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Ku GMV, van de Put W, Katsuva D, Ahmed MAA, Rosenberg M, Meessen B. Quality of care for chronic conditions: identifying specificities of quality aims based on scoping review and Delphi survey. Glob Health Action 2024; 17:2381878. [PMID: 39149932 PMCID: PMC11332280 DOI: 10.1080/16549716.2024.2381878] [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: 04/04/2024] [Accepted: 07/12/2024] [Indexed: 08/17/2024] Open
Abstract
There is a growing need to implement high quality chronic care to address the global burden of chronic conditions. However, to our knowledge, there have been no systematic attempts to define and specify aims for chronic care quality. To address this gap, we conducted a scoping review and Delphi survey to establish and validate comprehensive specifications. The Institute of Medicine's (IOM) quality of care definition and aims were used as the foundation. We purposively selected articles from the scientific (n=48) and grey literature (n=26). We sought papers that acknowledged and unpacked the plurality of quality in chronic care and proposed or utilised frameworks, studied their implementation, or investigated at least two IOM quality care aims and implementation. Articles were analysed both deductively and inductively. The findings were validated through a Delphi survey involving 49 international chronic care experts with varied knowledge of, and experience in, low-and-middle-income countries. Considering the natural history of chronic conditions and the journey of a person with a chronic condition, we defined and identified the aims of chronic care quality. The six IOM aims apply with specific meanings. We identified a seventh aim, continuity, which relates to the issue of chronicity. The group endorsed our specifications and several participants gave contextualised interpretations and concrete examples. Chronic conditions pose specific challenges underscoring the relevance of tailoring quality of care aims. The next steps require a tailored definition and specific aims to improve, measure and assure the quality of chronic care.
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Affiliation(s)
- Grace Marie V. Ku
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
- Department of Gerontology, Faculty of Medicine & Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- Department of Preventive Medicine, Faculty of Medicine & Surgery, University of Santo Tomas, Manila, Philippines
| | - Willem van de Put
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Deogratias Katsuva
- Department of Public Health, Institute of Tropical Medicine, Antwerp, Belgium
| | - Mohamad Ali Ag Ahmed
- Sherpa University Institute, Montreal, Canada
- Department of Health Management, Evaluation and Policy, School of Public Health, University of Montreal, Montreal, Canada
| | - Megumi Rosenberg
- Centre for Health Development, World Health Organization, Kobe, Japan
| | - Bruno Meessen
- Health Financing and Economics Department, World Health Organization, Geneva, Switzerland
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Suetani S, Hull J, Zeniou L, Chong L, Stimming A, Nelson C, Panagoda G. A model of care for attention deficit and hyperactivity disorder among adults in the community. Australas Psychiatry 2023; 31:616-618. [PMID: 37358370 DOI: 10.1177/10398562231186237] [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] [Indexed: 06/27/2023]
Abstract
OBJECTIVE To describe the process of collaborative, contextualised development and implementation of a model of care for adults with symptoms suggestive of attention deficit and hyperactivity disorder in an Aboriginal community-controlled health service. CONCLUSION The current article describes an attempt to reduce unmet mental health needs through a systemic approach within a well-established Indigenous community-controlled organisation.
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Affiliation(s)
- Shuichi Suetani
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
- Physical health and mental health stream, Queensland Centre for Mental Health Research, Wacol, QLD, Australia
- Queensland Brain Institute, The University of Queensland, St Lucia, QLD, Australia
- School of Medicine and Dentistry, Griffith University, Southport, QLD, Australia
| | - Jaimie Hull
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Lakis Zeniou
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Leshay Chong
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Andrea Stimming
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Carmel Nelson
- Institute for Urban Indigenous Health, Windsor, QLD, Australia
| | - Gaj Panagoda
- School of Human Movement and Nutrition Sciences, The University of Queensland, St Lucia, QLD, Australia
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Pérez Valencia JJ, Vázquez Díaz JR. [The new program of the Family and Community Medicine specialty: An opportunity not to be missed]. Aten Primaria 2023:S0212-6567(23)00083-5. [PMID: 37353460 DOI: 10.1016/j.aprim.2023.102650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 04/17/2023] [Accepted: 04/17/2023] [Indexed: 06/25/2023] Open
Abstract
The training program for the Family and Community Medicine specialty (MFyC), which has been in effect since 2005, is currently undergoing a review and update process. This article proposes contributions to deepen the specific contents of the specialty in order to guide towards a more significant competency development. To carry out values-oriented training, it is suggested to deploy the values function and promote the creation of care spaces where the daily experience of those values is possible. It is proposed to establish a scale of values where the two essential values of the family physician are, in this order, a commitment to the individual person, and a commitment to the group of people under their care. Additionally, it is proposed to reorganize the competency map around five competency integrators or meta-competencies: patient-centered clinical method, population-based clinical governance, primary care oriented to the community, health promotion or community health based on assets, and research in the family and community field.
