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Wilson G, Hutchison JS. In Pursuit of a Person-Centered Approach to Care Delivery: A Qualitative Descriptive Study of the Patient Experience of a Long-Term Conditions Clinic in General Practice. QUALITATIVE HEALTH RESEARCH 2024:10497323241272003. [PMID: 39326875 DOI: 10.1177/10497323241272003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Innovative ways of working are emerging in health care to meet the complex needs of people living with multiple long-term conditions. While these initiatives are often measured for their health and economic outcomes, few studies prioritize the patient experience. This qualitative descriptive study is one of a few studies exploring the patient experience of attending a dedicated long-term conditions annual review clinic in a primary care setting in England. The service model aims to provide a person-centered, holistic approach to the management and support of people living with multiple long-term conditions. The study presents findings from in-depth interviews with 12 participants. Data analyzed through framework analysis revealed four themes relating to the patient experience: the clinic as a place, continuity, staying healthy, and partnership opportunities. Results highlight the challenges to providing personalized care. We found that attendance at the clinic prompted self-care behaviors, however, patients wanted a more holistic, integrated, and consistent service that provided continuity of therapeutic relationships that involved them in decision-making and care planning. We conclude that the experience of patients in this study suggests this service model can enable patients to manage their health and improve well-being, however, while a person-centered philosophy may underpin service models, our research shows that ensuring this philosophy is born out in service delivery and recognized by patients is problematic. Therefore, service providers need to recognize the values and perspectives of patients, aligning these with the design and delivery of services.
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Affiliation(s)
- Gillian Wilson
- Faculty of Health Sciences, University of Hull, Hull, UK
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Hjelm M, Andersson A, Ujkani V, Andersson EK. Registered nurse case managers' work experiences with a person-centered collaborative healthcare model: an interview study. BMC Health Serv Res 2024; 24:1108. [PMID: 39313787 PMCID: PMC11421112 DOI: 10.1186/s12913-024-11500-3] [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: 05/13/2024] [Accepted: 08/28/2024] [Indexed: 09/25/2024] Open
Abstract
BACKGROUND Multimorbidity is increasingly acknowledged as a significant health concern, particularly among older individuals. It is associated with a decline in quality of life and psychosocial well-being as well as an increased risk of being referred to multiple healthcare providers, including more frequent admissions to emergency departments. Person-centered care interventions tailored to individuals with multimorbidity have shown promising results in improving patient outcomes. Research is needed to explore how work practices within integrated care models are experienced from Registered Nurse Case Managers' (RNCMs) perspective to identify areas of improvement. Therefore, the aim of this study was to describe RNCMs' work experience with a person-centered collaborative healthcare model (PCCHCM). METHODS This study used an inductive design. The data were collected through individual interviews with 11 RNCMs and analyzed using qualitative content analysis. RESULTS Data analysis resulted in four generic categories: 'Being a detective, 'Being a mediator', 'Being a partner', and 'Being a facilitator of development' which formed the basis of the main category 'Tailoring healthcare, and social services to safeguard the patient's best.' The findings showed that RNCMs strive to investigate, identify, and assess older persons' needs for coordinated care. They worked closely with patients and their relatives to engage them in informed decision-making and to implement those decisions in a personalized agreement that served as the foundation for the care and social services provided. Additionally, the RNCMs acted as facilitators of the development of the PCCHCM, improving collaboration with other healthcare professionals and enhancing the possibility of securing the best care for the patient. CONCLUSIONS The results of this study demonstrated that RNCMs tailor healthcare and social services to provide care in various situations, adhering to person-centered care principles and continuity of care. The findings underline the importance of implementing integrated care models that consider the unique characteristics of each care context and adapt different case managers' roles based on the patient's individual needs as well as on the specific needs of the local setting. More research is needed from the patients' and their relatives' perspectives to deepen the understanding of the PCCHCM concerning its ability to provide involvement, security, and coordination of care.
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Affiliation(s)
- Markus Hjelm
- Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden.
- Department of Clinical Sciences in Malmö, Lund University, Lund, Sweden.
| | - Anna Andersson
- Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden
| | - Venera Ujkani
- Blekinge Centre of Competence, Region Blekinge, Karlskrona, Sweden
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Kintzoglanakis K, Pavlou-Skantzis L, Themeli T, Kyprianou M, Paschou SA. Determinants of health-related quality of life of patients with type 2 diabetes and multimorbidity: a cross-sectional study. Hormones (Athens) 2024; 23:407-414. [PMID: 38485876 DOI: 10.1007/s42000-024-00545-y] [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: 08/18/2023] [Accepted: 03/06/2024] [Indexed: 09/28/2024]
Abstract
PURPOSE To examine the determinants of health-related quality of life (HRQoL) of patients with type 2 diabetes (PwD) and multimorbidity (MM) (at least one co-occurring condition besides T2D) among sociodemographic, disease-related, and MM variables and the association of MM with therapeutic targets. METHODS A total of 179 PwD attending primary care (PC) in Greece answered the 15 dimension HRQoL (15D) questionnaire between August 2019 and October 2020. Sociodemographic, disease-related, and MM characteristics were recorded. MM was categorized as concordant or discordant based on whether or not it was related to the pathophysiology of T2D. Independent predictors of the 15D score were examined in stepwise regression models among sociodemographic, disease-related, and MM variables and the association of MM with glycated hemoglobin (A1C) and low-density lipoprotein cholesterol (LDL-C) was assessed. RESULTS The mean 15D score was 0.85 ± 0.11 and the mean MM count was 4.3 ± 1.8. Significant predictors of a higher 15D score were male gender, married state, higher monthly income, and more physical activity. Significant predictors of a lower 15D score were employment, depression, musculoskeletal disease, coronary artery disease, neuropathy, and MM count, but discordant had a stronger effect than concordant MM. Increasing MM count was not significantly correlated with A1C and was correlated with lower LDL-C. CONCLUSION Non-medical (physical activity and sociodemographic) rather than disease-related characteristics and discordant more than concordant co-occurring conditions affected HRQoL of multimorbid PwD who did not have worse (A1C) or achieved better (LDL-C) therapeutic targets. A generalist approach to the non-medical needs and overall health conditions of PwD could be promoted in PC within the social determinants of health and MM.
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Affiliation(s)
| | | | | | | | - Stavroula A Paschou
- Endocrine Unit and Diabetes Center, School of Medicine, Alexandra Hospital, National and Kapodistrian University of Athens, Athens, Greece
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Frank HA, Karim ME. Physical comorbidity is associated with overnight hospitalization in U.S. adults with asthma: an assessment of the 2005-2018 National Health and Nutrition Examination Surveys. J Asthma 2024:1-12. [PMID: 39155766 DOI: 10.1080/02770903.2024.2393677] [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: 10/17/2023] [Revised: 07/17/2024] [Accepted: 08/14/2024] [Indexed: 08/20/2024]
Abstract
OBJECTIVE Identifying the effects of comorbidity on healthcare utilization is critical for understanding the benefits of improved comorbidity management. Asthma is a common respiratory condition, associated with gastrointestinal, metabolic, psychiatric, and other respiratory conditions. Adults with asthma represent a key population in understanding comorbidity and its consequences. The objective was to explore the relationship between comorbidity and overnight hospitalizations in U.S. adults with asthma. STUDY DESIGN AND METHODS A cross-sectional sample of 3,887 subjects aged 20-79 was aggregated from seven cycles (2005-2018) of the National Health and Nutrition Examination Survey (NHANES). The survey design was created using the full seven cycles, then a subpopulation was used for the analysis. Design-based modified Poisson regression with robust standard errors compared the prevalence of overnight hospitalizations in subjects with and without comorbidities. Comorbidity was defined as the presence of one or more additional chronic conditions. RESULTS Over half (61.6%) of patients with asthma reported having comorbidities. The overnight hospitalization prevalence was higher in those with comorbidities (21.6%) than those without (7.4%). The adjusted prevalence ratio of overnight hospitalizations in those with comorbidities vs. those without was 2.02 (95% CI: 1.54-2.66). Conclusions from sensitivity analyses remained the same. CONCLUSIONS Comorbidity in U.S. adult asthma patients is associated with increased overnight hospitalizations. Study results concur with examinations of other healthcare utilization outcomes, revealing how comorbidity influences healthcare utilization patterns in patients with asthma. The reduction of overnight hospitalizations should be a targeted goal when developing and evaluating interventions to manage comorbidities in patients with asthma.
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Affiliation(s)
- Hanna A Frank
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
| | - Mohammad Ehsanul Karim
- School of Population and Public Health, The University of British Columbia, Vancouver, Canada
- Centre for Advancing Health Outcomes, University of British Columbia, Vancouver, Canada
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Zaidi SH, Axon DR. Assessing the Association of Healthcare Resource Utilization and Patient-Reported Outcomes on Shared Decision-Making among Multimorbid Individuals. Healthcare (Basel) 2024; 12:1709. [PMID: 39273733 PMCID: PMC11395068 DOI: 10.3390/healthcare12171709] [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: 06/26/2024] [Revised: 08/23/2024] [Accepted: 08/26/2024] [Indexed: 09/15/2024] Open
Abstract
Shared decision-making (SDM) is an essential component of patient-centered healthcare and disease management. However, the association of SDM with healthcare resource utilization and patient-reported outcomes among multimorbid individuals is not well understood. This study sought to evaluate the association of SDM with healthcare resource utilization and patient-reported outcomes among United States (US) adults with multimorbidity. Data were collected from the 2020 Medical Expenditure Panel Survey (MEPS) for this cross-sectional study. Eligible participants were US adults with two or more comorbidities. The predictor variable was SDM (optimal versus not optimal). The outcome variables were healthcare resource utilization and patient-reported outcomes. Logistic regression models, adjusted for demographic characteristics, assessed associations with SDM for each healthcare resource utilization and patient-reported outcome variable. The analysis maintained the complex survey data and was weighted to produce nationally representative estimates. Individuals who reported optimal SDM in adjusted analyses utilized more healthcare resources compared to those who reported not optimal SDM. Individuals with optimal SDM had more than one outpatient visit (odds ratio OR = 1.23, 95% CI = 1.03-1.47), emergency room visit (OR = 1.55, 95% CI = 1.17-2.06), and inpatient discharge (OR = 1.44, 95% CI = 1.05-1.96). Additionally, these individuals had higher odds of reporting limitations in their ability to work or engage in other activities due to their physical health in the past four weeks (OR = 1.27, 95% CI = 1.01-1.60). This study indicated evidence of increased healthcare resource utilization among patients who participate in SDM with their providers, which should be explored in future studies.
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Affiliation(s)
- Syeda Hina Zaidi
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 North Martin Avenue, P.O. Box 210202, Tucson, AZ 85721, USA
| | - David Rhys Axon
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, 1295 North Martin Avenue, P.O. Box 210202, Tucson, AZ 85721, USA
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Yordanov Y, Beauvais A, Thiébaud PC. Multimorbidity in emergency departments: urgent need for integrated care. BMJ MEDICINE 2024; 3:e000989. [PMID: 39175922 PMCID: PMC11340237 DOI: 10.1136/bmjmed-2024-000989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/05/2024] [Accepted: 08/05/2024] [Indexed: 08/24/2024]
Affiliation(s)
- Youri Yordanov
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
| | - Agathe Beauvais
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, Paris, France
| | - Pierre-Clément Thiébaud
- Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, Paris, France
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O’Brien E, Duffy S, Harkins V, Smith SM, O’Herlihy N, Walsh A, Clyne B, Wallace E. A scoping review of evidence-based guidance and guidelines published by general practice professional organizations. Fam Pract 2024; 41:404-418. [PMID: 36812366 PMCID: PMC11324327 DOI: 10.1093/fampra/cmad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND General practitioners (GPs) need robust, up-to-date evidence to deliver high-quality patient care. There is limited literature regarding the role of international GP professional organizations in developing and publishing clinical guidelines to support GPs clinical decision making. OBJECTIVE To identify evidence-based guidance and clinical guidelines produced by GP professional organizations and summarize their content, structure, and methods of development and dissemination. METHODS Scoping review of GP professional organizations following Joanna Briggs Institute guidance. Four databases were searched and a grey literature search was conducted. Studies were included if they were: (i) evidence-based guidance documents or clinical guidelines produced de novo by a national GP professional organization, (ii) developed to support GPs clinical care, and (iii) published in the last 10 years. GP professional organizations were contacted to provide supplementary information. A narrative synthesis was performed. RESULTS Six GP professional organizations and 60 guidelines were included. The most common de novo guideline topics were mental health, cardiovascular disease, neurology, pregnancy and women's health and preventive care. All guidelines were developed using a standard evidence-synthesis method. All included documents were disseminated through downloadable pdfs and peer review publications. GP professional organizations indicated that they generally collaborate with or endorse guidelines developed by national or international guideline producing bodies. CONCLUSION The findings of this scoping review provide an overview of de novo guideline development by GP professional organizations and can support collaboration between GP organizations worldwide thus reducing duplication of effort, facilitating reproducibility, and identifying areas of standardization. PROTOCOL REGISTRATION Open Science Framework: https://doi.org/10.17605/OSF.IO/JXQ26.
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Affiliation(s)
- Emer O’Brien
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Seamus Duffy
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Velma Harkins
- Irish College of General Practitioners, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Public Health and Primary Care, Trinity College Dublin, DublinIreland
| | | | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of General Practice, University College Cork, Cork, Ireland
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Knudsen AM, Dalgård Dunvald AC, Hangaard S, Hejlesen O, Kronborg T. The Effectiveness of Collaborative Care Interventions for the Management of Patients With Multimorbidity: Protocol for a Systematic Review, Meta-Analysis, and Meta-Regression Analysis. JMIR Res Protoc 2024; 13:e58296. [PMID: 39115256 PMCID: PMC11342003 DOI: 10.2196/58296] [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: 03/12/2024] [Revised: 07/02/2024] [Accepted: 07/09/2024] [Indexed: 08/26/2024] Open
Abstract
BACKGROUND Collaborative care interventions have been proposed as a promising strategy to support patients with multimorbidity. Despite this, the effectiveness of collaborative care interventions requires further evaluation. Existing systematic reviews describing the effectiveness of collaborative care interventions in multimorbidity management tend to focus on specific interventions, patient subgroups, and settings. This necessitates a comprehensive review that will provide an overview of the effectiveness of collaborative care interventions for adult patients with multimorbidity. OBJECTIVE This systematic review aims to systematically assess the effectiveness of collaborative care interventions in comparison to usual care concerning health-related quality of life (HRQoL), mental health, and mortality among adult patients with multimorbidity. METHODS Randomized controlled trials evaluating collaborative care interventions designed for adult patients (18 years and older) with multimorbidity compared with usual care will be considered for inclusion in this review. HRQoL will be the primary outcome. Mortality and mental health outcomes such as rating scales for anxiety and depression will serve as secondary outcomes. The systematic search will be conducted in the CENTRAL, PubMed, CINAHL, and Embase databases. Additional reference and citation searches will be performed in Google Scholar, Web of Science, and Scopus. Data extraction will be comprehensive and include information about participant characteristics, study design, intervention details, and main outcomes. Included studies will be assessed for limitations according to the Cochrane Risk of Bias tool. Meta-analysis will be conducted to estimate the pooled effect size. Meta-regression or subgroup analysis will be undertaken to explore if certain factors can explain the variation in effect between studies, if feasible. The certainty of evidence will be evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. RESULTS The preliminary literature search was performed on February 16, 2024, and yielded 5255 unique records. A follow-up search will be performed across all databases before submission. The findings will be presented in forest plots, a summary of findings table, and in narrative format. This systematic review is expected to be completed by late 2024. CONCLUSIONS This review will provide an overview of pooled estimates of treatment effects across HRQoL, mental health, and mortality from randomized controlled trials evaluating collaborative care interventions for adults with multimorbidity. Furthermore, the intention is to clarify the participant, intervention, or study characteristics that may influence the effect of the interventions. This review is expected to provide valuable insights for researchers, clinicians, and other decision-makers about the effectiveness of collaborative care interventions targeting adult patients with multimorbidity. TRIAL REGISTRATION International Prospective Register of Systematic Reviews (PROSPERO) CRD42024512554; https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=512554. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/58296.
