health and well-being outcomes: one randomised clinical trial (n = 134) and one controlled cohort (n = 1933). Outcome measures included quality of life, self-efficacy, well-being, anxiety, depression, functional status, healthcare utilisation and mortality. Outcomes favouring the co-design interventions compared to control were minimal, with only 4 of 17 outcomes considered beneficial. Co-design approaches included needs assessment/ideation (12 of 13), prototype (11 of 13), pilot testing (5 of 13) (i.e. focus on usability) and health and well-being evaluations (2 of 13). Common challenges to the co-design process include poor stakeholder interest, passive participation, power imbalances and a lack of representativeness in the design group. Enablers include flexibility in approach, smaller group work, advocating for stakeholders' views and commitment to the process or decisions made. CONCLUSIONS In this systematic review of co-design health interventions, we found that few projects assessed health and well-being outcomes, and the observed health and well-being benefits were minimal. The intensity and variability in the co-design approaches were substantial, and challenges were evident. Co-design aided the design of novel services and interventions for those with multimorbidity, improving their relevance, usability and acceptability. However, the clinical benefits of co-designed interventions for those with multimorbidity are unclear.
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Affiliation(s)
- Jennifer Sumner
- Alexandra Hospital, National University Health System, Singapore, Singapore.
| | | | | | - Adena Li Tyin Peh
- Alexandra Hospital, National University Health System, Singapore, Singapore
| | - Yee Wei Lim
- Alexandra Hospital, National University Health System, Singapore, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Brahmbhatt S, Mikalachki A, Lawrence JA, Blackwell L, Bleah P, Khan Y, Tung TH, Austin K, Craig L, Clemens KK. Supporting Type 1 and Type 2 Diabetes Care in the Hemodialysis Unit: A Quality-improvement Initiative Throughout the COVID-19 Pandemic. Can J Diabetes 2024; 48:3-9.e7. [PMID: 37549869 DOI: 10.1016/j.jcjd.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 07/18/2023] [Accepted: 07/31/2023] [Indexed: 08/09/2023]
Abstract
OBJECTIVE People living with diabetes mellitus (DM) and chronic kidney disease can have difficulty attending multiple appointments to receive DM care. We developed and studied the utility of a DM outreach program to offer in the hemodialysis (HD) unit. METHODS We conducted a quality improvement project in a satellite HD unit in London, Ontario, Canada, between August 1, 2019, and July 31, 2022. We assessed for baseline gaps in DM care among those with DM, performed root-cause analysis with key stakeholders to identify critical drivers of gaps, and conceptualized a certified diabetes educator-led outreach program to offer in the HD unit. We aimed to improve DM self-monitoring, hypo- and hyperglycemia, and DM-related screening. We used run and control charts to track outcome measures over time and modified our outreach program iteratively. RESULTS Fifty-eight persons with DM receiving HD participated in our program. Support spanned multiple waves of the COVID-19 pandemic. With 4 tests of change, we observed improvement in DM self-monitoring with a modest decline in self-reported hyperglycemia. There were no adverse consequences, and satisfaction with our program was high. CONCLUSIONS Although we did not meet all measures of success during the pandemic, outreach DM support in the HD unit appeared to improve self-monitoring and self-reported hyperglycemia. Similar programs could be modified and implemented in other centres.
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Affiliation(s)
- Shaily Brahmbhatt
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Amanda Mikalachki
- Primary Care Diabetes Support Program, St. Joseph's Health Care London, London, Ontario, Canada
| | - Julie Ann Lawrence
- Regional Renal Program, London Health Sciences Centre, London, Ontario, Canada
| | - Lindsay Blackwell
- Regional Renal Program, London Health Sciences Centre, London, Ontario, Canada
| | | | - Yumna Khan
- Lawson Health Research Institute, London, Ontario, Canada; Thames Valley Family Health Team, London, Ontario, Canada
| | - Tsan-Hua Tung
- Centre for Quality, Innovation and Patient Safety, Western University, London, Ontario, Canada
| | - Kathy Austin
- Regional Renal Program, London Health Sciences Centre, London, Ontario, Canada
| | - Laura Craig
- Regional Renal Program, London Health Sciences Centre, London, Ontario, Canada
| | - Kristin K Clemens
- Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; Centre for Quality, Innovation and Patient Safety, Western University, London, Ontario, Canada; Division of Endocrinology and Metabolism, Western University, Department of Medicine, London, Ontario, Canada; Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada; ICES, Ontario, Canada.