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Affiliation(s)
- Juan José Pérez Valencia
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria La Laguna-Tenerife Norte (Tenerife zona II-La Laguna), Gerencia de Atención Primaria del Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España
| | - José Ramón Vázquez Díaz
- Unidad Docente Multiprofesional de Atención Familiar y Comunitaria La Laguna-Tenerife Norte (Tenerife zona II-La Laguna), Gerencia de Atención Primaria del Área de Salud de Tenerife, Servicio Canario de la Salud, Santa Cruz de Tenerife, España.
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Casado Vicente V. Presente y futuro de la especialidad de Medicina Familiar y Comunitaria en España. REVISTA CLÍNICA DE MEDICINA DE FAMILIA 2023. [DOI: 10.55783/rcmf.160101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023] Open
Affiliation(s)
- Verónica Casado Vicente
- Especialista en Medicina Familiar y Comunitaria.CS Universitario Parquesol. Profesora asociada y coordinadora de la Unidad Docente Universitaria de Medicina Familiar y Comunitaria. Facultad de Medicina. Valladolid (España)
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Bougioukas KI, Pamporis K, Vounzoulaki E, Karagiannis T, Haidich AB. Types and associated methodologies of overviews of reviews in health care: a methodological study with published examples. J Clin Epidemiol 2023; 153:13-25. [PMID: 36351511 DOI: 10.1016/j.jclinepi.2022.11.003] [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: 03/25/2022] [Revised: 10/16/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES To provide a descriptive insight into the different types of research questions/objectives and associated methodologies of overviews of reviews, supplemented by representative examples from the health care literature. STUDY DESIGN AND SETTING We searched in methodological articles for information on types and methodologies used in overviews and we explored the typology of reviews to identify similar types in literature of overviews. We categorized the types of overviews based on the research question/objective and the methodological approach used. Indicative examples for each category were selected from a sample of 2,121 overviews that were retrieved between 2000 and 2022 from MEDLINE, Scopus, and Cochrane Database of Systematic Reviews. RESULTS Based on type of research question, overviews were classified as overviews of reviews of interventions, associations, prediction, diagnostic accuracy, prevalence/incidence, experiences/views, economic evaluation, and measurement properties. Based on the methodological approach, we identified a variety of methods (systematic, living, rapid, scoping, evidence mapping, framework, and methodological) used in overviews. CONCLUSION The proposed classification and examples provide an essential starting point for future theory-building research on typologies and study designs of overviews of reviews. It is important for methodologists to make vigorous effort to create consensus-based methodological and reporting guidelines to cover these diverse types and key methodological challenges.
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Affiliation(s)
- Konstantinos I Bougioukas
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Konstantinos Pamporis
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Elpida Vounzoulaki
- Diabetes Research Centre, Leicester General Hospital, University of Leicester, Leicester LE5 4PW, UK
| | - Thomas Karagiannis
- Clinical Research and Evidence-Based Medicine Unit, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece; Diabetes Centre, Second Medical Department, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Anna-Bettina Haidich
- Department of Hygiene, Social-Preventive Medicine & Medical Statistics, Medical School, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece.
