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Chiu K, Sud A. Reframing conceptualizations of primary care involvement in opioid use disorder treatment. BMC PRIMARY CARE 2024; 25:356. [PMID: 39350088 PMCID: PMC11443781 DOI: 10.1186/s12875-024-02607-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: 03/14/2024] [Accepted: 09/23/2024] [Indexed: 10/04/2024]
Abstract
BACKGROUND Opioid-related harms and opioid use disorder (OUD) are health priorities requiring urgent policy responses. There have been many calls for improved OUD care in primary care, as well as increasing involvement of primary care providers in countries like Canada and Australia, which have been experiencing high rates of opioid-related harms. METHODS Using Starfield's 4Cs conceptualization of primary care functions, we examined how and why primary care systems may be suited towards, or pose challenges to providing OUD care, and identified health system opportunities to address these challenges. We conducted 14 semi-structured interviews with 16 key informants with experience in opioid use policy in Canada and Australia. RESULTS Primary care was identified to be an ideal setting for OUD care delivery due to its potential as the first point of contact in the health system; the opportunity to offer other health services to people with OUD; and the ability to coordinate care with other health providers (e.g. specialists, social workers) and thus also provide care continuity. However, challenges include a lack of resources and support for chronic disease management more broadly in primary care, and the prevailing model of OUD treatment, where addictions care is not seen as part of comprehensive primary care. Additionally, the highly regulated OUD policy landscape is also a barrier, manifesting as a 'regulatory cascade' in which restrictive oversight of OUD treatment passes from regulators to health providers to patients, normalizing the overly restrictive nature and inaccessibility of OUD care. CONCLUSIONS While primary care is an essential arena for providing OUD care, existing sociocultural, political, health professional, and health system factors have led to the current model of care that limits primary care involvement. Addressing this may involve structurally embedding OUD care into primary care and strengthening primary care in general.
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Affiliation(s)
- Kellia Chiu
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
- School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - Abhimanyu Sud
- Department of Family and Community Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Humber River Health, Toronto, ON, Canada
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Mills SJ, Halstead H, Howie J, Hutchins S, Forte L, Unsworth D, Walters T, Jelbart M, Dodd B, van den Berg M, Killington M. Team-based rehabilitation after mild traumatic brain injury - description of the clinical pathway. Brain Inj 2024; 38:807-817. [PMID: 38695320 DOI: 10.1080/02699052.2024.2347570] [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: 04/20/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Describe clinical practice, inter-disciplinary clinical pathway and core principles of care within a mild traumatic brain injury (mTBI) rehabilitation team. METHODS An observational study examined inter-disciplinary practice, nested within an observational trial investigating team-based mTBI rehabilitation. Data were collected to describe clinical service over 12 months. Activity data quantified clinical sessions per participant, mode of service delivery and content of sessions using custom-designed codes. The clinical team gathered narrative data to confirm the inter-disciplinary clinical pathway and individual discipline practice. RESULTS 168 participants entered the rehabilitation program during the 12 months. A single Allied Health Screening Assessment identified patient priorities. Occupational Therapy (OT) and Physiotherapy (PT) provided the majority of clinical sessions; the team also comprised Social Work, Rehabilitation Medicine, Speech Pathology and Clinical Psychology. Telehealth was the most common service delivery mode (54%). Median session numbers per participant ranged 1-4 for all disciplines; mean/maximum occasions of service were highest for PT (6.9/44) and OT (6.8/39). CONCLUSION A small proportion of participants received much higher number of sessions, consistent with intractable issues after mTBI. High attendance rates indicate the predominantly telehealth-delivered model was feasible. The clinical approach included early prioritizing of discipline input and follow-up after discharge.