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Zimbudzi E, Lo C, Ranasinha S, Usherwood T, Polkinghorne KR, Fulcher G, Gallagher M, Jan S, Cass A, Walker R, Russell G, Johnson G, Kerr PG, Zoungas S. A codesigned integrated kidney and diabetes model of care improves patient activation among patients from culturally and linguistically diverse backgrounds. Health Expect 2023; 26:2584-2593. [PMID: 37635378 PMCID: PMC10632627 DOI: 10.1111/hex.13859] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 06/15/2023] [Accepted: 08/18/2023] [Indexed: 08/29/2023] Open
Abstract
BACKGROUND Little is known about the relationship between patients' cultural and linguistic backgrounds and patient activation, especially in people with diabetes and chronic kidney disease (CKD). We examined the association between culturally and linguistically diverse (CALD) background and patient activation and evaluated the impact of a codesigned integrated kidney and diabetes model of care on patient activation by CALD status in people with diabetes and CKD. METHODS This longitudinal study recruited adults with diabetes and CKD (Stage 3a or worse) who attended a new diabetes and kidney disease service at a tertiary hospital. All completed the patient activation measure at baseline and after 12 months and had demographic and clinical data collected. Patients from CALD backgrounds included individuals who spoke a language other than English at home, while those from non-CALD backgrounds spoke English only as their primary language. Paired t-tests compared baseline and 12-month patient activation scores by CALD status. RESULTS Patients from CALD backgrounds had lower activation scores (52.1 ± 17.6) compared to those from non-CALD backgrounds (58.5 ± 14.6) at baseline. Within-group comparisons showed that patient activation scores for patients from CALD backgrounds significantly improved by 7 points from baseline to 12 months follow-up (52.1 ± 17.6-59.4 ± 14.7), and no significant change was observed for those from non-CALD backgrounds (58.5 ± 14.6-58.8 ± 13.6). CONCLUSIONS Among patients with diabetes and CKD, those from CALD backgrounds report worse activation scores. Interventions that support people from CALD backgrounds with comorbid diabetes and CKD, such as the integrated kidney and diabetes model of care, may address racial and ethnic disparities that exist in patient activation and thus improve clinical outcomes. PATIENT OR PUBLIC CONTRIBUTION Patients, caregivers and national consumer advocacy organisations (Diabetes Australia and Kidney Health Australia) codesigned a new model of care in partnership with healthcare professionals and researchers. The development of the model of care was informed by focus groups of patients and healthcare professionals and semi-structured interviews of caregivers and healthcare professionals. Patients and caregivers also provided a rigorous evaluation of the new model of care, highlighting its strengths and weaknesses.
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Affiliation(s)
- Edward Zimbudzi
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Monash Nursing and MidwiferyMonash UniversityMelbourneVictoriaAustralia
- Department of NephrologyMonash HealthMelbourneVictoriaAustralia
| | - Clement Lo
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Diabetes and Vascular Medicine Unit, Monash HealthMelbourneVictoriaAustralia
| | - Sanjeeva Ranasinha
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
| | - Tim Usherwood
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Department of General Practice, Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Kevan R. Polkinghorne
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Department of NephrologyMonash HealthMelbourneVictoriaAustralia
- School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Gregory Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore HospitalUniversity of SydneySydneyNew South WalesAustralia
- Northern Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Martin Gallagher
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Concord Clinical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Stephen Jan
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Sydney Medical SchoolUniversity of SydneySydneyNew South WalesAustralia
| | - Alan Cass
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
- Menzies School of Health ResearchCharles Darwin UniversityCasuarinaNorthern TerritoryAustralia
| | - Rowan Walker
- Department of Renal MedicineAlfred HealthMelbourneVictoriaAustralia
| | - Grant Russell
- School of Primary Health CareMonash UniversityMelbourneVictoriaAustralia
| | - Greg Johnson
- Diabetes AustraliaCanberraAustralian Capital TerritoryAustralia
| | - Peter G. Kerr
- Department of NephrologyMonash HealthMelbourneVictoriaAustralia
- School of Clinical SciencesMonash UniversityMelbourneVictoriaAustralia
| | - Sophia Zoungas
- School of Public Health and Preventive MedicineMonash UniversityMelbourneVictoriaAustralia
- Diabetes and Vascular Medicine Unit, Monash HealthMelbourneVictoriaAustralia
- The George Institute for Global HealthUniversity of New South WalesSydneyNew South WalesAustralia