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CLARKE LORCAN, ANDERSON MICHAEL, ANDERSON ROB, KLAUSEN MORTENBONDE, FORMAN REBECCA, KERNS JENNA, RABE ADRIAN, KRISTENSEN SØRENRUD, THEODORAKIS PAVLOS, VALDERAS JOSE, KLUGE HANS, MOSSIALOS ELIAS. Economic Aspects of Delivering Primary Care Services: An Evidence Synthesis to Inform Policy and Research Priorities. Milbank Q 2021; 99:974-1023. [PMID: 34472653 PMCID: PMC8718591 DOI: 10.1111/1468-0009.12536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
Policy Points The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. While there is a large amount of literature on the economic aspects of delivering primary care services, there is a need for more comprehensive overviews of this evidence. In this article, we offer such an overview. Evidence suggests that there are several strategies involving coverage, financing, service delivery, and governance arrangements which can, if implemented, have positive economic impacts on the delivery of primary care services. These include arrangements such as worker task-shifting and telemedicine. The implementation of any such arrangements, based on positive economic evidence, should carefully account for potential impacts on overall health care access and quality. There are many opportunities for further research, with notable gaps in evidence on the impacts of increasing primary care funding or the overall supply of primary care services. CONTEXT The 2018 Declaration of Astana reemphasized the importance of primary health care and its role in achieving universal health coverage. To strengthen primary health care, policymakers need guidance on how to allocate resources in a manner that maximizes its economic benefits. METHODS We collated and synthesized published systematic reviews of evidence on the economic aspects of different models of delivering primary care services. Building on previous efforts, we adapted existing taxonomies of primary care components to classify our results according to four categories: coverage, financing, service delivery, and governance. FINDINGS We identified and classified 109 reviews that met our inclusion criteria according to our taxonomy of primary care components: coverage, financing, service delivery, and governance arrangements. A significant body of evidence suggests that several specific primary care arrangements, such as health workers' task shifting and telemedicine, can have positive economic impacts (such as lower overall health care costs). Notably absent were reviews on the impact of increasing primary care funding or the overall supply of primary care services. CONCLUSIONS There is a great opportunity for further research to systematically examine the broader economic impacts of investing in primary care services. Despite progress over the last decade, significant evidence gaps on the economic implications of different models of primary care services remain, which could help inform the basis of future research efforts.
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Affiliation(s)
- LORCAN CLARKE
- London School of Economics and Political Science
- Trinity College Dublin
| | | | | | | | | | - JENNA KERNS
- London School of Economics and Political Science
| | | | | | | | | | - HANS KLUGE
- World Health Organization Regional Office for Europe (WHO/Europe)
| | - ELIAS MOSSIALOS
- London School of Economics and Political Science
- Imperial College London
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Ghavamabad LH, Vosoogh-Moghaddam A, Zaboli R, Aarabi M. Establishing clinical governance model in primary health care: A systematic review. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2021; 10:338. [PMID: 34761024 PMCID: PMC8552259 DOI: 10.4103/jehp.jehp_1299_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Accepted: 01/12/2021] [Indexed: 06/13/2023]
Abstract
Clinical governance is a systematic approach to enhancing the quality of primary health care and ensuring high clinical standards, responsiveness to performance, and continuous improvement in service quality. The objective of the current study was to investigate the global experiences of clinical governance in primary health care. In the present systematic review, relevant articles from different countries were searched in various databases such as MD PubMed from Medline portal, Emerald Springer link, ProQuest, Cochrane, Scopus, Web of Science, and Consult until April 2019. The searched articles were checked through CASP and PRISMA checklists, and their results were extracted. Of the 17 selected studies, 16 belonged to developed countries, including England (13), Australia, Italy, and New Zealand, and one was from Turkey. The findings were divided into three general categories: (1) principles of effectiveness and risk management, (2) deployment requirements such as structural and organizational needs, resource and communication, and information management, and (3) barriers of clinical governance toward providing primary health care. it is recommended that a suitable framework or model be developed and designed adapted to the local culture and taking into account all effective dimensions for a proper establishment and implementation of clinical governance in primary health care.
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Affiliation(s)
| | - Abbas Vosoogh-Moghaddam
- Governance and Health Research Group, Neuroscience Research Institute, Tehran University of Medical Sciences and Health Services, Tehran, Iran
- Leadership and Governance Scientific Group, Health Managers Development Institute, Ministry of Health and Medical Education, Tehran, Iran
| | - Rouhollah Zaboli
- Healthcare Management Research Center, Baqiyatallah University of Medical Sciences, Tehran, Iran
| | - Mohsen Aarabi
- Department of Epidemiology and Biostatistics, Mazandaran University of Medical Sciences, Sari, Iran
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O Brien I, de Groot R, Champion V, Gauld R. Clinical governance in New Zealand: perceptions from registered health professionals in health care delivery compared with social insurance. AUST HEALTH REV 2021; 45:753-760. [PMID: 34340746 DOI: 10.1071/ah21102] [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: 03/25/2021] [Accepted: 05/13/2021] [Indexed: 11/23/2022]
Abstract