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Affiliation(s)
- Simon J Mills
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Hannah Halstead
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Joanne Howie
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Selena Hutchins
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Leah Forte
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - David Unsworth
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Terri Walters
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Miranda Jelbart
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Beverley Dodd
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
| | - Maayken van den Berg
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Maggie Killington
- South Australian Brain Injury Rehabilitation Service, Repat Health Precinct, Adelaide, Australia
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Adelsjö I, Lehnbom EC, Hellström A, Nilsson L, Flink M, Ekstedt M. The impact of discharge letter content on unplanned hospital readmissions within 30 and 90 days in older adults with chronic illness - a mixed methods study. BMC Geriatr 2024; 24:591. [PMID: 38987669 PMCID: PMC11238400 DOI: 10.1186/s12877-024-05172-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2023] [Accepted: 06/24/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND Care transitions are high-risk processes, especially for people with complex or chronic illness. Discharge letters are an opportunity to provide written information to improve patients' self-management after discharge. The aim of this study is to determine the impact of discharge letter content on unplanned hospital readmissions and self-rated quality of care transitions among patients 60 years of age or older with chronic illness. METHODS The study had a convergent mixed methods design. Patients with chronic obstructive pulmonary disease or congestive heart failure were recruited from two hospitals in Region Stockholm if they were living at home and Swedish-speaking. Patients with dementia or cognitive impairment, or a "do not resuscitate" statement in their medical record were excluded. Discharge letters from 136 patients recruited to a randomised controlled trial were coded using an assessment matrix and deductive content analysis. The assessment matrix was based on a literature review performed to identify key elements in discharge letters that facilitate a safe care transition to home. The coded key elements were transformed into a quantitative variable of "SAFE-D score". Bivariate correlations between SAFE-D score and quality of care transition as well as unplanned readmissions within 30 and 90 days were calculated. Lastly, a multivariable Cox proportional hazards model was used to investigate associations between SAFE-D score and time to readmission. RESULTS All discharge letters contained at least five of eleven key elements. In less than two per cent of the discharge letters, all eleven key elements were present. Neither SAFE-D score, nor single key elements correlated with 30-day or 90-day readmission rate. SAFE-D score was not associated with time to readmission when adjusted for a range of patient characteristics and self-rated quality of care transitions. CONCLUSIONS While written summaries play a role, they may not be sufficient on their own to ensure safe care transitions and effective self-care management post-discharge. TRIAL REGISTRATION Clinical Trials. giv, NCT02823795, 01/09/2016.
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Affiliation(s)
- Igor Adelsjö
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 39182, Kalmar, Sweden.
| | - Elin C Lehnbom
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 39182, Kalmar, Sweden
- Department of Pharmacy, Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Amanda Hellström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 39182, Kalmar, Sweden
| | - Lina Nilsson
- Department of Medicine and Optometry, Faculty of Health and Life Sciences, eHealth Institute, Linnaeus University, Kalmar, Sweden
| | - Maria Flink
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Mirjam Ekstedt
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, 39182, Kalmar, Sweden
- Learning, Informatics, Management and Ethics (LIME), Karolinska Institutet, Stockholm, Sweden
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Clancy TL. Deconstructing nursing's paradoxical relationship with the concept of complexity. Nurs Philos 2024; 25:e12487. [PMID: 38952204 DOI: 10.1111/nup.12487] [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: 03/05/2024] [Revised: 05/09/2024] [Accepted: 06/18/2024] [Indexed: 07/03/2024]
Abstract
Although nursing seems to understand itself and its practice as complex, the literature is less clear about what this actually means. While complexity is discussed as an attribute of nursing, it is also suggested that complexity in nursing remains misunderstood and poorly articulated, is devalued, is not considered as a measure of health outcomes and remains invisible. Despite the overarching lack of a definition, some nurse scholars have conceptualized complexity as a complex intervention. For these authors, complexity becomes a complex intervention defined as that which is composed of component parts interacting in a variety of ways that influence the delivery of and outcomes of health-related interventions for populations. Conceptualizing complexity as a complex intervention forces nursing to embrace and adopt a received interpretation of complexity as expressed through complexity theory and complexity science. While complexity theory may afford us some tools for thinking about complexity, when we deconstruct nursing complexity to explicitly determinate and quantifiable tasks, this artificially narrowed orientation to complexity reveals an oversimplified explanation of the complexities associated with nursing and serves to blind us to its real qualities. Through a consideration of complexity from a Western philosophical tradition, I demonstrate that when nursing adopts the received interpretation of complexity as a complex intervention, this perspective on complexity contains nursing epistemologically and ontologically. I offer an extended conceptualization of complexity framed upon the consideration that nurses assume complexity and do not reduce it; that nurses have the capacity to not be paralysed by complexity and have developed logics to mobilize it in productive ways. Mobilizing complexity through navigating paradox and contradiction shapes an orientation to complexity that embraces an extended epistemology. This extended epistemology is characterized by a 'yes/and' mindset that expresses the dynamic and generative relationship between forms of knowledge which reflects complexity that characterizes nursing.