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Liu Y, Wen H, Bai J, Shi F, Bi R, Yu C. Burden of diabetes and kidney disease attributable to non-optimal temperature from 1990 to 2019: A systematic analysis from the Global Burden of Disease Study 2019. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 838:156495. [PMID: 35671854 DOI: 10.1016/j.scitotenv.2022.156495] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 05/26/2022] [Accepted: 06/01/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION This study quantitatively described the disease burden of diabetes and kidney disease attributable to non-optimal temperatures and explored the influencing factors. METHODS We quantitatively described the mortality burden of diabetes and kidney disease attributable to non-optimal temperatures in six countries (China, USA, South Africa, Australia, Iraq, Portugal), and compare trends in mortality in six countries from 1990 to 2019. We used the APC model to analyse age, period, and cohort effects on mortality in six countries. We used restricted cubic splines and quantile regression to analyse the association of SDI with mortality and YLL using data from 21 regions in the world. RESULTS The mortality rates of diabetes and kidney disease in the six countries in 2019 were 1.72% (Australia), 1.83% (China), 2.99% (USA), 3% (Portugal), 7.45% (South Africa) and 8.71% (Iraq) attributable to non-optimal temperatures. Cold was more harmful than heat. The mortality, YLLs of diabetes and kidney disease of male were higher than females. The mortality rate showed an upwards trend with age. The period effect had little changes or showed a slight upwards trend. The cohort effect showed a downwards trend. The regions with higher mortality or YLLs rates were mainly had SDI values of 0.45-0.80. CONCLUSIONS Among the death burdens of diabetes and kidney disease attributed to non-optimal temperatures, cold had a greater burden than heat. The burden of death was affected by sex, age, period, cohort, and SDI.
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Affiliation(s)
- Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Haoyu Wen
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Jianjun Bai
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Fang Shi
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China
| | - Ran Bi
- College of Letter and Science, University of California, Davis, CA 95618, the United States of America
| | - Chuanhua Yu
- Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China.
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Blanchfield D, O'Connor L. A participatory action research study to inform combined type 2 diabetes and chronic kidney disease care provided in the context of advanced practice nursing. J Adv Nurs 2022; 78:3427-3443. [PMID: 35855655 DOI: 10.1111/jan.15362] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Revised: 02/24/2022] [Accepted: 06/27/2022] [Indexed: 11/28/2022]
Abstract
AIM To outline the development, implementation and evaluation of an alternative combined type 2 diabetes and chronic kidney disease (CKD) care delivery strategy provided in the context of advanced practice nursing informed by co-created knowledge, between patients and healthcare teams to address identified gaps in care provision. DESIGN This study was informed by the theoretical underpinnings of critical theory and operationalized using a participatory action research (PAR) design. This approach enabled alignment between the theoretical underpinnings and research methodology to respond to practice-level problems and address issues related to healthcare delivery. METHODS The study was undertaken in a series of three cycles of enquiry over a 20 month period (July 2018-February 2020) in five geographically diverse specialist diabetes and nephrology centres. Data collection methods included PAR group minute consensus, retrospective chart review, discovery and focus group interviews. Thematic analysis and descriptive statistics were used to analyse the data. RESULTS Compared with international standard care outcomes, a higher proportion of patients attending combined care achieved best practice recommendations for blood pressure, Hba1c and lipid management (64.3% vs. <40%). Patients attending combined care experienced improved detection and management of CKD-related anaemia. Additionally, the combined care service experienced significantly lower levels of patient's failure to attend scheduled reviews compared with participating standard care services (0% vs. 7%-23.3%). CONCLUSIONS Best practice clinical care outcomes and patient attendance improved when a combined type 2 diabetes and CKD care delivery strategy provided in the context of advanced practice nursing was adopted. IMPACT This alternative care strategy represented a departure from standard care delivery approaches, in which care for type 2 diabetes and CKD is provided separately and led by physicians. Outcomes demonstrate improved clinical and attendance outcomes which may inform the development of future services led by advanced nurse practitioners.