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Affiliation(s)
- Anne-Maj Knudsen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Ann-Cathrine Dalgård Dunvald
- Department of Clinical Pharmacology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Stine Hangaard
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
| | - Ole Hejlesen
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
| | - Thomas Kronborg
- Department of Health Science and Technology, Aalborg University, Gistrup, Denmark
- Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark
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Rink L, Floto C, Apel K, Weiss M, Stegmeier E, Kühlein T, Sebastião M. Development of a self-assessment tool to address the functioning of community-dwelling older adults in general practice: a validation study of the EFA23 questionnaire. BMC PRIMARY CARE 2024; 25:280. [PMID: 39095690 PMCID: PMC11297772 DOI: 10.1186/s12875-024-02539-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 07/24/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Multimorbidity is increasingly prevalent among ageing patients, leading to reduced daily functioning. To address the challenges posed by multimorbidity in older adults, a person- and context-centred approach is needed. This study aimed to develop a questionnaire as a self-assessment tool for older adults focusing on functioning in general practice based on the International Classification of Functioning, Disability and Health (ICF). METHODS A mixed-methods approach was employed in the development and validation of the German EFA23 (Erfassung Funktionaler Gesundheit im Alter - 23 Fragen; Assessing Functional Health in Old Age - 23 questions) questionnaire. Based on an ICF subset developed in a preparatory phase and consensus study, questionnaire items were formulated and tested in a qualitative pretest, followed by a validation study. A workshop with general practitioners (GPs) was held to develop a supplementary manual for GPs on how to interpret the questionnaire results and discuss them with the patients. RESULTS A total of 69 items were developed and tested in the qualitative pretest with 15 respondents, resulting in 37 items for the validation study. The validation study, involving 237 older adults, showed the presence of one significant principal component. It demonstrated good internal consistency (Cronbach's alpha = 0.967) and construct validity, showing positive correlations with established assessment tools. Descriptive statistics showed differences between the means of self-assessment by patients and an external GP assessment. The final EFA23 questionnaire consists of 23 items assessing limitations in functioning. CONCLUSIONS The EFA23 questionnaire can be used as a valid self-assessment instrument to measure functioning in older adults, supporting a person- and context-centred approach in general practice.
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Affiliation(s)
- Laura Rink
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstr. 29, 91054, Erlangen, Germany.
| | - Caroline Floto
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstr. 29, 91054, Erlangen, Germany
| | - Katharina Apel
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstr. 29, 91054, Erlangen, Germany
| | - Maren Weiss
- Department of Psychology, SRH Wilhelm Löhe Hochschule Fürth, Fürth, Germany
| | - Elmar Stegmeier
- Koordinierungsgesellschaft Gesundheit, Aschau im Chiemgau, Germany
| | - Thomas Kühlein
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstr. 29, 91054, Erlangen, Germany
| | - Maria Sebastião
- Institute of General Practice, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsstr. 29, 91054, Erlangen, Germany
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Kemp BJ, Thompson DR, Coates V, Bond S, Ski CF, Monaghan M, McGuigan K. International guideline comparison of lifestyle management for acute coronary syndrome and type 2 diabetes mellitus: A rapid review. Health Policy 2024; 146:105116. [PMID: 38943831 DOI: 10.1016/j.healthpol.2024.105116] [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: 07/31/2023] [Revised: 05/07/2024] [Accepted: 06/16/2024] [Indexed: 07/01/2024]
Abstract
Acute coronary syndrome (ACS) is a life-threatening condition, with ACS-associated morbidity and mortality causing substantial human and economic challenges to the individual and health services. Due to shared disease determinants, those with ACS have a high risk of comorbid Type 2 diabetes mellitus (T2DM). Despite this, the two conditions are managed separately, duplicating workload for staff and increasing the number of appointments and complexity of patient management plans. This rapid review compared current ACS and T2DM guidelines across Australia, Canada, Europe, Ireland, New Zealand, the UK, and the USA. Results highlighted service overlap, repetition, and opportunities for integrated practice for ACS-T2DM lifestyle management across diet and nutrition, physical activity, weight management, clinical and psychological health. Recommendations are made for potential integration of ACS-T2DM service provision to streamline care and reduce siloed care in the context of the health services for ACS-T2DM and similar comorbid conditions.
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Affiliation(s)
- Bridie J Kemp
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - David R Thompson
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Vivien Coates
- School of Nursing and Paramedic Science, Ulster University, Magee Campus, Londonderry, UK
| | - Sarah Bond
- School of Nursing and Paramedic Science, Ulster University, Magee Campus, Londonderry, UK
| | - Chantal F Ski
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK; Australian Centre for Heart Health, Deakin University, Melbourne, Australia
| | | | - Karen McGuigan
- Queen's Communities and Place, Queen's University Belfast, Belfast, UK.
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Ahrén J, Pirouzifard M, Holmquist B, Sundquist J, Sundquist K, Zöller B. Multimorbidity disease clusters are associated with venous thromboembolism: an extended cross-sectional national study. J Thromb Thrombolysis 2024; 57:898-906. [PMID: 38678153 PMCID: PMC11315723 DOI: 10.1007/s11239-024-02987-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/18/2024] [Indexed: 04/29/2024]
Abstract
Multimorbidity, i.e., two or more non-communicable diseases (NCDs), is an escalating challenge for society. Venous thromboembolism (VTE) is a common cardiovascular disease and it is unknown which multimorbidity clusters associates with VTE. Our aim was to examine the association between different common disease clusters of multimorbidity and VTE. The study is an extended (1997-2015) cross-sectional Swedish study using the National Patient Register and the Multigeneration Register. A total of 2,694,442 Swedish-born individuals were included in the study. Multimorbidity was defined by 45 NCDs. A principal component analysis (PCA) identified multimorbidity disease clusters. Odds ratios (OR) for VTE were calculated for the different multimorbidity disease clusters. There were 16% (n = 440,742) of multimorbid individuals in the study population. Forty-four of the individual 45 NCDs were associated with VTE. The PCA analysis identified nine multimorbidity disease clusters, F1-F9. Seven of these multimorbidity clusters were associated with VTE. The adjusted OR for VTE in the multimorbid patients was for the first three clusters: F1 (cardiometabolic diseases) 3.44 (95%CI 3.24-3.65), F2 (mental disorders) 2.25 (95%CI 2.14-2.37) and F3 (digestive system diseases) 4.35 (95%CI 3.63-5.22). There was an association between multimorbidity severity and OR for VTE. For instance, the occurrence of at least five diseases was in F1 and F2 associated with ORs for VTE: 8.17 (95%CI 6.32-10.55) and 6.31 (95%CI 4.34-9.17), respectively. In this nationwide study we have shown a strong association between VTE and different multimorbidity disease clusters that might be useful for VTE prediction.
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Affiliation(s)
- Jonatan Ahrén
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden.
- University Clinic Primary Care Skåne, Region Skåne, Sweden.
| | - MirNabi Pirouzifard
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | | | - Jan Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Kristina Sundquist
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
| | - Bengt Zöller
- Center for Primary Health Care Research, Lund University/Region Skåne, Malmö, Sweden
- University Clinic Primary Care Skåne, Region Skåne, Sweden
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Gray L, Bullock L, Chew-Graham CA, Jinks C, Paskins Z, Hider S. Reviews for multimorbidity risk in people with inflammatory conditions: a qualitative study. BJGP Open 2024:BJGPO.2024.0011. [PMID: 38580391 DOI: 10.3399/bjgpo.2024.0011] [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: 01/09/2024] [Revised: 03/18/2024] [Accepted: 03/25/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions (IRCs) are at high risk of developing other conditions including cardiovascular disease (CVD) and mood disorders. AIM To explore perspectives of people with IRCs and healthcare practitioners (HCPs) on the content and delivery of a review consultation aimed at identification and management of multiple long-term conditions (mLTCs). DESIGN & SETTING Semi-structured interviews and focus groups with people with IRCs and HCPs in primary and secondary care. METHOD People with IRCs participated in individual semi-structured interviews by telephone or online platform. HCPs (including primary and secondary care clinicians) participated in online focus groups. Data were transcribed verbatim and analysed using inductive thematic analysis. RESULTS Fifteen people with IRCs were interviewed; three focus groups with HCPs were conducted. The following two main themes were identified: reflecting on the value of review consultations; and what would a new review look like? Overall, people with IRCs and HCPs reflected that access to reviews is inequitable, leading to duplication of reviews and fragmentation in care. People with IRCs, at times, had difficulty conceptualising reviews, especially when discussing their future risk of conditions. People suggested that preparation before the healthcare review could align patient and HCP agendas as part of a flexible and person-centred discussion. CONCLUSION Any review introduced for people with IRCs must move beyond a 'tick-box' exercise. To gain maximum value from a review, preparation from both patient and HCP may be required alongside a person-centred approach while ensuring they are targeted at people most likely to benefit.
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Affiliation(s)
- Lauren Gray
- Haywood Academic Rheumatology Centre, Midlands Partnership University Foundation Trust, Stoke-on-Trent, UK
- School of Medicine, Keele University, Keele, UK
| | | | | | - Clare Jinks
- School of Medicine, Keele University, Keele, UK
| | - Zoe Paskins
- Haywood Academic Rheumatology Centre, Midlands Partnership University Foundation Trust, Stoke-on-Trent, UK
- School of Medicine, Keele University, Keele, UK
| | - Samantha Hider
- Haywood Academic Rheumatology Centre, Midlands Partnership University Foundation Trust, Stoke-on-Trent, UK
- School of Medicine, Keele University, Keele, UK
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13
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Bammert P, Franke S, Flemming R, Iashchenko I, Brittner M, Gerlach R, Voß K, Sundmacher L. Comparing the quality of care in physician networks to usual care for elderly patients in three German regions: a quasi-experimental cohort study. Public Health 2024; 232:161-169. [PMID: 38788492 DOI: 10.1016/j.puhe.2024.04.031] [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: 11/17/2023] [Revised: 04/22/2024] [Accepted: 04/23/2024] [Indexed: 05/26/2024]
Abstract
OBJECTIVES Patients in Germany have free choice of physicians in the ambulatory care sector and can consult them as often as they wish without a referral. This can lead to inefficiencies in treatment pathways. In response, some physicians have formed networks to improve the coordination and quality of care. This study aims to investigate whether the care provided by these networks results in better health and process outcomes than usual care. STUDY DESIGN This was a quasi-experimental cohort study. METHODS We analysed claims data from 2017 to 2018 in Bavaria, Brandenburg, and Westphalia-Lippe. Our study population includes patients aged 65 years or older with heart failure (n = 267,256), back pain (n = 931,672), or depression (n = 483,068). We compared condition-specific and generic quality indicators between patients treated in physician networks and usual care. Ambulatory care-sensitive emergency department cases were used as a primary outcome measure. Imbalances between the groups were minimized using propensity score matching. RESULTS Rates of ambulatory care-sensitive emergency department cases yielded insignificant differences between networks and usual care in the depression and heart failure subgroups. For back pain patients, rates were 0.17 percentage points higher (P < 0.01) in network patients compared with usual care. Among network patients, generic indicators for prevention and coordination showed significantly better performance. For instance, the rate of completed vaccination against influenza is 3.03 percentage points higher (P < 0.01), and the rate of specialist visits after referral is 1.6 percentage points higher (P < 0.01) in heart failure patients, who are treated in physician networks. This is accompanied by higher rates of polypharmacy. Furthermore, the results for condition-specific indicators suggest that for most indicators, a greater proportion of the care provided by physician networks adhered to national treatment guidelines. CONCLUSIONS Our findings suggest that physician networks in Germany do not reduce rates of ambulatory care-sensitive emergency department cases but perform better than usual care in terms of care coordination and prevention. Further research is needed to confirm our findings and explore the implications of the potentially higher rates of polypharmacy seen in physician networks.
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Affiliation(s)
- P Bammert
- School of Medicine and Health, Technical University of Munich, Munich, Germany.
| | - S Franke
- School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - R Flemming
- School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - I Iashchenko
- School of Medicine and Health, Technical University of Munich, Munich, Germany
| | - M Brittner
- Association of Statutory Health Insurance Physicians Westphalia-Lippe, Dortmund, Germany
| | - R Gerlach
- Association of Statutory Health Insurance Physicians Bavaria, Munich, Germany
| | - K Voß
- Association of Statutory Health Insurance Physicians Brandenburg, Potsdam, Germany
| | - L Sundmacher
- School of Medicine and Health, Technical University of Munich, Munich, Germany
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14
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Nakayama S, Hirota Y, Suzuki Y, Nonaka R, Kurosawa E, Arima Y, Oizumi T, Yamagata T, Mashiko S, Furukawa K. Number of medicines taken correlates with renal function in older patients. Geriatr Gerontol Int 2024; 24:742-743. [PMID: 38764199 DOI: 10.1111/ggi.14899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2024] [Accepted: 05/06/2024] [Indexed: 05/21/2024]
Affiliation(s)
- Saki Nakayama
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yurika Hirota
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Yuiko Suzuki
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Ryo Nonaka
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Emiko Kurosawa
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Youtaro Arima
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Tomoya Oizumi
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Toshihiro Yamagata
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Shigeto Mashiko
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Katsutoshi Furukawa
- Division of Geriatric and Community Medicine, Faculty of Medicine, Tohoku Medical and Pharmaceutical University, Sendai, Japan
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15
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Lammila-Escalera E, Greenfield G, Pan Z, Nicholls D, Majeed A, Hayhoe B. Interventions to improve medication adherence in adults with mental-physical multimorbidity in primary care: a systematic review. Br J Gen Pract 2024; 74:e442-e448. [PMID: 38429109 PMCID: PMC11181560 DOI: 10.3399/bjgp.2023.0406] [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: 08/15/2023] [Accepted: 02/26/2024] [Indexed: 03/03/2024] Open
Abstract
BACKGROUND Medication non-adherence is a notable contributor to healthcare inefficiency, resulting in poor medication management, impaired patient outcomes, and ineffective symptom control. AIM To summarise interventions targeting medication adherence for adults with mental-physical multimorbidity in primary healthcare settings. DESIGN AND SETTING A systematic review of the literature - published in any language and with any country of origin - was conducted. METHOD MEDLINE, EMBASE, PsycInfo, Web of Science, Cochrane Library, and the Cumulated Index to Nursing and Allied Health Literature - more commonly known as CINAHL - were searched for relevant studies. Data were extracted and synthesised using narrative synthesis. The Effective Practice and Organisation of Care (EPOC) taxonomy was used to classify intervention types. Risk of bias was assessed using the National Heart, Lung, and Blood Institute's quality assessment tool for controlled intervention studies. RESULTS Eleven studies, representing 2279 patients, were included. All interventions examined were classified into one EPOC domain, namely 'delivery arrangements'. All included studies examined patients who had a physical condition and depression. Seven studies examining interventions focused on coordination of care and management of care processes reported statistically significant improvements in medication adherence that were attributed to the intervention. Four studies considering the use of information and communication technology observed no changes in medication adherence. CONCLUSION Interventions that coordinate and manage healthcare processes may help improve patients' adherence to medication regimes in those with mental-physical multimorbidity. However, it is still necessary to better understand how digital health technology can support patients in following their medication regimes. As the growing challenges of treating multimorbidity are faced, everyone involved in health services - from providers to policymakers - must be receptive to a more integrated approach to healthcare delivery.