ObjectiveEffective clinical governance can improve delivery of health outcomes. This exploratory study compared perceptions of clinical governance development held by registered health professionals employed by two different but interrelated health organisations in the broader New Zealand (NZ) health system. Most staff in public sector healthcare service delivery organisations (i.e. District Health Boards (DHBs)) are registered health professionals, whereas these clinical staff represent a small minority (5%) in social insurance organisations (i.e. the Accident Compensation Corporation (ACC)). Given these different contexts, comparison of results from three surveys of clinical governance perceptions identified key learnings for the development of clinical governance.MethodsThe Clinical Governance Development Index (CGDI) was administered to registered health professional staff in NZ DHBs and ACC, at different time points. The data were explored, compared and reported.ResultsResponses to survey items completed by NZ DHB staff and registered health professionals employed by ACC were compared. For each administration, there was a similar profile of positive responses across the seven CGDI items. The 2020 ACC survey results for one item were clearly different. This item asked about perceptions of full and active involvement in organisational processes and decision making (i.e. clinical engagement).ConclusionsPerceptions of registered health professionals working in the NZ public sector delivering health services were compared with those held by staff employed by a NZ social insurer predominantly commissioning and influencing care. The results indicated similar levels of clinical governance development. Clinical governance development in the ACC context can benefit from clear communication, building strong supporting structures and greater management-clinical provider partnerships. Clinical governance development drives health outcomes and regular measurement of developmental progress can provide momentum. There is room across the NZ health system to raise awareness and leverage clinical governance to deliver improved health outcomes.What is known about the topic?Little is known about the perceptions held by registered health professionals employed by social insurance organisations. There are no published comparative studies exploring differences in perceptions between registered health professionals across two different organisational contexts, both with a goal of improving health outcomes.What does this paper add?Effective clinical governance drives coordinated, quality systems that promote optimal health outcomes. Social insurance organisations predominantly commission healthcare providers to deliver health outcomes. Although registered health professionals employed by social insurance organisations represent a small total number of staff, their perspective on clinical governance, as reported via survey, indicated there is most to be gained in the development of partnerships between management and clinical providers. This exploratory study fills a gap in the existing clinical governance development literature and evidence base.What are the implications for practitioners?Any health organisation can leverage clinical governance to deliver improved health outcomes. Effective clinical governance interventions are targeted to specific organisational context and culture. For ACC, a clear definition, enhanced management-clinical provider partnerships and strong supporting structures or organisational arrangements can be further developed. The survey results indicated that a focus on management-clinical provider partnerships is a clear priority for ACC clinical governance development. Partnerships based in empowered collaboration require greater clinical engagement, as well as increased capability for aligning with organisational priorities. Effective clinical governance development requires attention to context and culture. It can improve delivery of health outcomes.
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Affiliation(s)
- Inga O Brien
- The Accident Compensation Corporation, Wellington, New Zealand. ; and Corresponding author.
| | - Roy de Groot
- The Accident Compensation Corporation, Wellington, New Zealand. ; and Present address: Ministry of Health, Wellington, New Zealand.
| | - Vera Champion
- The Accident Compensation Corporation, Wellington, New Zealand.
| | - Robin Gauld
- Otago Business School, University of Otago, Dunedin, New Zealand. ; and Centre for Health Systems and Technology, University of Otago, Dunedin, New Zealand
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Li J, Pu J, Liu J, Wang Q, Zhang R, Zhang T, Zhou J, Xing W, Liang S, Hu D, Li Y. Determinants of self-management behaviors among pulmonary tuberculosis patients: a path analysis. Infect Dis Poverty 2021; 10:103. [PMID: 34330337 PMCID: PMC8325183 DOI: 10.1186/s40249-021-00888-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Accepted: 07/19/2021] [Indexed: 11/10/2022] Open
Abstract
Background Tuberculosis (TB) is one of the top 10 causes of death in the world. Since Directly Observed Therapy (DOT) as a core strategy for the global TB control are not applicable to all types of TB patients, and self-management of TB patients (SMTP) as a patient-centered supervision type is a supplement to DOT and can improve TB case management. However, the factors related to SMTP are complex and need more study. This study aimed at identifying the determinants of SMTP and examining the direct/indirect effects of these determinants. Methods The purposive sampling technique was used to select study sites and participants were recruited from the study sites by the consecutive sampling method. The PRECEDE model was used as the framework to analyze the determinants of SMTP. The responses of TB patients were acquired via a questionnaire survey for data collection. A Pearson correlation analysis was used to define the relationship between the predisposing, enabling, reinforcing factors with SMTP behaviors. A regression-based path analysis was used to determine the action paths of the predisposing, enabling, and reinforcing factors on SMTP behaviors. Results The predisposing (TB knowledge), enabling [health education and healthcare workers (HCWs) support], reinforcing factors (family support) had significant positive correlations with SMTP behaviors (P < 0.05). The predisposing, enabling, reinforcing factors were positively correlated with each other (r = 0.123‒0.918, P < 0.05), except for family support and HCWs support. The predisposing factors (TB knowledge, β = 0.330) and the enabling factors (HCWs support, β = 0.437) had direct effects on SMTP behaviors. The enabling factors (health education and HCWs support) and the reinforcing factors (family support) had indirect effects on SMTP behaviors. Conclusions This study revealed the effects and action path of TB knowledge, health education, HCWs support, and family support on SMTP behaviors via a path analysis. Assessing patient’s needs for SMTP along with promoting effective TB health education and providing firm support from HCWs and family members are potential strategies to promote SMTP behaviors. Graphic abstract ![]()