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Affiliation(s)
- Denise Blanchfield
- School of Nursing & Midwifery Royal College of Surgeons Ireland, University College Dublin (UCD), Dublin, Ireland
| | - Laserina O'Connor
- School of Nursing, Midwifery and Health Systems University College Dublin (UCD), Dublin, Ireland
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Fildes K, Stefoska‐Needham A, Atkinson J, Lambert K, Lee A, Pugh D, Smyth M, Turner R, Wallace S, Nealon J. Optimising health care for people living with chronic kidney disease: Health‐professional perspectives. J Ren Care 2022; 48:168-176. [DOI: 10.1111/jorc.12409] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Revised: 09/29/2021] [Accepted: 12/05/2021] [Indexed: 12/25/2022]
Affiliation(s)
- Karen Fildes
- School of Medicine, Faculty of Science Medicine and Health, Health Impact Research Cluster University of Wollongong Wollongong New South Wales Australia
| | - Anita Stefoska‐Needham
- School of Medicine, Faculty of Science Medicine and Health, Health Impact Research Cluster University of Wollongong Wollongong New South Wales Australia
| | - Josie Atkinson
- School of Medicine, Faculty of Science Medicine and Health, Health Impact Research Cluster University of Wollongong Wollongong New South Wales Australia
| | - Kelly Lambert
- School of Medicine, Faculty of Science Medicine and Health, Health Impact Research Cluster University of Wollongong Wollongong New South Wales Australia
| | - Anna Lee
- Nurse Practitioner Renal Service, Illawarra Shoalhaven Local Health District Warrawong New South Wales Australia
| | - Debbie Pugh
- Renal Unit, Illawarra Shoalhaven Local Health District Warrawong New South Wales Australia
| | - Mikki Smyth
- Renal Unit, Illawarra Shoalhaven Local Health District Warrawong New South Wales Australia
| | - Rebecca Turner
- School of Medicine, Faculty of Science Medicine and Health University of Wollongong Wollongong New South Wales Australia
| | - Samantha Wallace
- School of Medicine, Faculty of Science Medicine and Health University of Wollongong Wollongong New South Wales Australia
| | - Jessica Nealon
- School of Medicine, Faculty of Science Medicine and Health, Health Impact Research Cluster University of Wollongong Wollongong New South Wales Australia
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Zimbudzi E, Lo C, Ranasinha S, Earnest A, Teede H, Usherwood T, Polkinghorne KR, Fulcher G, Gallagher M, Jan S, Cass A, Walker R, Russell G, Johnson G, Kerr PG, Zoungas S. A co-designed integrated kidney and diabetes model of care improves mortality, glycaemic control and self-care. Nephrol Dial Transplant 2021; 37:1472-1481. [PMID: 34314493 DOI: 10.1093/ndt/gfab230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Current health-care models are ill-equipped for managing people with diabetes and chronic kidney disease (CKD). We evaluated the impact of a new diabetes and kidney disease service (DKS) on hospitalisation, mortality, clinical and patient relevant outcomes. METHODS Longitudinal analyses of adult patients with diabetes and CKD (stages 3a to 5) were performed using outpatient and hospitalisation data from January 2015 to October 2018. Data was handled according to whether patients received the DKS intervention (n = 196) or standard care (n = 7511). The DKS provided patient-centered, coordinated multi-disciplinary assessment and management of patients. Primary analyses examined hospitalisation and mortality rates between the two groups. Secondary analyses evaluated the impact of the DKS on clinical target attainment, changes in eGFR, HbA1c, self-care and patient activation at 12 months. RESULTS Patients who received the intervention had a higher hospitalisation rate (incidence rate ratio (IRR), 1.20; 95% CI, 1.13 to 1.30; P < 0.0001), shorter median length of stay (2 days [interquartile range (IQR), 6-1] versus 4 days [IQR 9-1]; P < 0.0001) and lower all-cause mortality rate (IRR 0.4; 95% CI, 0.29 to 0.64; P < 0.0001) than those who received standard care. Improvements in overall self-care (MD 2.26, 95% CI 0.83, 3.69; P < 0.001) and in statin use, foot and eye examination were observed. Mean eGFR did not significantly change after 12 months (MD 1.30, 95% CI -4.17, 1.67; P = 0.40) mls/min per 1.73 m2. HbA1c levels significantly decreased by 0.40, 0.35, 0.34 and 0.23% at 3, 6, 9 and 12 months follow-up respectively. CONCLUSIONS A co-designed, person-centred integrated model of care improved all-cause mortality, kidney function, glycaemic control and self-care for patients with diabetes and CKD.