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Affiliation(s)
| | | | - Ziyang Pan
- Department of Primary Care and Public Health
| | | | | | - Benedict Hayhoe
- Department of Primary Care and Public Health, Imperial College London, London
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16
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Wei L, Butterly E, Rodríguez Pérez J, Chowdhury A, Shemilt R, Hanlon P, McAllister D. Description of subgroup reporting in clinical trials of chronic diseases: a meta-epidemiological study. BMJ Open 2024; 14:e081315. [PMID: 38908852 PMCID: PMC11328666 DOI: 10.1136/bmjopen-2023-081315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/24/2024] Open
Abstract
INTRODUCTION In trials, subgroup analyses are used to examine whether treatment effects differ by important patient characteristics. However, which subgroups are most commonly reported has not been comprehensively described. DESIGN AND SETTINGS Using a set of trials identified from the US clinical trials register (ClinicalTrials.gov), we describe every reported subgroup for a range of conditions and drug classes. METHODS We obtained trial characteristics from ClinicalTrials.gov via the Aggregate Analysis of ClinicalTrials.gov database. We subsequently obtained all corresponding PubMed-indexed papers and screened these for subgroup reporting. Tables and text for reported subgroups were extracted and standardised using Medical Subject Headings and WHO Anatomical Therapeutic Chemical codes. Via logistic and Poisson regression models we identified independent predictors of result reporting (any vs none) and subgroup reporting (any vs none and counts). We then summarised subgroup reporting by index condition and presented all subgroups for all trials via a web-based interactive heatmap (https://ihwph-hehta.shinyapps.io/subgroup_reporting_app/). RESULTS Among 2235 eligible trials, 23% (524 trials) reported subgroups. Follow-up time (OR, 95%CI: 1.13, 1.04-1.24), enrolment (per 10-fold increment, 3.48, 2.25-5.47), trial starting year (1.07, 1.03-1.11) and specific index conditions (eg, hypercholesterolaemia, hypertension, taking asthma as the reference, OR ranged from 0.15 to 10.44), predicted reporting, sponsoring source and number of arms did not. Results were similar on modelling any result reporting (except number of arms, 1.42, 1.15-1.74) and the total number of subgroups. Age (51%), gender (45%), racial group (28%) were the most frequently reported subgroups. Characteristics related to the index condition (severity/duration/types etc) were frequently reported (eg, 69% of myocardial infarction trials reported on its severity/duration/types). However, reporting on comorbidity/frailty (five trials) and mental health (four trials) was rare. CONCLUSION Other than age, sex, race ethnicity or geographic location and characteristics related to the index condition, information on variation in treatment effects is sparse. PROSPERO REGISTRATION NUMBER CRD42018048202.
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Affiliation(s)
- Lili Wei
- University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - Elaine Butterly
- University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | | | | | - Richard Shemilt
- University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - Peter Hanlon
- University of Glasgow School of Health and Wellbeing, Glasgow, UK
| | - David McAllister
- University of Glasgow School of Health and Wellbeing, Glasgow, UK
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17
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van der Feltz-Cornelis CM, Sweetman J, Turk F, Allsopp G, Gabbay M, Khunti K, Williams N, Montgomery H, Heightman M, Lip GYH, Crooks MG, Strain WD, Loveless A, Hishmeh L, Smith N, Banerjee A. Integrated care policy recommendations for complex multisystem long term conditions and long COVID. Sci Rep 2024; 14:13634. [PMID: 38871773 DOI: 10.1038/s41598-024-64060-1] [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: 11/15/2023] [Accepted: 06/05/2024] [Indexed: 06/15/2024] Open
Abstract
The importance of integrated care for complex, multiple long term conditions was acknowledged before the COVID pandemic but remained a challenge. The pandemic and consequent development of Long COVID required rapid adaptation of health services to address the population's needs, requiring service redesigns including integrated care. This Delphi consensus study was conducted in the UK and found similar integrated care priorities for Long COVID and complex, multiple long term conditions, provided by 480 patients and health care providers, with an 80% consensus rate. The resultant recommendations were based on more than 1400 responses from survey participants and were supported by patients, health care professionals, and by patient charities. Participants identified the need to allocate resources to: support integrated care, provide access to care and treatments that work, provide diagnostic procedures that support the personalization of treatment in an integrated care environment, and enable structural consultation between primary and specialist care settings including physical and mental health care. Based on the findings we propose a model for delivering integrated care by a multidisciplinary team to people with complex multisystem conditions. These recommendations can inform improvements to integrated care for complex, multiple long term conditions and Long COVID at international level.
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Affiliation(s)
- Christina M van der Feltz-Cornelis
- Department of Health Sciences, University of York, York, UK.
- Hull York Medical School, (HYMS), University of York, York, UK.
- Institute of Health Informatics, University College London, London, UK.
| | | | - Fidan Turk
- Department of Health Sciences, University of York, York, UK
| | - Gail Allsopp
- Royal College of General Practitioners, London, UK
| | - Mark Gabbay
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester, UK
| | - Nefyn Williams
- Department of Primary Care and Mental Health, University of Liverpool, Liverpool, UK
| | - Hugh Montgomery
- Department of Medicine, University College London, London, UK
| | - Melissa Heightman
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart and Chest Hospital, Liverpool, UK
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Michael G Crooks
- Hull York Medical School, University of Hull, Hull, UK
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - W David Strain
- Diabetes and Vascular Medicine Research Centre, Institute of Clinical and Biomedical Science and College of Medicine and Health, University of Exeter, Exeter, UK
| | | | - Lyth Hishmeh
- PPI Member for STIMULATE-ICP Consortium, London, UK
| | - Natalie Smith
- Department of Health Sciences, University of York, York, UK
| | - Amitava Banerjee
- Institute of Health Informatics, University College London, London, UK
- Department of Cardiology, University College London Hospitals NHS Trust, London, UK
- Department of Cardiology, Barts Health NHS Trust, London, UK
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18
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Kimura T, Nomura K, Hashimoto M, Shinmura K. Relationship between the characteristics of Japanese physicians involved in medical care for older adults and their approaches to treating older patients with multimorbidity. PLoS One 2024; 19:e0302532. [PMID: 38865339 PMCID: PMC11168666 DOI: 10.1371/journal.pone.0302532] [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: 10/13/2023] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
One countermeasure against the increasing prevalence of multimorbidity is the need to provide clinical education and training that considers the characteristics of physicians. We conducted a questionnaire survey to determine the relationship between physicians' characteristics and their approach to treating older patients with multimorbidity. A total of 3300 geriatric specialists and primary care specialists in Japan were enrolled. A 4-point Likert scale was used to score the following items: difficult diseases (43 items), difficult patient backgrounds (14 items), important clinical factors (32 items), and important clinical management (32 items). Exploratory factor analysis was performed to examine the constructs in each of the scales Diseases, Backgrounds, Clinical Factors, and Clinical Management, and group comparisons by physician characteristics were conducted. A total of 778 respondents were included in the analysis. Six factors for Diseases, two factors for Patient Background, four factors for Clinical Factors, and two factors for Clinical Management were explored as patterns. Group comparison between mean scores for each factor and the characteristics of responding physicians showed statistically significant differences in at least one factor for all patterns in terms of years of experience as a physician (26 years or less, 27 years or more), the clinical setting (providing or not providing home medical care), and sex (male or female). Our results suggest a need for clinical education and training that takes into account not only physicians' experience and clinical setting, but also their sex.
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Affiliation(s)
- Takuma Kimura
- Department of R&D Innovation for Home Care Medicine, Department of General Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Masayoshi Hashimoto
- Department of R&D Innovation for Home Care Medicine, Department of General Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Ken Shinmura
- Department of General Internal Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Hyogo, Japan
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19
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Sources of diagnostic delay for people with Crohn's disease and ulcerative colitis: Qualitative research study. PLoS One 2024; 19:e0301672. [PMID: 38857292 PMCID: PMC11164383 DOI: 10.1371/journal.pone.0301672] [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: 09/12/2023] [Accepted: 03/20/2024] [Indexed: 06/12/2024] Open
Abstract
OBJECTIVE An improved understanding of the causes and experience of diagnostic delay in Inflammatory Bowel Disease (IBD). METHODS Framework analysis of semi-structured interviews with 20 adults with IBD. RESULTS Participants' prior knowledge of normal bowel function/IBD was limited. Symptoms were sometimes misattributed to mild/transient conditions or normalised until intolerable. Family pressures, work, education, mistrust of doctors, fear and embarrassment could exacerbate delays. Poor availability of face-to-face appointments deterred people from seeing a GP. Patients feared that by the time they got to see their GP, their symptoms would have resolved. Patients instead self-managed symptoms, but often regretted not seeking help earlier. Limited time in consultations, language barriers, embarrassment, and delays in test results subsequently delayed specialist referrals. GPs misattributed symptoms to other conditions due to atypical or non-specific presentations, leading to reduced trust in health systems. Patients complained of poor communication, delays in accessing test results, appointments, and onward referrals-all associated with clinical deterioration. GPs were sometimes unable to 'fast-track' patients into specialist care. Consultations and endoscopies were often difficult experiences for patients, especially for non-English speakers who are also less likely to receive information on mental health support and the practicalities of living with IBD. CONCLUSIONS The framework analysis demonstrates delay in the diagnosis of IBD at each stage of the patient journey. RECOMMENDATIONS Greater awareness of IBD amongst the general population would facilitate presentation to healthcare services through symptom recognition by individuals and community advice. Greater awareness in primary care would help ensure IBD is included in differential diagnosis. In secondary care, greater attention to the wider needs of patients is needed-beyond diagnosis and treatment. All clinicians should consider atypical presentations and the fluctuating nature of IBD. Diagnostic overshadowing is a significant risk-where other diagnoses are already in play the risk of delay is considerable.
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Affiliation(s)
- AWARE-IBD Diagnostic Delay Working Group
- Sheffield CTRU, University of Sheffield, Regent Court, Sheffield, United Kingdom
- The Medical School, The University of Sheffield, Sheffield, United Kingdom
- Academic Unit of Medical Education, The Medical School, The University of Sheffield, Sheffield, United Kingdom
- Sheffield Inflammatory Bowel Disease Centre, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
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20
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Tsang JY, Sperrin M, Blakeman T, Payne RA, Ashcroft D. Defining, identifying and addressing problematic polypharmacy within multimorbidity in primary care: a scoping review. BMJ Open 2024; 14:e081698. [PMID: 38803265 PMCID: PMC11129052 DOI: 10.1136/bmjopen-2023-081698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 05/11/2024] [Indexed: 05/29/2024] Open
Abstract
INTRODUCTION Polypharmacy and multimorbidity pose escalating challenges. Despite numerous attempts, interventions have yet to show consistent improvements in health outcomes. A key factor may be varied approaches to targeting patients for intervention. OBJECTIVES To explore how patients are targeted for intervention by examining the literature with respect to: understanding how polypharmacy is defined; identifying problematic polypharmacy in practice; and addressing problematic polypharmacy through interventions. DESIGN We performed a scoping review as defined by the Joanna Briggs Institute. SETTING The focus was on primary care settings. DATA SOURCES Medline, Embase, Cumulative Index to Nursing and Allied Health Literature and Cochrane along with ClinicalTrials.gov, Science.gov and WorldCat.org were searched from January 2004 to February 2024. ELIGIBILITY CRITERIA We included all articles that had a focus on problematic polypharmacy in multimorbidity and primary care, incorporating multiple types of evidence, such as reviews, quantitative trials, qualitative studies and policy documents. Articles focussing on a single index disease or not written in English were excluded. EXTRACTION AND ANALYSIS We performed a narrative synthesis, comparing themes and findings across the collective evidence to draw contextualised insights and conclusions. RESULTS In total, 157 articles were included. Case-finding methods often rely on basic medication counts (often five or more) without considering medical history or whether individual medications are clinically appropriate. Other approaches highlight specific drug indicators and interactions as potentially inappropriate prescribing, failing to capture a proportion of patients not fitting criteria. Different potentially inappropriate prescribing criteria also show significant inconsistencies in determining the appropriateness of medications, often neglecting to consider multimorbidity and underprescribing. This may hinder the identification of the precise population requiring intervention. CONCLUSIONS Improved strategies are needed to target patients with polypharmacy, which should consider patient perspectives, individual factors and clinical appropriateness. The development of a cross-cutting measure of problematic polypharmacy that consistently incorporates adjustment for multimorbidity may be a valuable next step to address frequent confounding.
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Affiliation(s)
- Jung Yin Tsang
- Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester Division of Population Health Health Services Research and Primary Care, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Matthew Sperrin
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
- Division of Informatics, Imaging and Data Sciences, School of Health Sciences, The University of Manchester, Manchester, UK
| | - Thomas Blakeman
- Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester Division of Population Health Health Services Research and Primary Care, Manchester, UK
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
| | - Rupert A Payne
- Department of Health and Community Sciences, University of Exeter Medical School, Exeter, UK
| | - Darren Ashcroft
- NIHR Greater Manchester Patient Safety Research Collaboration (GMPSRC), Faculty of Biology, Medicine and Health, Manchester Academic Health Sciences Centre (MAHSC), The University of Manchester, Manchester, UK
- Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology Medicine and Health, The University of Manchester, Manchester, UK
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21
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Schrimpf A, Scheiwe E, Bleckwenn M. Insights from end-of-career general practitioners on changing working conditions and generational differences: considerations for future strategies. BMC PRIMARY CARE 2024; 25:171. [PMID: 38762452 PMCID: PMC11102275 DOI: 10.1186/s12875-024-02419-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Accepted: 05/07/2024] [Indexed: 05/20/2024]
Abstract
The landscape of general practice has experienced notable transformations in recent decades, profoundly influencing the working conditions of general practitioners (GPs). This study aimed to examine the most salient changes affecting GPs' daily practices. Through semi-structured qualitative interviews with 15 end-of-career GPs, the study explored how these changes affected work organization, equipment, working hours, work-life balance, job satisfaction, training, patient relationships, and reputation. The interviews revealed that these changes were perceived as barriers, opportunities, or a complex interplay of both for general practice. While the interviewed GPs valued technological advancements and reported positive developments in working conditions, challenges included a gradual reduction in the range of tasks, growing administrative burdens, and less practical training for young physicians. Other changes, such as new doctor-patient dynamics, the transition from single to group practice, and differing professional expectations of the younger generation, were seen as both challenging and strengthening for general practice. By combining these factors and trade-offs observed by end-of-career GPs in our study over the past few decades with general societal changes, we provide ideas for the design of future framework conditions in general practice that might enhance the attractiveness of the profession. These insights offer key considerations that can guide future strategies for general practice and medical education.