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Kapustianyk G, Durbin A, Shukor A, Law S. Beyond Diagnosis and Comorbidities-A Scoping Review of the Best Tools to Measure Complexity for Populations with Mental Illness. Diagnostics (Basel) 2024; 14:1300. [PMID: 38928714 PMCID: PMC11203348 DOI: 10.3390/diagnostics14121300] [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: 04/03/2024] [Revised: 05/31/2024] [Accepted: 06/12/2024] [Indexed: 06/28/2024] Open
Abstract
Beyond the challenges of diagnosis, complexity measurement in clients with mental illness is an important but under-recognized area. Accurate and appropriate psychiatric diagnoses are essential, and further complexity measurements could contribute to improving patient understanding, referral, and service matching and coordination, outcome evaluation, and system-level care planning. Myriad conceptualizations, frameworks, and definitions of patient complexity exist, which are operationalized by a variety of complexity measuring tools. A limited number of these tools are developed for people with mental illness, and they differ in the extent to which they capture clinical, psychosocial, economic, and environmental domains. Guided by the PRISMA Extension for Scoping Reviews, this review evaluates the tools best suited for different mental health settings. The search found 5345 articles published until November 2023 and screened 14 qualified papers and corresponding tools. For each of these, detailed data on their use of psychiatric diagnostic categories, definition of complexity, primary aim and purpose, context of use and settings for their validation, best target populations, historical references, extent of biopsychosocial information inclusion, database and input technology required, and performance assessments were extracted, analyzed, and presented for comparisons. Two tools-the INTERMED, a clinician-scored and multiple healthcare data-sourced tool, and the VCAT, a computer-based instrument that utilizes healthcare databases to generate a comprehensive picture of complexity-are exemplary among the tools reviewed. Information on these limited but suitable tools related to their unique characteristics and utilities, and specialized recommendations for their use in mental health settings could contribute to improved patient care.
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Affiliation(s)
- Grace Kapustianyk
- St. Michael’s Hospital, 17th Floor, 30 Bond Street, Toronto, ON M5B 1W8, Canada
| | - Anna Durbin
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 209 Victoria Street, Toronto, ON M5B 1T8, Canada
| | - Ali Shukor
- Department of Public and Occupational Health, Amsterdam University Medical Center (UMC), Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands
| | - Samuel Law
- Department of Psychiatry, University of Toronto, St. Michael’s Hospital, 17th Floor, 30 Bond Street, Toronto, ON M5B 1W8, Canada
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Paul C, Schöttker B, Hartmann M, Friederich HC, Brenner H, Wild B. Gender-specific factors associated with case complexity in middle-aged and older adults-Evidence from a large population-based study. Int J Geriatr Psychiatry 2024; 39:e6113. [PMID: 38877644 DOI: 10.1002/gps.6113] [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: 12/05/2023] [Accepted: 05/29/2024] [Indexed: 06/16/2024]
Abstract
OBJECTIVES To investigate gender-specific factors associated with case complexity in a population-based sample of middle-aged and older adults using a holistic approach to complexity. METHODS Data were derived from the 8-year follow-up home visits of the ESTHER study-a German population-based study in middle-aged and older adults. Cross-sectional analyses were conducted for 2932 persons (aged 57-84). Complexity was assessed by the well-established INTERMED for the elderly interview, which uses a holistic approach to the definition of case complexity. The association between various bio-psycho-social variables and case complexity was analyzed using gender-specific logistic regression models, adjusted for sociodemographic factors (age, marital status, education). RESULTS Prevalence of complexity was 8.3% with significantly higher prevalence in female (10.6%) compared to male (5.8%) participants (p < 0.001). Variables associated with increased odds for complexity in both, women and men were: being divorced (odds ratio [OR] women: 1.86, 95% CI 1.05-3.30; OR men: 3.19, 1.25-8.12), higher total somatic morbidity (women: 1.08, 1.04-1.12; men: 1.06, 1.02-1.11), higher depression severity (women: 1.34, 1.28-1.40; men: 1.35, 1.27-1.44), and higher loneliness scores (women: 1.19, 1.05-1.36; men: 1.23, 1.03-1.47). Women (but not men) with obesity (Body mass index [BMI] ≥30) had higher odds (1.79, 1.11-2.89) for being complex compared to those with a BMI <25. High oxidative stress measured by derivatives of reactive oxygen metabolites in serum was associated with 2.02 (1.09-3.74) higher odds for complexity only in men. CONCLUSIONS This study provides epidemiological evidence on gender differences in prevalence and factors associated with case complexity in middle-aged and older adults. Moreover, this study adds to the holistic understanding of complexity by identifying novel variables linked to complexity among middle-aged and older individuals. These factors include loneliness for both genders, and high oxidative stress for men. These findings should be confirmed in future longitudinal studies.