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Affiliation(s)
- Jin Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jie Pu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Jiaqing Liu
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Qingya Wang
- Chongqing Institute of TB Prevention and Treatment, Jiulongpo District, Chongqing, China
| | - Rui Zhang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Ting Zhang
- Chongqing Institute of TB Prevention and Treatment, Jiulongpo District, Chongqing, China
| | - Jiani Zhou
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Wei Xing
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Shengxiang Liang
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China
| | - Daiyu Hu
- Chongqing Institute of TB Prevention and Treatment, Jiulongpo District, Chongqing, China
| | - Ying Li
- Department of Social Medicine and Health Service Management, Army Medical University (Third Military Medical University), Chongqing, China.
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Paukkonen L, Oikarinen A, Kähkönen O, Kyngäs H. Patient participation during primary health-care encounters among adult patients with multimorbidity: A cross-sectional study. Health Expect 2021; 24:1660-1676. [PMID: 34247439 PMCID: PMC8483210 DOI: 10.1111/hex.13306] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 05/11/2021] [Accepted: 06/11/2021] [Indexed: 11/29/2022] Open
Abstract
Background Patient participation is essential for achieving high‐quality care and positive outcomes, especially among patients with multimorbidity, which is a major challenge for health care due to high prevalence, care complexity and impact on patients' lives. Objective To explore the patient participation related to their own care among patients with multimorbidity in primary health‐care settings. Methods A cross‐sectional survey was conducted among adult multimorbid patients who visited primary health‐care facilities. The key instrument used was the Participation in Rehabilitation Questionnaire. Data representing 125 patients were analysed using various statistical methods. Results The respondents generally felt patient participation to be important, yet provided highly varying accounts regarding the extent to which it was realized by professionals. Information and knowledge and Respect and encouragement were considered the most important and best implemented subcategories of participation. Several patient‐related factors had a statistically significant effect on patient perceptions of participation for all subcategories and as explanatory factors for perceptions of total participation in univariate models. Most patients reported active participation in health‐care communication, positively associated with patient activation and adherence. Gender, perceived health, patient activation and active participation were explanatory factors for total importance of participation in multivariate models, while patient activation was retained for realization of participation. Conclusions Multimorbid patients require individualized care that promotes participation and active communication; this approach may further improve patient activation and adherence. Poor perceived health and functional ability seemed to be related to worse perceptions of participation. Patient and public involvement The study topic importance was based on the patients' experiences in author's previous research and the need to develop patient‐centred care.
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Affiliation(s)
- Leila Paukkonen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Anne Oikarinen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Outi Kähkönen
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland
| | - Helvi Kyngäs
- Research Unit of Nursing Science and Health Management, University of Oulu, Oulu, Finland.,Medical Research Centre, Oulu, Finland.,Oulu University Hospital, Oulu, Finland
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Alves KCG, Guimarães RA, de Souza MR, de Morais Neto OL. Performance of family health teams for tackling chronic diseases in a state of the Amazon. PLoS One 2020; 15:e0241765. [PMID: 33156831 PMCID: PMC7647065 DOI: 10.1371/journal.pone.0241765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Accepted: 10/20/2020] [Indexed: 11/21/2022] Open
Abstract
The most common cause of death worldwide is noncommunicable diseases. A cross-sectional study was conducted to evaluate the adequacy of the work process among family health teams and compare differences in regional adequacy in the state of Tocantins, in the Amazonian Region, Brazil. Categorical principal components analysis was used, and scores of each principal component extracted in the analysis were compared among health regions in Tocantins. A post hoc analysis was performed to compare the heath region pairs. The adequacy of family health teams’ work process was evaluated with respect to the Strategic Action Plan to Tackle NCDs. The results showed that the family health teams performed actions according to the Strategic Action Plan to Tackle NCDs. However, overall, the adequacy percentages of these actions according to the axes of the Plan are very uneven in Tocantins, with large variations among health regions. The family health teams in the Bico do Papagaio (Region 1), Médio Norte Araguaia (Region 2), Cantão (Region 4) and Capim Dourado (Region 5) regions have adequacy percentages ≥ 50% with the Strategic Action Plan to Tackle NCDs, whereas all other regions have percentages <50%. Health teams perform surveillance actions, health promotion, and comprehensive care for NCDs in accordance with the guidelines of the Strategic Action Plan to Tackle NCDs. The challenge of NCDs in primary care requires a care model that is tailored to users’ needs and has the power to reduce premature mortality and its determinants.