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Affiliation(s)
- Anne Schrimpf
- Institute for General Practice, Faculty of Medicine, Leipzig University, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany.
| | - Elisabeth Scheiwe
- Institute of General Practice and Family Medicine, University Hospital Bonn, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Markus Bleckwenn
- Institute for General Practice, Faculty of Medicine, Leipzig University, Philipp-Rosenthal-Straße 55, 04103, Leipzig, Germany
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22
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Bloemeke-Cammin J, Groene O, Ballester M, Guanais F, Groenewegen P, Kendir C, Porter I, Rehsi A, Rijken M, Spreeuwenberg P, Suñol R, Valderas JM, Williams R, van den Berg M. International cross-cultural development and field testing of the primary care practice questionnaire for the PaRIS survey (PaRIS-PCPQ). BMC PRIMARY CARE 2024; 25:168. [PMID: 38760733 PMCID: PMC11100105 DOI: 10.1186/s12875-024-02375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/09/2024] [Indexed: 05/19/2024]
Abstract
BACKGROUND The PaRIS survey, an initiative of the Organisation for Economic Co-operation and Development (OECD), aims to assess health systems performance in delivering primary care by measuring the care experiences and outcomes of people over 45 who used primary care services in the past six months. In addition, linked data from primary care practices are collected to analyse how the organisation of primary care practices and their care processes impact care experiences and outcomes. This article describes the development and validation of the primary care practice questionnaire for the PaRIS survey, the PaRIS-PCPQ. METHOD The PaRIS-PCPQ was developed based on domains of primary care practice and professional characteristics included in the PaRIS conceptual framework. Questionnaire development was conducted in four phases: (1) a multi-step consensus-based development of the source questionnaire, (2) translation of the English source questionnaire into 17 languages, (3) cross-national cognitive testing with primary care professionals in participating countries, and (4) cross-national field-testing. RESULTS 70 items were selected from 7 existing questionnaires on primary care characteristics, of which 49 were included in a first draft. Feedback from stakeholders resulted in a modified 34-item version (practice profile, care coordination, chronic care management, patient follow-up, and respondent characteristics) designed to be completed online by medical or non-medical staff working in a primary care practice. Cognitive testing led to changes in the source questionnaire as well as to country specific localisations. The resulting 32-item questionnaire was piloted in an online survey and field test. Data from 540 primary care practices from 17 countries were collected and analysed. Final revision resulted in a 34-item questionnaire. CONCLUSIONS The cross-national development of a primary care practice questionnaire is challenging due to the differences in care delivery systems. Rigorous translation and cognitive testing as well as stakeholder engagement helped to overcome most challenges. The PaRIS-PCPQ will be used to assess how key characteristics of primary care practices relate to the care experiences and outcomes of people living with chronic conditions. As such, policymakers and care providers will be informed about the performance of primary care from the patient's perspective.
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Affiliation(s)
- Janika Bloemeke-Cammin
- Department Research & Innovation, OptiMedis AG, Burchardstraße 17, 20095, Hamburg, Germany
| | - Oliver Groene
- Department Research & Innovation, OptiMedis AG, Burchardstraße 17, 20095, Hamburg, Germany.
- Faculty of Management, Economics and Society, University of Witten/Herdecke, Witten, Germany.
| | - Marta Ballester
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Frederico Guanais
- OECD, Health Division, Directorate for Employment, Labour and Social Affairs, Paris, France
| | - Peter Groenewegen
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Candan Kendir
- OECD, Health Division, Directorate for Employment, Labour and Social Affairs, Paris, France
- Department of Public and Occupational Health, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Ian Porter
- Health Services & Policy Research Group, University of Exeter, Exeter, UK
| | | | - Mieke Rijken
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
- Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - Peter Spreeuwenberg
- Nivel, Netherlands Institute for Health Services Research, Utrecht, Netherlands
| | - Rosa Suñol
- Avedis Donabedian Research Institute (FAD), Universitat Autonoma de Barcelona, Barcelona, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Jose Maria Valderas
- Health Services & Policy Research Group, University of Exeter, Exeter, UK
- Centre for Research in Health Systems Performance, Yon Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Family Medicine, National University Health System, Singapore, Singapore
| | | | - Michael van den Berg
- OECD, Health Division, Directorate for Employment, Labour and Social Affairs, Paris, France
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Stratton RJ. Managing malnutrition and multimorbidity in primary care: dietary approaches to reduce treatment burden. Proc Nutr Soc 2024:1-9. [PMID: 38751299 DOI: 10.1017/s0029665124004695] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
There are many health and nutrition implications of suffering from multimorbidity, which is a huge challenge facing health and social services. This review focuses on malnutrition, one of the nutritional consequences of multimorbidity. Malnutrition can result from the impact of chronic conditions and their management (polypharmacy) on appetite and nutritional intake, leading to an inability to meet nutritional requirements from food. Malnutrition (undernutrition) is prevalent in primary care and costly, the main cause being disease, accentuated by multiple morbidities. Most of the costs arise from the deleterious effects of malnutrition on individual's function, clinical outcome and recovery leading to a substantially greater burden on treatment and health care resources, costing at least £19·6 billion in England. Routine identification of malnutrition with screening should be part of the management of multimorbidity together with practical, effective ways of treating malnutrition that overcome anorexia where relevant. Nutritional interventions that improve nutritional intake have been shown to significantly reduce mortality in individuals with multimorbidities. In addition to food-based interventions, a more 'medicalised' dietary approach using liquid oral nutritional supplements (ONS) can be effective. ONS typically have little impact on appetite, effectively improve energy, protein and micronutrient intakes and may significantly improve functional measures. Reduced treatment burden can result from effective nutritional intervention with improved clinical outcomes (fewer infections, wounds), reducing health care use and costs. With the right investment in nutrition and dietetic resources, appropriate nutritional management plans can be put in place to optimally support the multimorbid patient benefitting the individual and the wider society.
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Affiliation(s)
- Rebecca J Stratton
- School of Human Development and Health, Faculty of Medicine, University of Southampton, SouthamptonSO16 6YD, UK
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24
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Stosic MB, Kaljevic J, Nikolic B, Tanaskovic M, Kolarov A. Smart Anklet Use to Measure Vascular Health Benefits of Preventive Intervention in a Nature-Based Environment-A Pilot Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:605. [PMID: 38791819 PMCID: PMC11121026 DOI: 10.3390/ijerph21050605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Revised: 04/23/2024] [Accepted: 05/02/2024] [Indexed: 05/26/2024]
Abstract
The present study aimed to investigate the associations between nature-based intervention and peripheral pulse characteristics of patients with PAOD using new smart technology specifically designed for this purpose. A longitudinal panel study performed between 1 January 2022 and 31 December 2022 included 32 patients diagnosed with peripheral arterial occlusive disease (PAOD) who were treated in the vascular surgeons' hospital "Dobb" in Valjevo. These patients were exposed for six months to moderate-intensity physical activity (MPA) in a nature-based environment. They practiced 150 to 300 min of walking 6 km/h and cycling activities (16-20 km/h) weekly as recommended for patients with chronic conditions and those living with disability. Univariate logistic regression analysis was used to identify factors associated with major improvements in peripheral pulse characteristics of patients with PAOD. After six months of MPA, half of the patients (50%, 16/32) achieved minor, and half of them major improvements in peripheral pulse characteristics. The major improvements were associated with current smoking (OR = 9.53; 95%CI = 1.85-49.20), diabetes (OR = 4.84; 95%CI = 1.09-21.58) and cardiac failure, and concurrent pulmonary disease and diabetes (OR = 2.03; 95%CI = 1.01-4.11). Our pilot study showed that patients with PAOD along with other chronic conditions and risk factors benefited more from continuous physical activity in a nature-based environment.
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Affiliation(s)
- Maja B. Stosic
- Faculty for Health and Business Studies, Singidunum University, 14000 Valjevo, Serbia; (J.K.); (B.N.)
- Institute of Public Health of Serbia “Dr Milan Jovanovic Batut”, Department for HIV, Hepatitis, STIs and Tuberculosis, 11000 Belgrade, Serbia
| | - Jelena Kaljevic
- Faculty for Health and Business Studies, Singidunum University, 14000 Valjevo, Serbia; (J.K.); (B.N.)
| | - Bojan Nikolic
- Faculty for Health and Business Studies, Singidunum University, 14000 Valjevo, Serbia; (J.K.); (B.N.)
| | - Marko Tanaskovic
- Faculty for Technical Science, Singidunum University, 11000 Belgrade, Serbia;
| | - Aleksandar Kolarov
- New Jersey Institute of Technology, Electrical and Computer Engineering Center, Ewing, NJ 07102, USA;
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25
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Bogerd MJ, Exmann CJ, Slottje P, Bont J, Van Hout HP. Predicting anticipated benefit from an extended consultation to personalise care in multimorbidity: a development and internal validation study of a prioritisation algorithm in general practice. Br J Gen Pract 2024; 74:e307-e314. [PMID: 38164549 PMCID: PMC11044021 DOI: 10.3399/bjgp.2023.0114] [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: 03/05/2023] [Accepted: 10/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Persons with multimorbidity may gain from person-centred care compared with the current protocolised chronic-disease management in Dutch general practice. Given time constraints and limited resources, it is essential to prioritise those most in need of an assessment of person-centred chronic-care needs. AIM To develop and validate a prioritisation algorithm based on routine electronic medical record (EMR) data that distinguishes between patients with multimorbidity who would, and those who would not, benefit from an extended person-centred consultation to assess person-centred chronic-care needs, as judged by GPs. DESIGN AND SETTING A mixed-methods study was conducted in five general practices in the north-west region of the Netherlands. Four out of the five practices were situated in rural areas. METHOD Multivariable logistic regression using EMR data to predict the GPs' judgement on patients' anticipated benefit from an extended consultation, as well as a thematic analysis of a focus group exploring GPs' clinical reasoning for this judgement were conducted. Internal validation was performed using 10-fold cross-validation. Multimorbidity was defined as the presence of ≥3 chronic conditions. RESULTS In total, EMRs from 1032 patients were included in the analysis; of these, 352 (34.1%) were judged to have anticipated benefit. The model's cross-validated C-statistic was 0.72 (95% confidence interval = 0.70 to 0.75). Calibration was good. Presence of home visit(s) and history of myocardial infarction were associated with anticipated benefit. Thematic analysis revealed three dimensions feeding anticipated benefit: GPs' cause for concern, patients' mindset regarding their conditions, and balance between received care/expected care needed. CONCLUSION This algorithm may facilitate automated prioritisation, potentially avoiding the need for GPs to personally triage the whole practice population that has multimorbidity. However, external validation of the algorithm and evaluation of actual benefit of consultation is recommended before implementation.
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Affiliation(s)
- Mieke Jl Bogerd
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Collin Jc Exmann
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Pauline Slottje
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jettie Bont
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Hein Pj Van Hout
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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Borboudaki L, Linardakis M, Tsiligianni I, Philalithis A. Utilization of Health Care Services and Accessibility Challenges among Adults Aged 50+ before and after Austerity Measures across 27 European Countries: Secular Trends in the SHARE Study from 2004/05 to 2019/20. Healthcare (Basel) 2024; 12:928. [PMID: 38727485 PMCID: PMC11083176 DOI: 10.3390/healthcare12090928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/20/2024] [Accepted: 04/27/2024] [Indexed: 05/13/2024] Open
Abstract
This study aimed to assess and compare the utilization of preventive and other health services and the cost or availability in different regions of Europe, before and during the economic crisis. The data used in the study were obtained from Wave 8 of the Survey of Health, Ageing and Retirement in Europe (2019/2020) and Wave 1 data (2004/5), with a sample size of 46,106 individuals aged ≥50 across 27 countries, adjusted to represent a population of N = 180,886,962. Composite scores were derived for preventive health services utilization (PHSU), health care services utilization (HCSU), and lack of accessibility/availability in health care services (LAAHCS). Southern countries had lower utilization of preventive services and higher utilization of other health services compared to northern countries, with a significant lack of convergence. Moreover, the utilization of preventive health services decreased, whereas the utilization of secondary care services increased during the austerity period. Southern European countries had a significantly higher prevalence of lack of accessibility. An increase in the frequency of lack of accessibility/availability in health care services was observed from 2004/5 to 2019/20. In conclusion, our findings suggest that health inequalities increase during crisis periods. Therefore, policy interventions could prioritize accessibility and expand health coverage and prevention services.
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Affiliation(s)
- Lena Borboudaki
- Department of Social Medicine, School of Medicine, University of Crete, 71500 Heraklion, Greece; (M.L.); (I.T.); (A.P.)
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Mols RE, Løgstrup BB, Bakos I, Horváth-Puhó E, Gustafsson F, Eiskjær H. Employment Status Following Heart Transplantation: Data From the Danish Nationwide Social Service Payment Register During 20 years. Transpl Int 2024; 37:12230. [PMID: 38694491 PMCID: PMC11061463 DOI: 10.3389/ti.2024.12230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Accepted: 04/03/2024] [Indexed: 05/04/2024]
Abstract
Most studies on vocational rehabilitation after heart transplantation (HTX) are based on self-reported data. Danish registries include weekly longitudinal information on all public transfer payments. We intended to describe 20-year trends in employment status for the Danish heart-transplant recipients, and examine the influence of multimorbidity and socioeconomic position (SEP). Linking registry and Scandiatransplant data (1994-2018), we conducted a study in recipients of working age (19-63 years). The cohort contained 492 recipients (79% males) and the median (IQR) age was 52 years (43-57 years). Five years after HTX, 30% of the survived recipients participated on the labor market; 9% were in a flexible job with reduced health-related working capacity. Moreover, 60% were retired and 10% eligible for labor market participation were unemployed. Recipients with multimorbidity had a higher age and a lower prevalence of employment. Five years after HTX, characteristics of recipients with labor market participation were: living alone (27%) versus cohabitation (73%); low (36%) versus medium-high (64%) educational level; low (13%) or medium-high (87%) income group. Heart-transplant recipients with multimorbidity have a higher age and a lower prevalence of employment. Socioeconomically disadvantaged recipients had a lower prevalence of labor market participation, despite being younger compared with the socioeconomically advantaged.
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Affiliation(s)
- Rikke Elmose Mols
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Brian Bridal Løgstrup
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - István Bakos
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Erzsébet Horváth-Puhó
- Department of Clinical Epidemiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Finn Gustafsson
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Hans Eiskjær
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
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28
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Bogerd MJ, Slottje P, Bont J, Van Hout HP. Development of a person-centred care approach for persons with chronic multimorbidity in general practice by means of participatory action research. BMC PRIMARY CARE 2024; 25:114. [PMID: 38627610 PMCID: PMC11020638 DOI: 10.1186/s12875-024-02364-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/03/2024] [Indexed: 04/19/2024]
Abstract
BACKGROUND The management of persons with multimorbidity challenges healthcare systems tailored to individual diseases. A person-centred care approach is advocated, in particular for persons with multimorbidity. The aim of this study was to describe the co-creation and piloting of a proactive, person-centred chronic care approach for persons with multimorbidity in general practice, including facilitators and challenges for successful implementation. METHODS A participatory action research (PAR) approach was applied in 13 general practices employing four subsequent co-creation cycles between 2019 and 2021. The target population included adults with ≥3 chronic conditions. Participating actors were general practitioners (GPs), practice nurses (PNs), patients (target group), the affiliated care cooperation, representatives of a health insurer and researchers. Each cycle consisted of a try-out period in practice and a reflective evaluation through focus groups with healthcare providers, interviews with patients and analyses of routine care data. In each cycle, facilitators, challenges and follow-up actions for the next cycle were identified. Work satisfaction among GPs and PNs was measured pre and at the end of the final co-creation cycle. RESULTS Identified essential steps in the person-centred chronic care approach include (1) appropriate patient selection for (2) an extended person-centred consultation, and (3) personalised goalsetting and follow-up. Key facilitators included improved therapeutic relationships, enhanced work satisfaction for care providers, and patient appreciation of extended time with their GP. Deliberate task division and collaboration between GPs and PNs based on patient, local setting, and care personnel is required. Challenges and facilitators for implementation encompassed a prioritisation tool to support GPs appropriately who to invite first for extended consultations, appropriate remuneration and time to conduct extended consultations, training in delivering person-centred chronic care available for all general practice care providers and an electronic medical record system accommodating comprehensive information registration. CONCLUSIONS A person-centred chronic care approach targeting patients with multimorbidity in general practice was developed and piloted in co-creation with stakeholders. More consultation time facilitated better understanding of persons' situations, their functioning, priorities and dilemma's, and positively impacted work satisfaction of care providers. Challenges need to be tackled before widespread implementation. Future evaluation on the quadruple aims is recommended.