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Affiliation(s)
- Cinara Paul
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Ben Schöttker
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
- DZPG German Centre for Mental Health-Partner Site Heidelberg/Mannheim/Ulm, Heidelberg, Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center, Heidelberg, Germany
- Network Aging Research, University of Heidelberg, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Medical University Hospital, Heidelberg, Germany
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Sehgal A, Henderson R, Murry A, Crowshoe LL, Barnabe C. Advancing health equity for Indigenous peoples in Canada: development of a patient complexity assessment framework. BMC PRIMARY CARE 2024; 25:144. [PMID: 38684966 PMCID: PMC11057171 DOI: 10.1186/s12875-024-02362-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 04/03/2024] [Indexed: 05/02/2024]
Abstract
BACKGROUND Indigenous patients often present with complex health needs in clinical settings due to factors rooted in a legacy of colonization. Healthcare systems and providers are not equipped to identify the underlying causes nor enact solutions for this complexity. This study aimed to develop an Indigenous-centered patient complexity assessment framework for urban Indigenous patients in Canada. METHODS A multi-phased approach was used which was initiated with a review of literature surrounding complexity, followed by interviews with Indigenous patients to embed their lived experiences of complexity, and concluded with a modified e-Delphi consensus building process with a panel of 14 healthcare experts within the field of Indigenous health to identify the domains and concepts contributing to health complexity for inclusion in an Indigenous-centered patient complexity assessment framework. This study details the final phase of the research. RESULTS A total of 27 concepts spanning 9 domains, including those from biological, social, health literacy, psychological, functioning, healthcare access, adverse life experiences, resilience and culture, and healthcare violence domains were included in the final version of the Indigenous-centered patient complexity assessment framework. CONCLUSIONS The proposed framework outlines critical components that indicate the presence of health complexity among Indigenous patients. The framework serves as a source of reference for healthcare providers to inform their delivery of care with Indigenous patients. This framework will advance scholarship in patient complexity assessment tools through the addition of domains not commonly seen, as well as extending the application of these tools to potentially mitigate racism experienced by underserved populations such as Indigenous peoples.
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Affiliation(s)
- Anika Sehgal
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada.
| | - Rita Henderson
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Adam Murry
- Department of Psychology, University of Calgary, 2500 University Dr NW, Calgary, AB, T2N 1N4, Canada
| | - Lynden Lindsay Crowshoe
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, 3330 Hospital Dr NW, Calgary, AB, T2N 4N1, Canada
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Quek JS, Lee ES, Low LL, Wong SKW. How family physicians in Singapore recognise complexity during consultations: a qualitative study. BMC PRIMARY CARE 2024; 25:134. [PMID: 38664724 PMCID: PMC11044365 DOI: 10.1186/s12875-024-02368-7] [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: 06/29/2023] [Accepted: 04/08/2024] [Indexed: 04/28/2024]
Abstract
BACKGROUND The prevalence of persons with complex needs in Singapore is rising. Poor understanding of what constitutes complexity impedes the identification of care gaps and development of interventions to improve care for these individuals. We aim to identify the characteristics contributing to complexity in primary care, from the Family Physicians' (FP) perspectives. METHODS Focus group discussions (FGDs) were conducted from January to September 2021 with experienced FPs across 14 study sites, employing a qualitative descriptive approach based on a complexity framework. Data were coded independently and categorised using thematic analysis by two independent investigators. RESULTS Five FGDs were conducted with 18 FPs aged 32 to 57 years old working in different primary care settings, with a mean of 13.5 years of primary care experience. Participants emphasised the need for a unified definition of complexity. Complexity is characterised by the presence of issues spanning across two or more domains (medical, psychological, social or behavioural) that adversely impact medical care and outcomes. Persons with complex needs contrast with persons with medically difficult issues. Medical domain issues include the number of active medical problems, poor chronic disease control, treatment interactions, ill-defined symptoms, management of end-of-life conditions and functional impairment. Psychological domain issues include the presence of mental health conditions or cognitive impairment. Social domain issues include the lack of social support, competing social responsibilities and financial issues, while behavioural domain issues include a lack of trust in healthcare workers, fixed health beliefs and poor health literacy. CONCLUSION Recognising the medical, psychological, social and behavioural factors that contribute to complexity aids in discerning the diverse needs of individuals with complex needs. This underscores the need for additional support in these pertinent areas.