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Affiliation(s)
| | - Rafael Alves Guimarães
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
| | - Marta Rovery de Souza
- Institute of Tropical Pathology and Public Health, Federal University of Goiás, Goiânia, Goiás, Brazil
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Quinaz Romana G, Kislaya I, Cunha Gonçalves S, Salvador MR, Nunes B, Matias Dias C. Healthcare use in patients with multimorbidity. Eur J Public Health 2020; 30:16-22. [PMID: 31978229 DOI: 10.1093/eurpub/ckz118] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The existence of multiple chronic conditions in the same patient is a public health problem increasingly recognized as relevant to health systems. Individuals with multimorbidity have additional health needs, which imply a heavy burden in healthcare use. It is estimated that between 70% and 80% of the total health expenditure is used with chronic conditions. Patients with multimorbidity are responsible for up to 75% of primary care appointments. These patients are also high hospital users, with up to 14.6 times more risk of hospitalization. METHODS This study analyses the association between healthcare use and multimorbidity in the Portuguese population aged 25-74 years old. The association between socioeconomic variables and healthcare use was studied, based on data from the first Portuguese Health Examination Survey using a logistic regression model, stratified by sex and adjusted for socioeconomic confounding variables. RESULTS In patients with multimorbidity, there was a greater use of primary healthcare consultations, medical or surgical specialist consultations and hospitalizations. An association was established between female, older age groups and lower educational levels, and increased healthcare use. When adjusted to socioeconomic variables, the likelihood of using healthcare services can be as high as 3.5 times, when compared to patients without chronic conditions. CONCLUSION Our results show a greater healthcare use in multimorbidity patients, both in primary and hospital care. The availability of scientific evidence regarding the use of healthcare services by multimorbidity patients may support health policy changes, which could allow a more efficient management of these patients.
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Affiliation(s)
- Guilherme Quinaz Romana
- ACES Lisboa Norte Public Health Unit, Lisbon, Portugal.,Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal
| | - Irina Kislaya
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Susana Cunha Gonçalves
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,ACES Médio Tejo Public Health Unit, Alcanena, Portugal
| | - Mário Rui Salvador
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,ACES Dão Lafões Public Health Unit, Viseu, Portugal
| | - Baltazar Nunes
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Carlos Matias Dias
- Departamento de Epidemiologia, Instituto Nacional de Saúde Doutor Ricardo Jorge, Lisbon, Portugal.,Centro de Investigação em Saúde Pública, Escola Nacional de Saúde Pública, Universidade Nova de Lisboa, Lisbon, Portugal
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13
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Kong DCH, Sturgiss EA, Dorai Raj AK, Fallon K. What factors contribute to uncontrolled gout and hospital admission? A qualitative study of inpatients and their primary care practitioners. BMJ Open 2019; 9:e033726. [PMID: 31874894 PMCID: PMC7008429 DOI: 10.1136/bmjopen-2019-033726] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Revised: 11/27/2019] [Accepted: 11/28/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To provide deeper insight into why patients are admitted to hospital with gout and discover potential targets for better disease control. DESIGN Data from semi-structured interviews were analysed using a thematic analysis approach. PARTICIPANTS AND SETTING Eleven inpatients from a tertiary institution in the Australian Capital Territory of Australia and their respective general practitioners (GPs) were invited to participate in the semi-structured interviews. RESULTS Despite significant pain and disability that accompanied acute flares, patients continue to experience shame in seeking treatment and regarded gout as being not particularly important. Other barriers included patients' poor continuity of care with and lack of confidence in GPs, suboptimal management in outpatient and inpatient settings, poor understanding of disease and treatment, and misconceptions held by both patients and physicians leading to uncontrolled disease activity. CONCLUSIONS Barriers to optimal gout management including patient and health practitioner factors have produced a complex effect which has led to a cycle of treatment avoidance behaviours and recurrent hospitalisations for severe acute gout flares. These barriers could be addressed using a multipronged approach guided by the chronic care model which has been applied in a variety of other chronic diseases with improved patient and professional-level outcomes. Managing gout according to best practice for chronic disease is more likely to prevent recurrent hospitalisations and improve health outcomes in patients with gout.