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Affiliation(s)
- Mieke Jl Bogerd
- Amsterdam UMC, location VUmc, Department of General Practice, Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands.
| | - Pauline Slottje
- Amsterdam UMC, location VUmc, Department of General Practice, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
| | - Jettie Bont
- Amsterdam Public Health, Quality of Care, Amsterdam, The Netherlands
- Amsterdam UMC, location AMC, Department of General Practice, Meibergdreef 9, Amsterdam, the Netherlands
| | - Hein Pj Van Hout
- Amsterdam UMC, location VUmc, Department of General Practice, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health, Aging & Later life, Amsterdam, the Netherlands
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29
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Marcuzzi A, Mork PJ, Aasdahl L, Skarpsno E, Moe K, Nilsen TIL. Incidence of sick leave and disability pension in adults with musculoskeletal pain and co-occurring long-term conditions: data from the Norwegian HUNT study and national registries. BMC Musculoskelet Disord 2024; 25:273. [PMID: 38589843 PMCID: PMC11003184 DOI: 10.1186/s12891-024-07405-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Musculoskeletal pain is one of the leading causes of work productivity loss. Long-term conditions (LTCs) commonly occur alongside musculoskeletal pain. However, the incidence of sick leave and disability pension according to LTC status in people with musculoskeletal pain has not been previously described. METHODS Working-age participants (20-65 years) with persistent musculoskeletal pain who participated in the HUNT3 Study (1995-97) were included. Twenty-five LTCs were classified into 8 LTC groups according to the International Classification of Diseases version 11. Data on sickness and disability benefits were obtained from the National Insurance Database and linked to the HUNT3 data using participants' personal identification number. Age-adjusted incidence rates (IRs) (per 10,000 person-years) and hazard ratios (HRs) of sick leave during 5-year follow-up and disability pension during ~ 25-year follow-up were estimated with 95% confidence intervals (CIs) and presented according to LTC status. RESULTS Overall, 11,080 participants with musculoskeletal pain were included. Of those, 32% reported one LTC and 45% reported ≥ 2 LTCs. During the follow up period, 1,312 participants (12%) received disability pension due to musculoskeletal conditions. The IR of sick leave and disability pension due to musculoskeletal conditions increased with number of LTCs. Specifically, the IR of sick leave was 720 (95% CI 672 to 768) in participants without any LTCs and 968 (95% CI 927 to 1,009) if they had ≥ 2 LTCs. The IRs of disability pension were 87 (95% CI 75 to 98) and 167 (95% CI 154 to 179) among those with no LTCs and ≥ 2 LTCs, respectively. The incidence of sick leave and disability pension due to musculoskeletal conditions was largely similar across LTCs, although the incidence of disability pension was somewhat higher among people with sleep disorders (IR: 223, 95% CI 194 to 252). CONCLUSIONS Among people with persistent musculoskeletal pain, the incidence of prematurely leaving the work force due to musculoskeletal conditions was twice as high for those with multiple LTCs compared to those without any LTCs. This was largely irrespective of the type of LTC, indicating that the number of LTCs are an important feature when evaluating work participation among people with musculoskeletal pain.
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Affiliation(s)
- Anna Marcuzzi
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
- Department of Physical Medicine and Rehabilitation, St. Olavs Hospital, Trondheim, Norway.
- Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
| | - Paul Jarle Mork
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Lene Aasdahl
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
- Unicare Helsefort Rehabilitation Center, Rissa, Norway
| | - Eivind Skarpsno
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Karoline Moe
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Tom Ivar Lund Nilsen
- Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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30
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Stenov V, Willaing I, Joensen LE, Knudsen L, Andersen GS, Hansen DL, Cleal B. Which self-reported measures are useful to explore diabetes support needs among adults with diabetes and severe mental illness? Chronic Illn 2024:17423953241241762. [PMID: 38584462 DOI: 10.1177/17423953241241762] [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] [Indexed: 04/09/2024]
Abstract
OBJECTIVES To construct and test patient-reported outcome measures (PROMs) for identifying diabetes support needs of adults with co-existing diabetes and severe mental illness (SMI) provided by mental health professionals at psychiatric outpatient clinics. METHODS Design thinking was used to identify, select, and modify PROMs in collaboration with 18 adults with type 1 or type 2 diabetes and SMI and 10 healthcare experts. The PROMs were then tested with 86 adults with diabetes and SMI recruited from eight psychiatric outpatient clinics in Denmark. Data were analysed using systematic text condensation (questionnaire construction) and descriptive statistics (testing). RESULTS Four principles for PROMs were identified: (a) be modified to be relevant for the target group, (b) be concise and simple to complete, (c) have a clear and unambiguous wording, and (d) be designed to measure topics that are perceived as meaningful. Test of the questionnaire contained 49 items in four domains. Missing response rates in the test were 1.2-4.7% in three domains and 4.7-11.6% in a domain addressing potential sources of diabetes support. DISCUSSION PROMs can successfully be constructed in collaboration with this vulnerable population that yield low rates of missing responses.
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Affiliation(s)
- Vibeke Stenov
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Ingrid Willaing
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Lene Eide Joensen
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
- Section of Health Services Research, Department of Public Health, Copenhagen University, Copenhagen, Denmark
| | - Lenette Knudsen
- Department of Education, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Gregers Stig Andersen
- Clinical Epidemiological Research, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Dorte Lindqvist Hansen
- Department of Diabetes Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
| | - Bryan Cleal
- Department of Prevention, Health Promotion and Community Care, Copenhagen University Hospital - Steno Diabetes Center Copenhagen, Herlev, Denmark
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31
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Nicholson K, Liu W, Fitzpatrick D, Hardacre KA, Roberts S, Salerno J, Stranges S, Fortin M, Mangin D. Prevalence of multimorbidity and polypharmacy among adults and older adults: a systematic review. THE LANCET. HEALTHY LONGEVITY 2024; 5:e287-e296. [PMID: 38452787 DOI: 10.1016/s2666-7568(24)00007-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/28/2023] [Accepted: 01/15/2024] [Indexed: 03/09/2024] Open
Abstract
Multimorbidity (multiple conditions) and polypharmacy (multiple medications) are increasingly common, yet there is a need to better understand the prevalence of co-occurrence. In this systematic review, we examined the prevalence of multimorbidity and polypharmacy among adults (≥18 years) and older adults (≥65 years) in clinical and community settings. Six electronic databases were searched, and 87 studies were retained after two levels of screening. Most studies focused on adults 65 years and older and were done in population-based community settings. Although the operational definitions of multimorbidity and polypharmacy varied across studies, consistent cut-points (two or more conditions and five or more medications) were used across most studies. In older adult samples, the prevalence of multimorbidity ranged from 4·8% to 93·1%, while the prevalence of polypharmacy ranged from 2·6% to 86·6%. High heterogeneity between studies indicates the need for more consistent reporting of specific lists of conditions and medications used in operational definitions.
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Affiliation(s)
- Kathryn Nicholson
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, McMaster University, Hamilton, ON, Canada.
| | - Winnie Liu
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Daire Fitzpatrick
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, Queen's University, Kingston, ON, Canada
| | - Kate Anne Hardacre
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Sarah Roberts
- Michael G DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada; Department of Family Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jennifer Salerno
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology and Biostatistics, Western University, London, ON, Canada; Department of Family Medicine, Western University, London, ON, Canada; Department of Medicine, Western University, London, ON, Canada; Department of Clinical Medicine and Surgery, Federico II University, Naples, Italy
| | - Martin Fortin
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Dee Mangin
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada; Department of General Practice, University of Otago, Christchurch, New Zealand
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Nikpour J, Brom H, Mason A, Chittams J, Poghosyan L, Carthon MB. Better Nurse Practitioner Primary Care Practice Environments Reduce Hospitalization Disparities Among Dually-Enrolled Patients. Med Care 2024; 62:217-224. [PMID: 38036459 PMCID: PMC10949042 DOI: 10.1097/mlr.0000000000001951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Abstract
BACKGROUND Over 12 million Americans are dually enrolled in Medicare and Medicaid. These individuals experience over twice as many hospitalizations for chronic diseases such as coronary artery disease and diabetes compared with Medicare-only patients. Nurse practitioners (NPs) are well-positioned to address the care needs of dually-enrolled patients, yet NPs often work in unsupportive clinical practice environments. The purpose of this study was to examine the association between the NP primary care practice environment and hospitalization disparities between dually-enrolled and Medicare-only patients with chronic diseases. METHODS Using secondary cross-sectional data from the Nurse Practitioner Primary Care Organizational Climate Questionnaire and Medicare claims files, we examined 135,648 patients with coronary artery disease and/or diabetes (20.0% dually-eligible, 80.0% Medicare-only), cared for in 450 practices employing NPs across 4 states (PA, NJ, CA, FL) in 2015. We compared dually-enrolled patients' odds of being hospitalized when cared for in practice environments characterized as poor, mixed, and good based on practice-level Nurse Practitioner Primary Care Organizational Climate Questionnaire scores. RESULTS After adjusting for patient and practice characteristics, dually-enrolled patients in poor practice environments had the highest odds of being hospitalized compared with their Medicare-only counterparts [odds ratio (OR): 1.48, CI: 1.37, 1.60]. In mixed environments, dually-enrolled patients had 27% higher odds of a hospitalization (OR: 1.27, CI: 1.12, 1.45). However, in the best practice environments, hospitalization differences were nonsignificant (OR: 1.02, CI: 0.85, 1.23). CONCLUSIONS As policymakers look to improve outcomes for dually-enrolled patients, addressing a modifiable aspect of care delivery in NPs' clinical practice environment is a key opportunity to reduce hospitalization disparities.
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Affiliation(s)
- Jacqueline Nikpour
- Center for Health Outcomes and Policy Research, University
of Pennsylvania School of Nursing, Philadelphia, PA
| | - Heather Brom
- Center for Health Outcomes and Policy Research, University
of Pennsylvania School of Nursing, Philadelphia, PA
| | - Aleigha Mason
- Center for Health Outcomes and Policy Research, University
of Pennsylvania School of Nursing, Philadelphia, PA
| | - Jesse Chittams
- Center for Health Outcomes and Policy Research, University
of Pennsylvania School of Nursing, Philadelphia, PA
| | - Lusine Poghosyan
- Center for Healthcare Delivery Research & Innovations,
Columbia School of Nursing, New York, NY
| | - Margo Brooks Carthon
- Center for Health Outcomes and Policy Research, University
of Pennsylvania School of Nursing, Philadelphia, PA
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Tran PB, Nikolaidis GF, Abatih E, Bos P, Berete F, Gorasso V, Van der Heyden J, Kazibwe J, Tomeny EM, Van Hal G, Beutels P, van Olmen J. Multimorbidity healthcare expenditure in Belgium: a 4-year analysis (COMORB study). Health Res Policy Syst 2024; 22:35. [PMID: 38519938 PMCID: PMC10960468 DOI: 10.1186/s12961-024-01113-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/24/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND The complex management of health needs in multimorbid patients, alongside limited cost data, presents challenges in developing cost-effective patient-care pathways. We estimated the costs of managing 171 dyads and 969 triads in Belgium, taking into account the influence of morbidity interactions on costs. METHODS We followed a retrospective longitudinal study design, using the linked Belgian Health Interview Survey 2018 and the administrative claim database 2017-2020 hosted by the Intermutualistic Agency. We included people aged 15 and older, who had complete profiles (N = 9753). Applying a system costing perspective, the average annual direct cost per person per dyad/triad was presented in 2022 Euro and comprised mainly direct medical costs. We developed mixed models to analyse the impact of single chronic conditions, dyads and triads on healthcare costs, considering two-/three-way interactions within dyads/triads, key cost determinants and clustering at the household level. RESULTS People with multimorbidity constituted nearly half of the study population and their total healthcare cost constituted around three quarters of the healthcare cost of the study population. The most common dyad, arthropathies + dorsopathies, with a 14% prevalence rate, accounted for 11% of the total national health expenditure. The most frequent triad, arthropathies + dorsopathies + hypertension, with a 5% prevalence rate, contributed 5%. The average annual direct costs per person with dyad and triad were €3515 (95% CI 3093-3937) and €4592 (95% CI 3920-5264), respectively. Dyads and triads associated with cancer, diabetes, chronic fatigue, and genitourinary problems incurred the highest costs. In most cases, the cost associated with multimorbidity was lower or not substantially different from the combined cost of the same conditions observed in separate patients. CONCLUSION Prevalent morbidity combinations, rather than high-cost ones, made a greater contribution to total national health expenditure. Our study contributes to the sparse evidence on this topic globally and in Europe, with the aim of improving cost-effective care for patients with diverse needs.
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Affiliation(s)
- Phuong Bich Tran
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.
- Department of Epidemiology and public health, Brussels, Belgium.
| | | | - Emmanuel Abatih
- Department of Applied Mathematics, Computer Sciences and Statistics, Ghent University, Ghent, Belgium
| | - Philippe Bos
- Department of Sociology, University of Antwerp, Antwerp, Belgium
| | - Finaba Berete
- Department of Epidemiology and public health, Brussels, Belgium
| | - Vanessa Gorasso
- Department of Epidemiology and public health, Brussels, Belgium
| | | | - Joseph Kazibwe
- Department of Clinical Sciences, Lund University, Malmö, Sweden
| | - Ewan Morgan Tomeny
- Department of Clinical Sciences, Liverpool School of Tropical Medicine, Liverpool, UK
| | - Guido Van Hal
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Philippe Beutels
- Centre for Health Economics Research & Modelling Infectious Diseases (CHERMID), University of Antwerp, Antwerp, Belgium
| | - Josefien van Olmen
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
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Taylor K, Demakakos P. Adverse childhood experiences and trajectories of multimorbidity in individuals aged over 50: Evidence from the English Longitudinal Study of Ageing. CHILD ABUSE & NEGLECT 2024; 149:106653. [PMID: 38277873 DOI: 10.1016/j.chiabu.2024.106653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/28/2024]
Abstract
BACKGROUND Adverse childhood experiences (ACE) are important for chronic diseases yet their association with multimorbidity remains understudied. Few studies consider the complexity of multimorbidity or observe multimorbidity development over time. OBJECTIVE We investigated whether ACE were associated with multimorbidity at baseline and over a 12-year follow-up period. PARTICIPANTS AND SETTING 5326 participants aged over 50 were obtained from the English Longitudinal Study of Ageing (ELSA). METHODS An ACE summary score was derived using eight ACE items measuring abuse, social care, and household dysfunction. From repeated measurements of 29 chronic conditions over a 12-year period (2008-2019) we derived two multimorbidity measures: number of chronic diseases and number of chronic disease categories. We used multinomial logistic regression to assess associations between ACE and both measures. Mixed effects models were estimated to examine trajectories of multimorbidity by ACE over time. RESULTS Graded associations between ACE and multimorbidity were observed. Compared to those without ACE, participants with ≥3 ACE had three times the risk of having ≥3 chronic diseases (RRR 3.06, 95 % CI 1.85-5.05) and falling into ≥3 chronic disease categories (RRR 2·93 95 % CI 1·74-4·95). Graded associations persisted during 12-year follow-up, though differences in multimorbidity between those with ≥3 ACE and those without ACE remained constant (B 0.02, 95 % CI 0·01-0·03, and B -0·01, 95 % CI -0·02-0·00, number of chronic conditions and chronic condition categories respectively). CONCLUSION ACE are associated with multimorbidity risk and complexity, associations arising before the age of 50. Early intervention amongst those with ACE could attenuate this association.