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Affiliation(s)
- Jing Sheng Quek
- National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, # 05-10, Singapore, 138543, Singapore.
| | - Eng Sing Lee
- National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, # 05-10, Singapore, 138543, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Headquarters & Clinical Sciences Building, 11 Mandalay Road, Level 18, Singapore, 308232, Singapore
| | - Lian Leng Low
- Department of Family Medicine and Continuing Care, Singapore General Hospital, Academia, 20 College Road, Singapore, 169856, Singapore
- Outram Community Hospital, 10 Hospital Boulevard, Singapore, 168582, Singapore
| | - Sabrina Kay Wye Wong
- National Healthcare Group Polyclinics, 3 Fusionopolis Link, Nexus@one-north, South Tower, # 05-10, Singapore, 138543, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Headquarters & Clinical Sciences Building, 11 Mandalay Road, Level 18, Singapore, 308232, Singapore
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Romiti GF, Corica B, Mei DA, Bisson A, Boriani G, Olshansky B, Chao TF, Huisman MV, Proietti M, Lip GYH. Patterns of comorbidities in patients with atrial fibrillation and impact on management and long-term prognosis: an analysis from the Prospective Global GLORIA-AF Registry. BMC Med 2024; 22:151. [PMID: 38589864 PMCID: PMC11003021 DOI: 10.1186/s12916-024-03373-4] [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: 09/20/2023] [Accepted: 03/26/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Clinical complexity, as the interaction between ageing, frailty, multimorbidity and polypharmacy, is an increasing concern in patients with AF. There remains uncertainty regarding how combinations of comorbidities influence management and prognosis of patients with atrial fibrillation (AF). We aimed to identify phenotypes of AF patients according to comorbidities and to assess associations between comorbidity patterns, drug use and risk of major outcomes. METHODS From the prospective GLORIA-AF Registry, we performed a latent class analysis based on 18 diseases, encompassing cardiovascular, metabolic, respiratory and other conditions; we then analysed the association between phenotypes of patients and (i) treatments received and (ii) the risk of major outcomes. Primary outcome was the composite of all-cause death and major adverse cardiovascular events (MACE). Secondary exploratory outcomes were also analysed. RESULTS 32,560 AF patients (mean age 70.0 ± 10.5 years, 45.4% females) were included. We identified 6 phenotypes: (i) low complexity (39.2% of patients); (ii) cardiovascular (CV) risk factors (28.2%); (iii) atherosclerotic (10.2%); (iv) thromboembolic (8.1%); (v) cardiometabolic (7.6%) and (vi) high complexity (6.6%). Higher use of oral anticoagulants was found in more complex groups, with highest magnitude observed for the cardiometabolic and high complexity phenotypes (odds ratio and 95% confidence interval CI): 1.76 [1.49-2.09] and 1.57 [1.35-1.81], respectively); similar results were observed for beta-blockers and verapamil or diltiazem. We found higher risk of the primary outcome in all phenotypes, except the CV risk factor one, with highest risk observed for the cardiometabolic and high complexity groups (hazard ratio and 95%CI: 1.37 [1.13-1.67] and 1.47 [1.24-1.75], respectively). CONCLUSIONS Comorbidities influence management and long-term prognosis of patients with AF. Patients with complex phenotypes may require comprehensive and holistic approaches to improve their prognosis.
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Affiliation(s)
- Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Bernadette Corica
- Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
| | - Davide Antonio Mei
- Department of Translational and Precision Medicine, Sapienza - University of Rome, Rome, Italy
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Arnaud Bisson
- Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK
- Service de Cardiologie, Centre Hospitalier Régional Universitaire et Faculté de Médecine de Tours, Tours, France
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Brian Olshansky
- Division of Cardiology, Department of Medicine, University of Iowa, Iowa City, USA
| | - Tze-Fan Chao
- Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Menno V Huisman
- Department of Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Marco Proietti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy
- Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, William Henry Duncan Building, 6 West Derby Street, Liverpool, L7 8TX, UK.