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Affiliation(s)
- Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.,Department of Nephrology, Monash Health, VIC, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, VIC, Australia
| | - Sanjeeva Ranasinha
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - Arul Earnest
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia
| | - Helena Teede
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, VIC, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of NSW, NSW, Australia.,Department of General Practice, Sydney Medical School, University of Sydney, Australia
| | - Kevan R Polkinghorne
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.,Department of Nephrology, Monash Health, VIC, Australia.,School of Clinical Sciences, Monash University, VIC, Australia
| | - Gregory Fulcher
- Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, University of Sydney, NSW, Australia.,Northern Clinical School, University of Sydney, Sydney, Australia
| | - Martin Gallagher
- The George Institute for Global Health, University of NSW, NSW, Australia.,Concord Clinical School, University of Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, University of NSW, NSW, Australia.,Sydney Medical School, University of Sydney, NSW, Australia
| | - Alan Cass
- The George Institute for Global Health, University of NSW, NSW, Australia.,Menzies School of Health Research, NT, Australia
| | - Rowan Walker
- Department of Renal Medicine, Alfred Health, VIC, Australia
| | - Grant Russell
- School of Primary Health Care, Monash University, VIC, Australia
| | | | - Peter G Kerr
- Department of Nephrology, Monash Health, VIC, Australia.,School of Clinical Sciences, Monash University, VIC, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, VIC, Australia.,Diabetes and Vascular Medicine Unit, Monash Health, VIC, Australia.,The George Institute for Global Health, University of NSW, NSW, Australia
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Burdett T, Inman J. Person-centred integrated care with a health promotion/public health approach: a rapid review. JOURNAL OF INTEGRATED CARE 2021. [DOI: 10.1108/jica-02-2021-0010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PurposeDue to the need for the development of person-centred integrated models of care with a population health approach, this paper explored contemporary literature in this arena.Design/methodology/approachA systematic literature review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Papers included in this review focused upon person-centred integrated care and a health promotion/public health approach (January 2018–October 2020). Papers were excluded due to not being written in English, not fitting the age criteria and not being peer reviewed.FindingsEight studies met the inclusion criteria and three overarching themes were identified with regards to person-centred integrated care as a health promotion/public health approach: Core components; Development, implementation, and evaluation of models of care and relationship to population health and wellbeing outcomes.Research limitations/implicationsThe need for person-centred integrated care as a health promotion/public health approach, to enhance population health and well-being outcomes requires further research to continue to develop, implement and evaluate models of care.Originality/valueThe international scope of this contemporary review brought together the three concepts of person-centred integrated care and public health, exploring the translation of policy into practice (WHO, 2016). The juxtaposition of public health approaches in the background/consequential or foreground/active agent demonstrates how promotion, prevention and population health can be re-valued in integrated people-centred health services (WHO, 2016).
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Lloyd N, Kenny A, Hyett N. Evaluating health service outcomes of public involvement in health service design in high-income countries: a systematic review. BMC Health Serv Res 2021; 21:364. [PMID: 33879149 PMCID: PMC8056601 DOI: 10.1186/s12913-021-06319-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 03/26/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Internationally, it is expected that health services will involve the public in health service design. Evaluation of public involvement has typically focused on the process and experiences for participants. Less is known about outcomes for health services. The aim of this systematic review was to a) identify and synthesise what is known about health service outcomes of public involvement and b) document how outcomes were evaluated. METHODS Searches were undertaken in MEDLINE, EMBASE, The Cochrane Library, PsycINFO, Web of Science, and CINAHL for studies that reported health service outcomes from public involvement in health service design. The review was limited to high-income countries and studies in English. Study quality was assessed using the Mixed Methods Appraisal Tool and critical appraisal guidelines for assessing the quality and impact of user involvement in health research. Content analysis was used to determine the outcomes of public involvement in health service design and how outcomes were evaluated. RESULTS A total of 93 articles were included. The majority were published in the last 5 years, were qualitative, and were located in the United Kingdom. A range of health service outcomes (discrete products, improvements to health services and system/policy level changes) were reported at various levels (service level, across services, and across organisations). However, evaluations of outcomes were reported in less than half of studies. In studies where outcomes were evaluated, a range of methods were used; most frequent were mixed methods. The quality of study design and reporting was inconsistent. CONCLUSION When reporting public involvement in health service design authors outline a range of outcomes for health services, but it is challenging to determine the extent of outcomes due to inadequate descriptions of study design and poor reporting. There is an urgent need for evaluations, including longitudinal study designs and cost-benefit analyses, to fully understand outcomes from public involvement in health service design.