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Affiliation(s)
- Katherine Taylor
- Division of Biosciences, Medical Sciences Building, University College London, Gower Street, London WC1E 6BT, United Kingdom of Great Britain and Northern Ireland.
| | - Panayotes Demakakos
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, United Kingdom of Great Britain and Northern Ireland
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Holm A, Lyhnebeck AB, Rozing M, Buhl SF, Willadsen TG, Prior A, Christiansen AKL, Kristensen J, Andersen JS, Waldorff FB, Siersma V, Brodersen JB, Reventlow S. Effectiveness of an adaptive, multifaceted intervention to enhance care for patients with complex multimorbidity in general practice: protocol for a pragmatic cluster randomised controlled trial (the MM600 trial). BMJ Open 2024; 14:e077441. [PMID: 38309759 PMCID: PMC10840032 DOI: 10.1136/bmjopen-2023-077441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 01/23/2024] [Indexed: 02/05/2024] Open
Abstract
INTRODUCTION Patients with complex multimorbidity face a high treatment burden and frequently have low quality of life. General practice is the key organisational setting in terms of offering people with complex multimorbidity integrated, longitudinal, patient-centred care. This protocol describes a pragmatic cluster randomised controlled trial to evaluate the effectiveness of an adaptive, multifaceted intervention in general practice for patients with complex multimorbidity. METHODS AND ANALYSIS In this study, 250 recruited general practices will be randomly assigned 1:1 to either the intervention or control group. The eligible population are adult patients with two or more chronic conditions, at least one contact with secondary care within the last year, taking at least five repeat prescription drugs, living independently, who experience significant problems with their life and health due to their multimorbidity. During 2023 and 2024, intervention practices are financially incentivised to provide an extended consultation based on a patient-centred framework to eligible patients. Control practices continue care as usual. The primary outcome is need-based quality of life. Outcomes will be evaluated using linear and logistic regression models, with clustering considered. The analysis will be performed as intention to treat. In addition, a process evaluation will be carried out and reported elsewhere. ETHICS AND DISSEMINATION The trial will be conducted in compliance with the protocol, the Helsinki Declaration in its most recent form and good clinical practice recommendations, as well as the regulation for informed consent. The study was submitted to the Danish Capital Region Ethical Committee (ref: H-22041229). As defined by Section 2 of the Danish Act on Research Ethics in Research Projects, this project does not constitute a health research project but is considered a quality improvement project that does not require formal ethical approval. All results from the study (whether positive, negative or inconclusive) will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT05676541.
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Affiliation(s)
- Anne Holm
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anna Bernhardt Lyhnebeck
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Maarten Rozing
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sussi Friis Buhl
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Tora Grauers Willadsen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Prior
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
| | - Ann-Kathrin Lindahl Christiansen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jette Kristensen
- The Center for General Practice, Aalborg University, Aalborg, Denmark
| | - John Sahl Andersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Frans Boch Waldorff
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Volkert Siersma
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John Brandt Brodersen
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Research Unit for General Practice, Department of Community Medicine, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromso, Norway
- Centre of Research & Education in General Practice Primary Health Care Research Unit, Zealand Region, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Reventlow
- Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Hamilton M, Christine Lin CW, Arora S, Harrison M, Tracy M, Nickel B, Shaheed CA, Gnjidic D, Mathieson S. Understanding general practitioners' prescribing choices to patients with chronic low back pain: a discrete choice experiment. Int J Clin Pharm 2024; 46:111-121. [PMID: 37882955 PMCID: PMC10831024 DOI: 10.1007/s11096-023-01649-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/07/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Although NSAIDs are recommended as a first line analgesic treatment, opioids are very commonly prescribed to patients with low back pain (LBP) despite risks of harms. AIM This study aimed to determine factors contributing to general practitioners' (GPs') prescribing choices to patients with chronic LBP in a primary care setting. METHOD This discrete choice experiment (DCE) presented 210 GPs with hypothetical scenarios of a patient with chronic LBP. Participants chose their preferred treatment for each choice set, either the opioid, NSAID or neither. The scenarios varied by two patient attributes; non-specific LBP or LBP with referred leg pain (sciatica) and number of comorbidities. The three treatment attributes also varied, being: the type of opioid or NSAID, degree of pain reduction and number of adverse events. The significance of each attribute in influencing clinical decisions was the primary outcome and the degree to which GPs preferred the alternative based on the number of adverse events or the amount of pain reduction was the secondary outcome. RESULTS Overall, GPs preferred NSAIDs (45.2%, 95% CI 38.7-51.7%) over opioids (28.8%, 95% CI 23.0-34.7%), however there was no difference between the type of NSAID or opioid preferred. Additionally, the attributes of pain reduction and adverse events did not influence a GP's choice between NSAIDs or opioids for patients with chronic LBP. CONCLUSION GPs prefer prescribing NSAIDs over opioids for a patient with chronic low back pain regardless of patient factors of comorbidities or the presence of leg pain (i.e. sciatica).
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Affiliation(s)
- Melanie Hamilton
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia.
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Chung-Wei Christine Lin
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Sheena Arora
- Centre for Health Economics Research and Evaluation, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia
| | - Mark Harrison
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
- The Centre for Health Evaluation and Outcomes Sciences (CHEOS) at St. Paul's Hospital, Vancouver, Canada
| | - Marguerite Tracy
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Brooke Nickel
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Christina Abdel Shaheed
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Danijela Gnjidic
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Stephanie Mathieson
- Institute for Musculoskeletal Health, Level 10 North, King George V Building, Royal Prince Alfred Hospital (C39), Missenden Road, PO Box M179, Camperdown, Sydney, NSW, 2050, Australia
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
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Yadav UN, Paudel G, Ghimire S, Khatiwada B, Gurung A, Parsekar SS, Mistry SK. A rapid review of opportunities and challenges in the implementation of social prescription interventions for addressing the unmet needs of individuals living with long-term chronic conditions. BMC Public Health 2024; 24:306. [PMID: 38279079 PMCID: PMC10821289 DOI: 10.1186/s12889-024-17736-2] [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: 09/15/2023] [Accepted: 01/10/2024] [Indexed: 01/28/2024] Open
Abstract
BACKGROUND People with long-term chronic conditions often struggle to access and navigate complex health and social services. Social prescription (SP) interventions, a patient-centred approach, help individuals identify their holistic needs and increase access to non-clinical resources, thus leading to improved health and well-being. This review explores existing SP interventions for people with long-term chronic conditions and identifies the opportunities and challenges of implementing them in primary healthcare settings. METHODS This rapid review followed the Preferred Reporting Items for Systematic Review and Meta-analysis guidelines and searched relevant articles in three databases (PubMed/MEDLINE, EMBASE, and Web of Science) by using subject headings and keywords combined with Boolean operators. The search encompassed articles published between January 2010 and June 2023. Two authors independently conducted study screening and data abstraction using predefined criteria. A descriptive synthesis process using content analysis was performed to summarise the literature. RESULTS Fifteen studies were included, with all but one conducted in the United Kingdom, and revealed that social prescribers help guide patients with long-term chronic conditions to various local initiatives related to health and social needs. Effective implementation of SP interventions relies on building strong relationships between social prescribers and patients, characterised by trust, empathy, and effective communication. A holistic approach to addressing the unmet needs of people with long-term chronic conditions, digital technology utilisation, competent social prescribers, collaborative healthcare partnerships, clinical leadership, and access to local resources are all vital components of successful SP intervention. However, the implementation of SP interventions faces numerous challenges, including accessibility and utilisation barriers, communication gaps, staffing issues, an unsupportive work environment, inadequate training, lack of awareness, time management struggles, coordination and collaboration difficulties, and resource constraints. CONCLUSION The present review emphasises the importance of addressing the holistic needs of people with long-term chronic conditions through collaboration and coordination, training of social prescribers, community connections, availability of local resources, and primary care leadership to ensure successful interventions, ultimately leading to improved patient health and well-being outcomes. This study calls for the need to develop or utilise appropriate tools that can capture people's holistic needs, as well as an implementation framework to guide future contextual SP interventions.
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Affiliation(s)
- Uday Narayan Yadav
- National Centre for Aboriginal and Torres Strait Islander Well-Being Research, The Australian National University, Canberra, ACT, Australia.
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia.
| | - Grish Paudel
- School of Health Medical and Applied Sciences, Central Queensland University, Sydney, Australia
| | - Saruna Ghimire
- Department of Sociology & Gerontology and Scripps Gerontology Center, Miami University, Oxford, OH, USA
| | | | - Ashmita Gurung
- Department of Public Health, Torres University, Sydney, Australia
| | - Shradha S Parsekar
- Independent Freelance Consultant, Goa, India
- Public Health Evidence South Asia, Prasanna School of Public Health, Manipal, Karnataka, India
| | - Sabuj Kanti Mistry
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, Australia
- School of Population Health, University of New South Wales, Sydney, Australia
- Department of Public Health, Daffodil International University, Dhaka, Bangladesh
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Angelsen A, Nakrem S, Zotcheva E, Strand BH, Strand LB. Health-promoting behaviors in older adulthood and intrinsic capacity 10 years later: the HUNT study. BMC Public Health 2024; 24:284. [PMID: 38267907 PMCID: PMC10809656 DOI: 10.1186/s12889-024-17840-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2023] [Accepted: 01/22/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND With the global population growing older, there is a need for more knowledge of how to improve and/or maintain functional capacities to promote healthy ageing. In this study we aimed to assess the effect of several known health-promoting behaviors in old age with intrinsic capacity ten years later. METHODS This was a prospective cohort study looking at participants that were ≥ 65 years at the time of the third wave of the Trøndelag Health Study (HUNT3, 2006-2008) who also took part in the 70 + sub-study of the fourth wave (HUNT4 70+, 2017-2019). Self-reported behavior data from short questionnaires, including diet and physical activity, were collected in HUNT3, and data on the five domains of intrinsic capacity defined by the World Health Organization were collected in HUNT4 70+. A composite index was created for both healthy life and intrinsic capacity, awarding points for how well participants adhered to guidelines for healthy living and their level of functional impairment, respectively. Ordinal logistic regression was used to assess the relationship between health-promoting behaviors and intrinsic capacity. RESULTS Of 12,361 participants in HUNT3 ≥ 65 years, 4699 (56.5% women) also participated in HUNT4 70+. On the health-promoting behaviors, lowest adherence to healthy living guidelines were seen for fruit and vegetables intake (47.2%), milk intake (46.7%) and physical activity (31.1%). On intrinsic capacity domains, highest impairment was seen in the domains of locomotion (29.7%), hearing (11.1%) and vitality (8.3%). A higher adherence to guidelines for healthy living was associated with higher intrinsic capacity 10 years later. A one-point increase in the healthy life index was associated with a 1.15 (95% confidence interval 1.10-1.21) times increased odds of being in a higher intrinsic capacity category. CONCLUSION Health-promoting behaviors in old age are associated with better intrinsic capacity ten years later. In clinical settings assessment of health-promoting behaviors could potentially be done using short questionnaires.
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Affiliation(s)
- Aslaug Angelsen
- Norwegian University of Science and Technology, Trondheim, Norway.
| | - Sigrid Nakrem
- Norwegian University of Science and Technology, Trondheim, Norway
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Kabir A, Conway DP, Ansari S, Tran A, Rhee JJ, Barr M. Impact of multimorbidity and complex multimorbidity on healthcare utilisation in older Australian adults aged 45 years or more: a large population-based cross-sectional data linkage study. BMJ Open 2024; 14:e078762. [PMID: 38199624 PMCID: PMC10806611 DOI: 10.1136/bmjopen-2023-078762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 11/24/2023] [Indexed: 01/12/2024] Open
Abstract
OBJECTIVES As life expectancy increases, older people are living longer with multimorbidity (MM, co-occurrence of ≥2 chronic health conditions) and complex multimorbidity (CMM, ≥3 chronic conditions affecting ≥3 different body systems). We assessed the impacts of MM and CMM on healthcare service use in Australia, as little was known about this. DESIGN Population-based cross-sectional data linkage study. SETTING New South Wales, Australia. PARTICIPANTS 248 496 people aged ≥45 years who completed the Sax Institute's 45 and Up Study baseline questionnaire. PRIMARY OUTCOME High average annual healthcare service use (≥2 hospital admissions, ≥11 general practice visits and ≥2 emergency department (ED) visits) during the 3-year baseline period (year before, year of and year after recruitment). METHODS Baseline questionnaire data were linked with hospital, Medicare claims and ED datasets. Poisson regression models were used to estimate adjusted and unadjusted prevalence ratios for high service use with 95% CIs. Using a count of chronic conditions (disease count) as an alternative morbidity metric was requested during peer review. RESULTS Prevalence of MM and CMM was 43.8% and 15.5%, respectively, and prevalence increased with age. Across three healthcare settings, MM was associated with a 2.02-fold to 2.26-fold, and CMM was associated with a 1.83-fold to 2.08-fold, increased risk of high service use. The association was higher in the youngest group (45-59 years) versus the oldest group (≥75 years), which was confirmed when disease count was used as the morbidity metric in sensitivity analysis.When comparing impact using three categories with no overlap (no MM/CMM, MM with no CMM, and CMM), CMM had greater impact than MM across all settings. CONCLUSION Increased healthcare service use among older adults with MM and CMM impacts on the demand for primary care and hospital services. Which of MM or CMM has greater impact on risk of high healthcare service use depends on the analytic method used. Ageing populations living longer with increasing burdens of MM and CMM will require increased Medicare funding and provision of integrated care across the healthcare system to meet their complex needs.