- Danish Center for Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark.
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Rafael Henriques H, Correia A, Santos T, Faria J, Sousa D, Portela J, Teixeira J. Nursing interventions to promote dyspnea self-management of complex chronic patients: An integrated review. Int J Nurs Sci 2024; 11:241-257. [PMID: 38707687 PMCID: PMC11064592 DOI: 10.1016/j.ijnss.2024.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/01/2024] [Accepted: 03/06/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives Chronic dyspnea, a distressing symptom in patients with complex chronic conditions, is linked to higher risks of mortality. This study aimed to identify nursing interventions that could improve self-management for complex chronic patients, thereby enhancing control over chronic dyspnea. The findings intend to guide nursing care strategies that promote self-management among this population. Methods We searched the databases Medline, Scopus, Web of Science, CINAHL, Cochrane Database of Systematic Reviews (CDSR), and Joanna Briggs Institute (JBI) databases were searched in December 2023. We included adult patients with complex chronic conditions with chronic dyspnoea. The team screened articles collaboratively, using Rayyan software. A qualitative appraisal was performed according to JBI Critical Appraisal Checklist tools. The review protocol is registered under the number CRD42023456021. Results Our review included 18 studies that explored a variety of interventions for chronic dyspnea. We identified pharmacological interventions (such as oxygen therapy and inhalation treatments) and non-pharmacological approaches (including educational programs, breathing exercises, fluid intake management, body awareness techniques, peer support, emotional intelligence training, and the use of web applications). Those interventions empower patients, improve their ability to fulfill life roles, mitigate emotional distress, and improve overall quality of life. Nursing care can be crucial in enabling individuals to achieve independence and autonomy in self-care. Conclusions Promoting self-management for chronic dyspnea in complex chronic patients requires a holistic approach, encompassing multidisciplinary interventions, individualized self-care education, peer engagement, and technological support. Current research on self-management inadequately addresses interventions targeting patient behaviour change. It highlights the need to delve deeper into the self-management process. Further research is needed to expand the evidence base and refine these interventions.
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Affiliation(s)
- Helga Rafael Henriques
- Nursing School of Lisbon, Lisbon, Portugal
- CIDNUR – Nursing Research, Innovation and Development Centre of Lisbon, Lisbon, Portugal
| | - Andreia Correia
- Nursing School of Lisbon, Lisbon, Portugal
- Unidade de Hemodiálise de Torres Vedras – Nephrocare, Torres Vedras, Portugal
| | - Tatiana Santos
- Nursing School of Lisbon, Lisbon, Portugal
- Unidade de Cuidados Continuados na AMETIC, Torres Vedras, Portugal
| | - José Faria
- Nursing School of Lisbon, Lisbon, Portugal
- CIDNUR – Nursing Research, Innovation and Development Centre of Lisbon, Lisbon, Portugal
- Unidade Local de Saúde São José, Cardiology Department, Lisbon, Portugal
| | - Diana Sousa
- Nursing School of Lisbon, Lisbon, Portugal
- CIDNUR – Nursing Research, Innovation and Development Centre of Lisbon, Lisbon, Portugal
| | - Joana Portela
- Nursing School of Lisbon, Lisbon, Portugal
- CIDNUR – Nursing Research, Innovation and Development Centre of Lisbon, Lisbon, Portugal
- Unidade Local de Saúde da Arrábida, General Surgery Department, Setúbal, Portugal
| | - Joana Teixeira
- Nursing School of Lisbon, Lisbon, Portugal
- CIDNUR – Nursing Research, Innovation and Development Centre of Lisbon, Lisbon, Portugal
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11
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Bogner MS, Eschevins C, Faulks D. Identifying people requiring special care dentistry: A scoping review. SPECIAL CARE IN DENTISTRY 2024; 44:269-279. [PMID: 37254590 DOI: 10.1111/scd.12880] [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] [Revised: 05/11/2023] [Accepted: 05/12/2023] [Indexed: 06/01/2023]
Abstract
AIMS This scoping review aimed to document tools designed to identify persons requiring special care dentistry (SCD) and to provide a better understanding of the factors that justify adaptation in the provision of care. METHODS A scoping review methodology was applied. An electronic search was performed in April 2021 using Pubmed and Embase. Additional tools were sought using hand searches and informal professional networking. RESULTS Ten tools were identified that either predict the complexity of dental management or that retrospectively judge the complexity of care, of which two are as yet unpublished. Some had been developed for a specific population (e.g., patients with Alzheimer's disease, with learning disability, elderly persons) whilst others were applicable for any population (case mix tools). Factors considered included the patient's medical history, ability to cooperate, physical and cognitive autonomy, communication skills, anxiety, need for sedation, oral risk factors, ability to consent and the administrative burden for the dentist. CONCLUSION Identifying persons requiring SCD is possible by looking at various factors that influence the provision of dental care. There may be need for adaptation of tools to local circumstances and to the intended usage of the tool at a health services, systems or policy level.