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Affiliation(s)
- Darren Chyi Hsiang Kong
- Department of Rheumatology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Elizabeth Ann Sturgiss
- Department of General Practice, Monash University, Notting Hill, Victoria, Australia
- School of Population Health, National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
| | | | - Kieran Fallon
- Department of Rheumatology, Canberra Hospital, Canberra, Australian Capital Territory, Australia
- Faculty of Medicine, College of Health and Medicine, Australian National University, Canberra, Australian Capital Territory, Australia
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14
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Boehmer KR, Holland DE, Vanderboom CE. Identifying and addressing gaps in the implementation of a community care team for care of Patients with multiple chronic conditions. BMC Health Serv Res 2019; 19:843. [PMID: 31730457 PMCID: PMC6858771 DOI: 10.1186/s12913-019-4709-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 11/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with multiple chronic conditions represent a growing segment for healthcare. The Chronic Care Model (CCM) supports leveraging community programs to support patients and their caregivers overwhelmed by their treatment plans, but this component has lagged behind the adoption of other model elements. Community Care Teams (CCTs) leverage partnerships between healthcare delivery systems and existing community programs to address this deficiency. There remains a gap in moving CCTs from pilot phase to sustainable full-scale programs. Therefore, the purpose of this study was to identify the cognitive and structural needs of clinicians, social workers, and nurse care coordinators to effectively refer appropriate patients to the CCT and the value these stakeholders derived from referring to and receiving feedback from the CCT. We then sought to translate this knowledge into an implementation toolkit to bridge implementation gaps. METHODS Our research process was guided by the Assess, Innovate, Develop, Engage, and Devolve (AIDED) implementation science framework. During the Assess process we conducted chart reviews, interviews, and observations and in Innovate and Develop phases, we worked with stakeholders to develop an implementation toolkit. The Engage and Devolve phases disseminate the toolkit through social networks of clinical champions and are ongoing. RESULTS We completed 14 chart reviews, 11 interviews, and 2 observations. From these, facilitators and barriers to CCT referrals and patient re-integration into primary care were identified. These insights informed the development of a toolkit with seven components to address implementation gaps identified by the researchers and stakeholders. CONCLUSION We identified implementation gaps to sustaining the CCT program, a community-healthcare partnership, and used this information to build an implementation toolkit. We established liaisons with clinical champions to diffuse this information. The AIDED Model, not previously used in high-income countries' primary care settings, proved adaptable and useful.
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Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Diane E Holland
- Nursing Research Division, Department of Nursing, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Catherine E Vanderboom
- Nursing Research Division, Department of Nursing, College of Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
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15
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Fueyo-Díaz R, Magallón-Botaya R, Masluk B, Palacios-Navarro G, Asensio-Martínez A, Gascón-Santos S, Olivan-Blázquez B, Sebastián-Domingo JJ. Prevalence of celiac disease in primary care: the need for its own code. BMC Health Serv Res 2019; 19:578. [PMID: 31419971 PMCID: PMC6697906 DOI: 10.1186/s12913-019-4407-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 08/06/2019] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Celiac disease (CD) is an autoimmune chronic enteropathy of the small intestine caused by exposure to gluten in genetically predisposed individuals. CD is not easy to diagnose due to its unspecific symptomatology, especially in adults, a diagnosed/undiagnosed ratio of 1:7 is estimated. CD does not have its own code in the International Classification of Primary Care (ICPC) but it is coded under code D99 "Disease digestive system, other", which hinders diagnosis, intervention and research. The aim of this study is to investigate the prevalence of CD in Aragón, Spain, using the information available from Primary Care, as well as to discuss the difficulties involved in determining prevalence of CD from data collected at this level of medical intervention. METHODS We designed an epidemiological cross-sectional study and analysed 26,964 electronic clinical records from the Aragonese Health Service under code ICPC D99 collected up to December 31st, 2016. The clinical records were classified by their editable field "descriptor" according to their probability of being related to CD. Analyses of gender, age, age at diagnosis, province and health sector were carried out. RESULTS We found 4534 clinical records under 293 different descriptors with a high probability of referring to CD. Prevalence in Aragón was estimated to be 0.35% ranging from 0.24 to 0.81% with important differences among health sectors. CONCLUSIONS The prevalence of 0.35% is a long way from the generally accepted 1% but within the usually considered ratio 1:7 of diagnosed:undiagnosed cases. Differences among sectors should be carefully analysed. Lacking its own ICPC code, diagnosis of CD in Primary Care Services is not included in a single category, but it is distributed under several descriptors, which makes it difficult to offer any firm diagnosis for treatment and hinders research. Finally, the high prevalence of CD justifies its own ICPC code and the need to withdraw CD from the generic D99 code "Disease digestive system other".