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Affiliation(s)
- Alamgir Kabir
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Damian P Conway
- Population and Community Health, South Eastern Sydney Local Health District, Sydney, New South Wales, Australia
- The Kirby Institute, University of New South Wales, Sydney, New South Wales, Australia
| | - Sameera Ansari
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
- Faculty of Health Sciences and Medicine, Bond University, Robina, Queensland, Australia
| | - An Tran
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
| | - Joel J Rhee
- School of Population Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Margo Barr
- Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia
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Khalil SA, Azar S, Hafidh K, Ayad G, Safwat M. Prevalence and Co-prevalence of Comorbidities among Patients with Type 2 Diabetes Mellitus in the MENA Region: A Systematic Review. Curr Diabetes Rev 2024; 20:e310723219277. [PMID: 37526192 PMCID: PMC11092551 DOI: 10.2174/1573399820666230731105704] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/25/2023] [Accepted: 07/02/2023] [Indexed: 08/02/2023]
Abstract
AIM The management of type 2 diabetes mellitus is affected by the presence of comorbidities. This meta-analysis aimed to determine how likely it is for individuals with type 2 diabetes in the Middle East and North Africa (MENA) region to be living with additional chronic health conditions. METHODS We searched for studies published from January 2010 to December 2020 in the PubMed, Ovid MEDLINE®, Cochrane CENTRAL, Scopus, and Web of Science databases. Studies of adults with type 2 diabetes in the MENA region were included. We performed a random-effects meta-analysis of single proportions to calculate each comorbidity's overall prevalence/coprevalence. RESULTS Statistically significant co-prevalence was detected at p < 0.01 for angina (pooled proportion: 0.24, 95% CI: 0.06, 0.49), cerebrovascular accident (pooled proportion: 0.16, 95% CI: 0.08, 0.26), coronary artery disease (pooled proportion: 0.25, 95% CI: 0.16, 0.35), coronary heart disease (pooled proportion: 0.05, 95% CI: 0.01, 0.12), peripheral vascular disease (pooled proportion: 0.19, 95% CI: 0.13, 0.26), hypertension (pooled proportion: 0.56, 95% CI: 0.43, 0.69), renal impairment (pooled proportion: 0.19, 95% CI: 0.10, 0.29), in addition to hyperlipidemia and overweight/ obesity. CONCLUSION There is evidence of co-prevalence of several comorbidities in patients with type 2 diabetes, highlighting the importance of enhancing communication among healthcare professionals to develop the optimal management plan for each patient.
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Affiliation(s)
- Samir Assaad Khalil
- Department of Internal Medicine, Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Sami Azar
- Department of Internal Medicine, Faculty of Medicine, American University of Beirut, Beirut, Lebanon
| | - Khadija Hafidh
- Department of Diabetes and Endocrinology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - George Ayad
- Regional Expert Input and Medical Education, EMEAC Region, MSD Egypt, Cairo, Egypt
| | - Mohamed Safwat
- Health Economics & Outcomes Research, CORE EEMEA, MSD United Arab Emirates, Dubai, United Arab Emirates
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Daniels CJ, Cupler ZA, Napuli JG, Walsh RW, Ziegler AML, Meyer KW, Knieper MJ, Walters SA, Salsbury SA, Trager RJ, Gliedt JA, Young MD, Anderson KR, Kirk EJ, Mooring SA, Battaglia PJ, Paris DJ, Brown AG, Goehl JM, Hawk C. Development of Preliminary Integrated Health Care Clinical Competencies for United States Doctor of Chiropractic Programs: A Modified Delphi Consensus Process. GLOBAL ADVANCES IN INTEGRATIVE MEDICINE AND HEALTH 2024; 13:27536130241275944. [PMID: 39157778 PMCID: PMC11329915 DOI: 10.1177/27536130241275944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 07/23/2024] [Accepted: 07/29/2024] [Indexed: 08/20/2024]
Abstract
Background There has been rapid growth of chiropractors pursuing career opportunities in both public and private hospitals and other integrated care settings. Chiropractors that prosper in integrated care settings deliver patient-centered care, focus on the institutional mission, understand and adhere to organizational rules, and are proficient in navigating complex systems. The Council on Chiropractic Education Accreditation Standards do not outline specific meta-competencies for integrated care clinical training. Objective The purpose of this study was to develop preliminary integrated health care competencies for DC programs to guide the advancement of clinical chiropractic education. Methods A systematic literature search was performed. Articles were screened for eligibility and extracted in duplicate. Domains and seed statements were generated from this literature, piloted at a conference workshop, and evaluated via a modified Delphi consensus process. Of 42 invited, 36 chiropractors participated as panelists. Public comment period yielded 20 comments, none resulting in substantive changes to the competencies. Results Of 1718 citations, 23 articles met eligibility criteria. After 2 modified Delphi rounds, consensus was reached on all competency statements. A total of 78 competency statements were agreed upon, which encompassed 4 domains and 11 subdomains. The 4 domains were: 1) Collaboration, (2) Clinical Excellence, (3) Communication, and (4) Systems Administration. Conclusion We identified 78 preliminary competencies appropriate for preparing DC students and early career chiropractors for clinical practice in integrated healthcare settings. Educational programs may consider these competencies for curricular design and reform to strengthen DC program graduates for integrated practice, advanced training, and employment.
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Affiliation(s)
- Clinton J Daniels
- Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, WA, USA
- Rehabilitation Medicine, University of Washington, Seattle, WA, USA
| | - Zachary A Cupler
- Physical Medicine and Rehabilitation Services, Butler VA Health Care, Butler PA, USA
- Institute of Clinical Research Education, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jason G Napuli
- Primary Care Services-Whole Health, VA St. Louis Health Care System, St. Louis, MO, USA
- College of Chiropractic, Logan University, Chesterfield, MO, USA
| | - Robert W Walsh
- Integrated Primary Care Service, VA Palo Alto Health Care System, Palo Alto, CA, USA
- Palmer College of Chiropractic, Palmer West College of Chiropractic, San Jose, CA, USA
| | - Anna-Marie L Ziegler
- Primary Care Services-Whole Health, VA St. Louis Health Care System, St. Louis, MO, USA
- College of Chiropractic, Logan University, Chesterfield, MO, USA
| | - Kevin W Meyer
- Rehabilitation Care Services, VA Puget Sound Health Care System, Tacoma, WA, USA
| | - Matthew J Knieper
- Primary Care Services-Whole Health, VA St. Louis Health Care System, St. Louis, MO, USA
- College of Chiropractic, Logan University, Chesterfield, MO, USA
| | | | - Stacie A Salsbury
- Palmer Center for Chiropractic Research, Palmer College of Chiropractic, Davenport, IA, USA
| | - Robert J Trager
- Connor Whole Health, University Hospitals, Cleveland, OH, USA
- Department of Family Medicine & Community Health, Case Western Reserve University, Cleveland, OH, USA
| | - Jordan A Gliedt
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Morgan D Young
- Washington State Department of Labor and Industries, Olympia, WA, USA
| | | | - Eric J Kirk
- Aurora Health Care, Milwaukee, WI, USA
- Southern California University of Health Sciences, Whittier, CA, USA
| | - Scott A Mooring
- Northwestern University Health Sciences, Bloomington, MN, USA
- Athletic Medicine Department, University of Minnesota, Minneapolis, MN, USA
| | - Patrick J Battaglia
- Community-Based Clinical Education, University of Western States, Portland, OR, USA
| | - David J Paris
- Physical Medicine and Rehabilitation, VA Northern California Health Care, Redding, CA, USA
- Mercy Medical Center Mt. Shasta, Mount Shasta, CA, USA
| | - Amanda G Brown
- Center for Integrative Medicine, Henry Ford Health, Detroit, MI, USA
| | - Justin M Goehl
- Family Medicine, Dartmouth Health, Dartmouth, Lebanon, NH, USA
- Community and Family Medicine, Geisel School of Medicine, Dartmouth, Lebanon, NH, USA
| | - Cheryl Hawk
- Texas Chiropractic College, Pasadena, TX, USA
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Keramat SA, Perales F, Alam K, Rashid R, Haque R, Monasi N, Hashmi R, Siddika F, Siddiqui ZH, Ali MA, Gebremariam ND, Kondalsamy-Chennakesavan S. Multimorbidity and health-related quality of life amongst Indigenous Australians: A longitudinal analysis. Qual Life Res 2024; 33:195-206. [PMID: 37587324 PMCID: PMC10784343 DOI: 10.1007/s11136-023-03500-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2023] [Indexed: 08/18/2023]
Abstract
BACKGROUND The burden of multimorbidity has been observed worldwide and it has significant consequences on health outcomes. In Australia, health-related quality of life (HRQoL) is comparatively low amongst Aboriginal and/or Torres Strait Islanders, yet no studies have examined the effect of multimorbidity on HRQoL within this at-risk population. This study seeks to fill that gap by employing a longitudinal research design. METHODS Longitudinal data were derived from three waves (9, 13, and 17) of the household, income and labour dynamics in Australia (HILDA) Survey. A total of 1007 person-year observations from 592 Aboriginal and/or Torres Strait Islander individuals aged 15 years and above were included. HRQoL was captured using the 36-item Short-Form Health Survey (SF-36), and multimorbidity was defined using self-reports of having been diagnosed with two or more chronic health conditions. Symmetric fixed-effects linear regression models were used to assess how intraindividual changes in multimorbidity were associated with intraindividual changes in HRQoL. RESULTS Approximately 21% of Indigenous Australians were classified as experiencing multimorbidity. Respondents had statistically significantly lower HRQoL on the SF-36 sub-scales, summary measures, and health-utility index in those observations in which they experienced multimorbidity. Among others, multimorbidity was associated with lower scores on the SF-36 physical-component scale (β = - 6.527; Standard Error [SE] = 1.579), mental-component scale (β = - 3.765; SE = 1.590) and short-form six-dimension utility index (β = - 0.075; SE = 0.017). CONCLUSION This study demonstrates that having multiple chronic conditions is statistically significantly associated with lower HRQoL amongst Indigenous Australians. These findings suggest that comprehensive and culturally sensitive health strategies addressing the complex needs of individuals with multimorbidity should be implemented to improve the HRQoL of Indigenous Australians.
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Affiliation(s)
- Syed Afroz Keramat
- Faculty of Medicine, Centre for Health Services Research, The University of Queensland, Brisbane, QLD, Australia.
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh.
| | - Francisco Perales
- School of Social Science, The University of Queensland, Michie Building (#9), St Lucia, Brisbane, QLD, 4067, Australia
| | - Khorshed Alam
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Rumana Rashid
- Economics Discipline, Khulna University, Khulna, 9208, Bangladesh
| | - Rezwanul Haque
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Nahid Monasi
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Rubayyat Hashmi
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
| | - Farzana Siddika
- Department of Mathematics and Natural Sciences, BRAC University, Dhaka, Bangladesh
| | - Zubayer Hassan Siddiqui
- Department of Business Administration, Bangladesh University of Professionals, Dhaka, Bangladesh
| | - Mohammad Afshar Ali
- School of Business and Centre for Health Research, University of Southern Queensland, Toowoomba, QLD, 4350, Australia
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Waldron C, Hughes J, Wallace E, Cahir C, Bennett K. Contexts and mechanisms relevant to General Practitioner (GP) based interventions to reduce adverse drug events (ADE) in community dwelling older adults: a rapid realist review. HRB Open Res 2023; 5:53. [PMID: 38283368 PMCID: PMC10811420 DOI: 10.12688/hrbopenres.13580.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/19/2023] [Indexed: 01/30/2024] Open
Abstract
Background Older adults in Ireland are at increased risk of adverse drug events (ADE) due, in part, to increasing rates of polypharmacy. Interventions to reduce ADE in community dwelling older adults (CDOA) have had limited success, therefore, new approaches are required.A realist review uses a different lens to examine why and how interventions were supposed to work rather than if, they worked. A rapid realist review (RRR) is a more focused and accelerated version.The aim of this RRR is to identify and examine the contexts and mechanisms that play a role in the outcomes relevant to reducing ADE in CDOA in the GP setting that could inform the development of interventions in Ireland. Methods Six candidate theories (CT) were developed, based on knowledge of the field and recent literature, in relation to how interventions are expected to work. These formed the search strategy. Eighty full texts from 633 abstracts were reviewed, of which 27 were included. Snowballing added a further five articles, relevant policy documents increased the total number to 45. Data were extracted relevant to the theories under iteratively developed sub-themes using NVivo software. Results Of the six theories, three theories, relating to GP engagement in interventions, relevance of health policy documents for older adults, and shared decision-making, provided data to guide future interventions to reduce ADEs for CDOA in an Irish setting. There was insufficient data for two theories, a third was rejected as existing barriers in the Irish setting made it impractical to use. Conclusions To improve the success of Irish GP based interventions to reduce ADEs for CDOA, interventions must be relevant and easily applied in practice, supported by national policy and be adequately resourced. Future research is required to test our theories within a newly developed intervention.
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Affiliation(s)
- Catherine Waldron
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland
| | - John Hughes
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland
| | - Emma Wallace
- Department of General Practice, University College Cork, Cork, Ireland
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland
| | - Caitriona Cahir
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland
| | - K. Bennett
- Data Science Centre, School of Population Health, RCSI University of Medicine and Health Sciences, Dublin 2, D02 DH60, Ireland
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O'Brien E, Walsh A, Boland F, Collins C, Harkins V, Smith SM, O'Herlihy N, Clyne B, Wallace E. GP preferences for, access to, and use of evidence in clinical practice: a mixed-methods study. BJGP Open 2023; 7:BJGPO.2023.0107. [PMID: 37442591 PMCID: PMC11176671 DOI: 10.3399/bjgpo.2023.0107] [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: 06/11/2023] [Revised: 06/11/2023] [Accepted: 06/16/2023] [Indexed: 07/15/2023] Open
Abstract
BACKGROUND GPs aim to provide patient-centred care combining clinical evidence, clinical judgement, and patient priorities. Despite a recognition of the need to translate evidence to support patient care, barriers exist to the use of evidence in practice. AIM To ascertain the needs and preferences of GPs regarding evidence-based guidance to support patient care. The study also aimed to prioritise content and optimise structure and dissemination of future evidence-based guidance. DESIGN & SETTING This was a convergent parallel mixed-methods study in collaboration with the national GP professional body in the Republic of Ireland (Irish College of General Practitioners [ICGP]). Quantitative and qualitative findings were integrated at the interpretive level. METHOD A national GP survey was administered via the ICGP (December 2020) and seven GP focus groups were undertaken (April-May 2021). RESULTS Of 3496 GPs, a total of 509 responders (14.6%) completed the survey and 40 GP participants took part in focus groups. Prescribing updates, interpretation of test results, chronic disease management, and older person care were the preferred topics for future evidence-based guidance. GPs reported that they required rapid access to up-to-date and relevant evidence summaries online for use in clinical practice. Access to more comprehensive reviews for the purposes of continuing education and teaching was also a priority. Multimodal forms of dissemination were preferred to increase uptake of evidence in practice. CONCLUSION GPs indicated that rapid access to up-to-date, summarised evidence-based resources, available from their professional organisation, is preferred. Evidence should reflect the disease burden of the population and involve multifaceted dissemination approaches.
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Affiliation(s)
- Emer O'Brien
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Fiona Boland
- Data Science Centre, School of Population Health Sciences, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | | | - Velma Harkins
- Irish College of General Practitioners, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Discipline of Public Health and Primary Care, Trinity College Dublin, Dublin, Ireland
| | | | - Barbara Clyne
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Emma Wallace
- Department of General Practice, Royal College of Surgeons in Ireland (RCSI) University of Medicine and Health Sciences, Dublin, Ireland
- Department of General Practice, University College Cork, Cork, Ireland
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Tingvold L, Melby L. Three ways of organising general practitioner's medical services in sheltered housing. A qualitative study. Scand J Prim Health Care 2023; 41:400-410. [PMID: 37706637 PMCID: PMC11001341 DOI: 10.1080/02813432.2023.2256381] [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: 01/24/2023] [Accepted: 09/02/2023] [Indexed: 09/15/2023] Open
Abstract
OBJECTIVE Explore care providers' experiences with the organisation of the medical services for residents in round-the-clock staffed sheltered housing. DESIGN Qualitative study and thematic analysis of individual interviews after strategic sampling of participants. SETTING Round-the-clock staffed sheltered housing in seven municipalities, inhabited by various user groups, and GPs in various locations in Norway. SUBJECTS In-depth interviews with 18 participants: 11 managers or employees in sheltered housing and seven GPs. MAIN OUTCOME MEASURES Main themes and subthemes reporting participants' experiences of medical provision to sheltered housing residents. RESULTS Three main models of organizing medical services for round-the-clock staffed sheltered housing were identified: (i) the 'multiple GP' model, where each resident has their own individual GP; (ii) the 'single GP' model, where all residents in the sheltered housing have one common GP; (iii) the 'hybrid' model, where a few dedicated GPs follow up the residents. CONCLUSION Residents in round-the-clock staffed sheltered housing constitute a varied group that generally has substantial medical assistance needs. Given that many residents lack autonomy to manage their own care needs and make decisions, models with fewer GPs like models ii and iii seem to provide a better medical professional offer. Moving towards such an organising of the medical services for sheltered housing residents could have implications for GPs' workload and competence needs. Future studies are needed to test models and assess implications.