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Affiliation(s)
- Nicola Lloyd
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Amanda Kenny
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
| | - Nerida Hyett
- Violet Vines Marshman Centre for Rural Health Research, La Trobe Rural Health School, La Trobe University, Bendigo, Australia
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Clemens KK, Ouédraogo AM, Liu SL, Bleah P, Mikalachki A, Spaic T. Providing diabetes education to patients with chronic kidney disease: A survey of diabetes educators in Ontario, Canada. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211062758. [PMID: 34926313 PMCID: PMC8671669 DOI: 10.1177/26335565211062758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Patients with diabetes and chronic kidney disease (CKD) have complex diabetes care needs. Diabetes educators can play an important role in their clinical care. AIM To understand diabetes educators' experience providing diabetes support to patients with CKD and elicit their view on the additional care needs of this population. METHODS We conducted a quantitative online survey of diabetes educators between May 2019 and May 2020. We surveyed English-speaking educators actively practicing in Ontario, Canada for at least 1 year. We recruited them through provincial Diabetes Education Programs and Diabetes Education Section Chairs of Diabetes Canada. RESULTS We made email contact with 219/233 (94%) Diabetes Education Programs and 11/12 (92%) provincial Diabetes Canada Section Chairs. 122 unique diabetes educators submitted complete surveys (survey participation rate ∼79%). Most worked in community education programs (91%). Almost half were registered nurses (48%), and 39% had practiced for more than 15 years. Respondents noted difficulty helping patients balance complex medical conditions (19%), faced socioeconomic barriers (17%), and struggled to provide dietary advice (16%). One-third were uncertain of how to support those receiving dialysis. Eighty-five percent felt they needed more training and education to care for this high-risk group. When asked about the care needs of patients with CKD, almost all (90%) felt that patients needed more diabetes support in general. Improvement in care coordination was most commonly suggested (38%). CONCLUSIONS In this study of the diabetes educators' experience treating patients with diabetes and CKD, respondents noted numerous challenges. There may be opportunities to better support both diabetes care professionals, and patients who live with multiple medical comorbidities.
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Affiliation(s)
- Kristin K Clemens
- Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, ON, Canada
- Centre for Diabetes, Endocrinology and Metabolism, St. Joseph’s Health Care London, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
- ICES Western, London, ON, Canada
| | | | - Selina L Liu
- Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, ON, Canada
- Centre for Diabetes, Endocrinology and Metabolism, St. Joseph’s Health Care London, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
| | - Paulina Bleah
- University Health Network, Division of Nephrology, Toronto General Hospital, Toronto, ON, Canada
| | | | - Tamara Spaic
- Department of Medicine, Division of Endocrinology and Metabolism, Western University, London, ON, Canada
- Centre for Diabetes, Endocrinology and Metabolism, St. Joseph’s Health Care London, London, ON, Canada
- Lawson Health Research Institute, London, ON, Canada
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Zimbudzi E, Lo C, Ranasinha S, Teede H, Usherwood T, Polkinghorne KR, Fulcher G, Gallagher M, Jan S, Cass A, Walker R, Russell G, Johnson G, Kerr PG, Zoungas S. Health-related quality of life among patients with comorbid diabetes and kidney disease attending a codesigned integrated model of care: a longitudinal study. BMJ Open Diabetes Res Care 2020; 8:8/1/e000842. [PMID: 31958294 PMCID: PMC6954749 DOI: 10.1136/bmjdrc-2019-000842] [Citation(s) in RCA: 4] [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] [Received: 08/21/2019] [Revised: 10/07/2019] [Accepted: 11/23/2019] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To evaluate the impact of an integrated diabetes and kidney disease model of care on health-related quality of life (HRQOL) of patients with comorbid diabetes and chronic kidney disease (CKD). RESEARCH DESIGN AND METHODS A longitudinal study of adult patients (over 18 years) with comorbid diabetes and CKD (stage 3a or worse) who attended a new diabetes kidney disease service was conducted at a tertiary hospital. A questionnaire consisting of demographics, clinical data, and the Kidney Disease Quality of Life (KDQOL-36) was administered at baseline and after 12 months. Paired t-tests were used to compare baseline and 12-month scores. A subgroup analysis examined the effects by patient gender. Multiple regression analysis examined the factors associated with changes in scores. RESULTS 179 patients, 36% of whom were female, with baseline mean±SD age of 65.9±11.3 years, were studied. Across all subscales, HRQOL did not significantly change over time (p value for all mean differences >0.05). However, on subgroup analysis, symptom problem list and physical composite summary scores increased among women (MD=9.0, 95% CI 1.25 to 16.67; p=0.02 and MD=4.5, 95% CI 0.57 to 8.42; p=0.03 respectively) and physical composite scores decreased among men (MD=-3.35, 95% CI -6.26 to -0.44; p=0.03). CONCLUSION The HRQOL of patients with comorbid diabetes and CKD attending a new codesigned, integrated diabetes and kidney disease model of care was maintained over 12 months. Given that HRQOL is known to deteriorate over time in this high-risk population, the impact of these findings on clinical outcomes warrants further investigation.