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Affiliation(s)
- Ricardo Fueyo-Díaz
- Aragon Institute of Health Sciences IACS, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Rosa Magallón-Botaya
- Aragon Institute of Health Sciences IACS, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
- Institute of Health Research of Aragon (IIS), Zaragoza, Spain
| | - Barbara Masluk
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | | | - Angela Asensio-Martínez
- Aragon Institute of Health Sciences IACS, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Santiago Gascón-Santos
- Aragon Institute of Health Sciences IACS, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
| | - Bárbara Olivan-Blázquez
- Aragon Institute of Health Sciences IACS, Zaragoza, Spain
- Department of Psychology and Sociology, University of Zaragoza, Zaragoza, Spain
- Institute of Health Research of Aragon (IIS), Zaragoza, Spain
| | - Juan José Sebastián-Domingo
- Aragon Institute of Health Sciences IACS, Zaragoza, Spain
- Department of Medicine, Psychiatry and Dermatology, University of Zaragoza, Zaragoza, Spain
- Hospital Royo Villanova, Zaragoza, Spain
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16
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Greaves RF, Bernardini S, Ferrari M, Fortina P, Gouget B, Gruson D, Lang T, Loh TP, Morris HA, Park JY, Roessler M, Yin P, Kricka LJ. Key questions about the future of laboratory medicine in the next decade of the 21st century: A report from the IFCC-Emerging Technologies Division. Clin Chim Acta 2019; 495:570-589. [DOI: 10.1016/j.cca.2019.05.021] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 05/24/2019] [Indexed: 12/21/2022]
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17
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Buja A, Rivera M, Soattin M, Corti MC, Avossa F, Schievano E, Rigon S, Baldo V, Boccuzzo G, Damiani G, Ebell MH. Impactibility Model for Population Health Management in High-Cost Elderly Heart Failure Patients: A Capture Method Using the ACG System. Popul Health Manag 2019; 22:495-502. [PMID: 31013467 DOI: 10.1089/pop.2018.0190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The aim of the present study is to use the ACG (Adjusted Clinical Groups) System to create an impactibility model by identifying homogeneous clinical subgroups of patients with high risk of an adverse health outcome in a population of heart failure patients with complex health care needs (PCHCN). This method will allow policy makers to target and prioritize services for the highest risk PCHCN in the context of limited health care resources, by identifying relatively homogeneous groups of patients with similar comorbidities. Subjects classified in 2012 as PCHCN in a local health unit by the ACG System were linked with hospital discharge records in 2013. The authors applied the Apriori algorithm to identify the most common sets of the most predictive diseases for the following outcomes of interest: at least 1 admission and at least 1 preventable admission in the year. Predictive performance for the former outcome was compared between the impactability model with the available ACG's individual risk score. The Apriori algorithm also was applied to predict the latter outcome as an example of an event that a policy maker would be able to prevent. Evidence showed no statistically significant difference between the 2 methods. The present model also displayed evidence of good calibration. The Apriori algorithm was applied as an impactibility model, built based on the ACG System, that allowed the authors to obtain an "ACG-based group risk score" and use it to identify clinically homogeneous subgroups of PCHCN. This will help policy makers develop "tool kits" for homogeneous groups of patients that improve health outcomes.
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Affiliation(s)
- Alessandra Buja
- Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Michele Rivera
- Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Marta Soattin
- Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | | | | | | | | | - Vincenzo Baldo
- Department of Cardiologic, Vascular, Thoracic Sciences and Public Health, University of Padova, Padova, Italy
| | - Giovanna Boccuzzo
- Department of Statistical Sciences, University of Padova, Padova, Italy
| | - Gianfranco Damiani
- Fondazione Policlinico Agostino Gemelli IRCSS. Rome, Italy.,Università Cattolica del Sacro Cuore. Rome, Italy
| | - Mark H Ebell
- College of Public Health, University of Georgia, Athens, Georgia
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