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Affiliation(s)
- Laila Tingvold
- Centre for Care Research East, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
| | - Line Melby
- Centre for Care Research East, Norwegian University of Science and Technology (NTNU), Trondheim, Norway
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Li L, Dai F, Zhang D. The effect of exercise intensity types on the self-rated health status of young-old comorbidities patients: a cross-sectional study in Guangdong, China. Front Public Health 2023; 11:1292712. [PMID: 38045961 PMCID: PMC10693424 DOI: 10.3389/fpubh.2023.1292712] [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: 09/12/2023] [Accepted: 10/31/2023] [Indexed: 12/05/2023] Open
Abstract
Objective Explore the effect of different types of exercise intensity on the self-rated health status of young-old comorbid patients with cardiovascular disease and metabolic disease, as well as the differences in effect among different genders. Provide more references and suggestions for chronic disease management in older comorbidities patients based on the results of the study. Methods A multi-stage stratified cluster random sampling method was used to select older (≥60 years old) comorbidities patients from communities in Guangdong Province as the survey subjects. Using the "Survey Questionnaire on the Current Status and Influencing Factors of older Comorbidities Patients," face-to-face interviews were conducted with 1,300 old patients. Data from 965 young-old patients (aged 60-74) who simultaneously suffered from cardiovascular and metabolic diseases were selected. Unordered multifactor Logistic regression analysis was used to explore the association between the type of exercise intensity and self-rated health. Stratified analysis was performed based on gender. Results The results of unordered multivariate logistic regression analysis showed that compared with young-old comorbidities patients with poor self-rated of health status, young-old comorbidities patients who underwent vigorous-intensity exercise were more likely to have better self-rated of health status (OR = 4.368, 95% CI: 2.491-7.661, p < 0.05). Stratified analysis based on gender showed that for young-old comorbidities male patients, those who engaged in vigorous-intensity exercise were more likely to have better self-rated of health status (OR = 2.924, 95% CI = 1.266-6.751, p < 0.05); for young-old comorbidities female patients, those who were encouraged by their family to exercise (OR = 2.460, 95% CI: 1.143-5.291, p < 0.05), participate in social activities (OR = 6.173, 95% CI: 2.285-16.678, p < 0.05), and engage in vigorous-intensity (OR = 4.232, 95% CI: 1.869-9.583, p < 0.05) or moderate-intensity exercise (OR = 4.555, 95% CI: 1.825-11.368, p < 0.05) were more likely to have better self-rated of health status. Conclusion If the physical condition allows, vigorous-intensity exercise has a significant positive effect on the self-rated of health status of young-old comorbidities patients with cardiovascular disease and metabolic disease. Specifically, for young-old comorbidities male patients, those who engage in vigorous-intensity exercise are more likely to self-evaluate their health as good; for young-old comorbidities female patients, both vigorous-intensity and moderate-intensity exercise can improve their self-rated of health status.
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Affiliation(s)
| | | | - Dan Zhang
- Tsinghua Shenzhen International Graduate School, Institute for Hospital Management, Tsinghua University, Shenzhen, China
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Maun A, Björkelund C, Arvidsson E. Primary care utilisation, adherence to guideline-based pharmacotherapy and continuity of care in primary care patients with chronic diseases and multimorbidity - a cross-sectional study. BMC PRIMARY CARE 2023; 24:237. [PMID: 37957554 PMCID: PMC10644564 DOI: 10.1186/s12875-023-02191-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2023] [Accepted: 10/24/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND To understand how to improve care for patients with chronic diseases and multimorbidity we wanted to describe the prevalence of different chronic diseases and the pattern of multimorbidity and to analyse the associations between occurrence of diseases and primary care utilization, adherence to guideline-based pharmacotherapy, and continuity of care. METHODS Retrospective cross-sectional study of routine care data of the general population in region Jönköping in Sweden (345 916 inhabitants using primary care services) covering 4.3 years. PARTICIPANTS Patients fulfilling the inclusion criteria of having ≥ 1 of 10 common chronic diseases and ≥ 3 visits to primary care between 2011 and 2015. PRIMARY OUTCOME MEASURES In order to determine diseases and multimorbidity, primary care utilisation, adherence to guideline-based pharmacotherapy, frequencies and percentages, interval and ratio scaled variables were described using means, standard deviations, and various percentiles in the population. Two continuity indices were used (MMCI, COC) to describe continuity. RESULTS Of the general population, 25 829 patients fulfilled the inclusion criteria (7.5% of the population). Number of diseases increased with increasing age, and multimorbidity was much more common than single diseases (mean 2.0 per patient). There was a slight positive correlation (0.29) between number of diseases and visits, but visits did not increase proportionally to the number of diseases. Patients with physical diseases combined with anxiety and/or depression made more visits than others. The number of diseases per patient was negatively associated with the adherence to pharmacotherapy guidelines. There was no association between continuity and healthcare utilisation or adherence to pharmacotherapy guidelines. CONCLUSIONS Multimorbid patients are common in primary care and for many chronic diseases it is more common to have other simultaneous diseases than having only one disease. This can make adherence to pharmacotherapy guidelines a questionable measure for aged multimorbid patients. Existing continuity indices also revealed limitations. Holistic and patient-centred measures should be used for quality assessment of care for multimorbid patients in primary care.
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Affiliation(s)
- Andy Maun
- Institute of General Practice / Primary Care, Faculty of Medicine and Medical Center, University of Freiburg, Elsässer Str 2m, Freiburg, DE-79110, Germany.
| | - Cecilia Björkelund
- Primary Health Care, Department of Public Health and Community Medicine, Sahlgrenska Academy, University of Gothenburg, Box 454, Göteborg, SE-405 30, Sweden
| | - Eva Arvidsson
- Research and Development Unit for Primary Care, Futurum, Hus B4, Länssjukhuset Ryhov, Jönköping, SE-551 85, Sweden
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Chen S, Marshall T, Jackson C, Cooper J, Crowe F, Nirantharakumar K, Saunders CL, Kirk P, Richardson S, Edwards D, Griffin S, Yau C, Barrett JK. Sociodemographic characteristics and longitudinal progression of multimorbidity: A multistate modelling analysis of a large primary care records dataset in England. PLoS Med 2023; 20:e1004310. [PMID: 37922316 PMCID: PMC10655992 DOI: 10.1371/journal.pmed.1004310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 11/17/2023] [Accepted: 10/09/2023] [Indexed: 11/05/2023] Open
Abstract
BACKGROUND Multimorbidity, characterised by the coexistence of multiple chronic conditions in an individual, is a rising public health concern. While much of the existing research has focused on cross-sectional patterns of multimorbidity, there remains a need to better understand the longitudinal accumulation of diseases. This includes examining the associations between important sociodemographic characteristics and the rate of progression of chronic conditions. METHODS AND FINDINGS We utilised electronic primary care records from 13.48 million participants in England, drawn from the Clinical Practice Research Datalink (CPRD Aurum), spanning from 2005 to 2020 with a median follow-up of 4.71 years (IQR: 1.78, 11.28). The study focused on 5 important chronic conditions: cardiovascular disease (CVD), type 2 diabetes (T2D), chronic kidney disease (CKD), heart failure (HF), and mental health (MH) conditions. Key sociodemographic characteristics considered include ethnicity, social and material deprivation, gender, and age. We employed a flexible spline-based parametric multistate model to investigate the associations between these sociodemographic characteristics and the rate of different disease transitions throughout multimorbidity development. Our findings reveal distinct association patterns across different disease transition types. Deprivation, gender, and age generally demonstrated stronger associations with disease diagnosis compared to ethnic group differences. Notably, the impact of these factors tended to attenuate with an increase in the number of preexisting conditions, especially for deprivation, gender, and age. For example, the hazard ratio (HR) (95% CI; p-value) for the association of deprivation with T2D diagnosis (comparing the most deprived quintile to the least deprived) is 1.76 ([1.74, 1.78]; p < 0.001) for those with no preexisting conditions and decreases to 0.95 ([0.75, 1.21]; p = 0.69) with 4 preexisting conditions. Furthermore, the impact of deprivation, gender, and age was typically more pronounced when transitioning from an MH condition. For instance, the HR (95% CI; p-value) for the association of deprivation with T2D diagnosis when transitioning from MH is 2.03 ([1.95, 2.12], p < 0.001), compared to transitions from CVD 1.50 ([1.43, 1.58], p < 0.001), CKD 1.37 ([1.30, 1.44], p < 0.001), and HF 1.55 ([1.34, 1.79], p < 0.001). A primary limitation of our study is that potential diagnostic inaccuracies in primary care records, such as underdiagnosis, overdiagnosis, or ascertainment bias of chronic conditions, could influence our results. CONCLUSIONS Our results indicate that early phases of multimorbidity development could warrant increased attention. The potential importance of earlier detection and intervention of chronic conditions is underscored, particularly for MH conditions and higher-risk populations. These insights may have important implications for the management of multimorbidity.
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Affiliation(s)
- Sida Chen
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Tom Marshall
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | | | - Jennifer Cooper
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Francesca Crowe
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Krish Nirantharakumar
- Institute of Applied Health Research, University of Birmingham, Birmingham, United Kingdom
| | - Catherine L. Saunders
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Paul Kirk
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Sylvia Richardson
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
| | - Duncan Edwards
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Simon Griffin
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, United Kingdom
| | - Christopher Yau
- Nuffield Department for Women’s & Reproductive Health, University of Oxford, Oxford, United Kingdom
- Health Data Research, Oxford, United Kingdom
| | - Jessica K. Barrett
- MRC Biostatistics Unit, University of Cambridge, Cambridge, United Kingdom
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Ando T, Sasaki T, Abe Y, Nishimoto Y, Hirata T, Haruta J, Arai Y. Measurement of polydoctoring as a crucial component of fragmentation of care among patients with multimorbidity: Cross-sectional study in Japan. J Gen Fam Med 2023; 24:343-349. [PMID: 38025930 PMCID: PMC10646296 DOI: 10.1002/jgf2.651] [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: 07/06/2023] [Revised: 09/03/2023] [Accepted: 09/11/2023] [Indexed: 12/01/2023] Open
Abstract
Background Care fragmentation, characterized by the uncoordinated involvement of multiple healthcare providers, leads to inefficient and ineffective healthcare, posing a significant challenge in managing patients with multimorbidity. In this context, "polydoctoring," where patients see multiple specialists, emerges as a crucial aspect of care fragmentation. This study seeks to develop an indicator to assess polydoctoring, which can subsequently enhance the management of multimorbidity. Methods Baseline survey data from the Kawasaki Aging and Wellbeing Project (KAWP) involving independent community-dwelling older adults aged 85-89 were utilized in this cross-sectional study. Polydoctoring measure was defined as the number of regularly visited facilities (RVFs). The association of RVF with the Fragmentation of Care Index (FCI) and the outcome measures of polypharmacy and ambulatory care costs were examined as indicators of care fragmentation. Results The analysis comprised 968 participants, with an average of 4.70 comorbid chronic conditions; 65.3% of the participants had two or more RVFs, indicating polydoctoring. A significant correlation between RVF and FCI was observed. Modified Poisson regression analyses revealed associations between higher RVF and increased prevalence ratio of polypharmacy. Likewise, a higher RVF was associated with higher outpatient medical costs. Conclusions RVF was significantly correlated with FCI, polypharmacy, and higher outpatient medical costs. Unlike complex indices, RVF is simple and intuitively comprehensible. Further research is needed to evaluate the impact of care fragmentation on patient outcomes, considering factors such as RVF thresholds, patient multimorbidity, and social support. Understanding the influence of polydoctoring can enhance care quality and efficiency for patients with multimorbidity.
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Affiliation(s)
- Takayuki Ando
- Center for General Medicine EducationKeio University School of MedicineTokyoJapan
| | - Takashi Sasaki
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
| | - Yukiko Abe
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
| | - Yoshinori Nishimoto
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
- Department of NeurologyKeio University School of MedicineTokyoJapan
| | - Takumi Hirata
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
- Institute for Clinical and Translational ScienceNara Medical UniversityKashiharaJapan
| | - Junji Haruta
- Center for General Medicine EducationKeio University School of MedicineTokyoJapan
- Medical Education CenterKeio University School of MedicineTokyoJapan
| | - Yasumichi Arai
- Center for Supercentenarian Medical ResearchKeio University School of MedicineTokyoJapan
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Engels LWS, van Merode T, Heijmans M, Menting J, Duncan P, Rademakers J. Measurement of treatment burden in patients with multimorbidity in the Netherlands: translation and validation of the Multimorbidity Treatment Burden Questionnaire (NL-MTBQ). Fam Pract 2023:cmad100. [PMID: 37878729 DOI: 10.1093/fampra/cmad100] [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] [Indexed: 10/27/2023] Open
Abstract
BACKGROUND Multimorbidity is a growing problem. The number and complexity of (non-)pharmaceutical treatments create a great burden for patients. Treatment burden refers to the perception of the weight of these treatments, and is associated with multimorbidity. Measurement of treatment burden is of great value for optimizing treatment and health-related outcomes. OBJECTIVE We aim to translate and validate the Multimorbidity Treatment Burden Questionnaire (MTBQ) for use in the Dutch population with multimorbidity and explore the level of treatment burden. METHODS Translating the MTBQ into Dutch included forward-backward translation, piloting, and cognitive interviewing (n = 8). Psychometric properties of the questionnaire were assessed in a cross-sectional study of patients with multimorbidity recruited from a panel in the Netherlands (n = 959). We examined item properties, dimensionality, internal consistency reliability, and construct validity. The level of treatment burden in the population was assessed. RESULTS The mean age among 959 participants with multimorbidity was 69.9 (17-96) years. Median global NL-MTBQ score was 3.85 (interquartile range 0-9.62), representing low treatment burden. Significant floor effects were found for all 13 items of the instrument. Factor analysis supported a single-factor structure. The NL-MTBQ had high internal consistency (α = 0.845), and provided good evidence on the construct validity of the scale. CONCLUSION The Dutch version of the 13-item MTBQ is a single-structured, valid, and compact patient-reported outcome measure to assess treatment burden in primary care patients with multimorbidity. It could identify patients experiencing high treatment burden, with great potential to enhance shared decision-making and offer additional support.
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Affiliation(s)
- Loes W S Engels
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Tiny van Merode
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Monique Heijmans
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Juliane Menting
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| | - Polly Duncan
- Centre for Academic Primary Care, University of Bristol, Bristol, United Kingdom
| | - Jany Rademakers
- Department of Family Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
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