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Affiliation(s)
- Edward Zimbudzi
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - Sanjeeva Ranasinha
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
| | - Helena Teede
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Clayton, Victoria, Australia
| | - Tim Usherwood
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Department of General Practice, The University of Sydney, Sydney, New South Wales, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Greg Fulcher
- Department of Diabetes, Endocrinology and Metabolism, Royal North Shore Hospital School, St Leonards, New South Wales, Australia
- Northern Clinical School, The University of Sydney Northern Clinical School, St Leonards, New South Wales, Australia
| | - Martin Gallagher
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Concord Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Steven Jan
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Alan Cass
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Rowan Walker
- Department of Renal Medicine, Alfred Health, Melbourne, Victoria, Australia
| | - Grant Russell
- Southern Academic Primary Care Research Unit, Department of General Practice, Monash University, Clayton, Victoria, Australia
| | - Greg Johnson
- Diabetes Australia, Canberra, Australian Capital Territory, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Clayton, Victoria, Australia
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
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Zimbudzi E, Lo C, Kerr PG, Zoungas S. A need-based approach to self-management education for adults with co-morbid diabetes and chronic kidney disease. BMC Nephrol 2019; 20:113. [PMID: 30940170 PMCID: PMC6444589 DOI: 10.1186/s12882-019-1296-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2018] [Accepted: 03/13/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Self-management education needs have not been assessed in patients with complex co-morbid conditions such as diabetes and chronic kidney disease (CKD). The objectives of this study were to 1) determine the self-management education needs for patients with co-morbid diabetes and CKD and 2) co-develop an educational resource meeting the self-management education needs of patients with co-morbid diabetes and CKD. METHODS Patients with co-morbid diabetes and CKD attending a co-designed, patient-centred outpatient diabetes and kidney clinic at a tertiary metropolitan hospital were recruited for semi-structured interviews. Maximal variation sampling was used, ensuring adequate representation of different gender, age, diabetes duration and stage of CKD. Data were thematically analysed using grounded theory. RESULTS Forty-two patients participated. Most were male (67%) and the mean age was 64.8 (11.1) years. The majority of patients preferred an educational resource in the form of a Digital Versatile Disc (DVD) and they thought that current education could be improved. In particular patients wanted further education on 1) management of diabetes and kidney disease (including nutrition and lifestyle, and prevention of the progression of kidney disease) and 2) complications of comorbid diabetes and kidney disease. CONCLUSION Patients with co-morbid diabetes and kidney disease have education gaps on the management of, and complications of diabetes and kidney disease. Interventions aimed at improving patient education need to be delivered through education resources co-developed by patients and health staff. A targeted education resource in the form of a DVD, addressing these needs, may potentially close these gaps.
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Affiliation(s)
- Edward Zimbudzi
- Department of Nephrology, Monash Health, Melbourne, Australia
- School of Public Health and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia
| | - Clement Lo
- School of Public Health and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia
| | - Peter G Kerr
- Department of Nephrology, Monash Health, Melbourne, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Alfred Centre, 99 Commercial Road, Melbourne, 3004, Australia.
- The George Institute for Global Health, University of Sydney, Sydney, Australia.
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia.
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