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Affiliation(s)
- Marie-Sophie Bogner
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Caroline Eschevins
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, Clermont-Ferrand, France
| | - Denise Faulks
- Centre de Recherche en Odontologie Clinique (CROC), Université Clermont Auvergne, Clermont-Ferrand, France
- Service d'Odontologie, CHU Clermont-Ferrand, CHU Estaing, Clermont-Ferrand, France
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12
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Dhiman K, Hall M, Crump T, Hoens AM, Lacaille D, Rankin JA, Then KL, Hazlewood G, Barnabe C, Katz S, Sutherland J, Dempsey E, Barber CEH. Content validity testing of the INTERMED Self-Assessment in a sample of adults with rheumatoid arthritis and rheumatology healthcare providers. Health Expect 2024; 27:e13978. [PMID: 38366795 PMCID: PMC10873686 DOI: 10.1111/hex.13978] [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: 04/12/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Care complexity can occur when patients experience health challenges simultaneously with social barriers including food and/or housing insecurity, lack of transportation or other factors that impact care and patient outcomes. People with rheumatoid arthritis (RA) may experience care complexity due to the chronicity of their condition and other biopsychosocial factors. There are few standardised instruments that measure care complexity and none that measure care complexity specifically in people with RA. OBJECTIVES We assessed the content validity of the INTERMEDS Self-Assessment (IMSA) instrument that measures care complexity with a sample of adults with RA and rheumatology healthcare providers (HCPs). Cognitive debriefing interviews utilising a reparative framework were conducted. METHODS Patient participants were recruited through two existing studies where participants agreed to be contacted about future studies. Study information was also shared through email blasts, posters and brochures at rheumatology clinic sites and trusted arthritis websites. Various rheumatology HCPs were recruited through email blasts, and divisional emails and announcements. Interviews were conducted with nine patients living with RA and five rheumatology HCPs. RESULTS Three main reparative themes were identified: (1) Lack of item clarity and standardisation including problems with item phrasing, inconsistency of the items and/or answer sets and noninclusive language; (2) item barrelling, where items asked about more than one issue, but only allowed a single answer choice; and (3) timeframes presented in the item or answer choices were either too long or too short, and did not fit the lived experiences of patients. Items predicting future healthcare needs were difficult to answer due to the episodic and fluctuating nature of RA. CONCLUSIONS Despite international use of the IMSA to measure care complexity, patients with RA and rheumatology HCPs in our setting perceived that it did not have content validity for use in RA and that revision for use in this population under a reparative framework was unfeasible. Future instrument development requires an iterative cognitive debriefing and repair process with the population of interest in the early stages to ensure content validity and comprehension. PATIENT OR PUBLIC CONTRIBUTION Patient and public contributions included both patient partners on the study team and people with RA who participated in the study. Patient partners were involved in study design, analysis and interpretation of the findings and manuscript preparation. Data analysis was structured according to emergent themes of the data that were grounded in patient perspectives and experiences.
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Affiliation(s)
- Kiran Dhiman
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Marc Hall
- Faculty of NursingUniversity of CalgaryCalgaryAlbertaCanada
| | - Trafford Crump
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Surgery, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Alison M. Hoens
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- Department of Physical TherapyUniversity of British ColumbiaVancouverBritish ColumbiaCanada
- Arthritis Patient Advisory Board, Arthritis Research CanadaVancouverBritish ColumbiaCanada
| | - Diane Lacaille
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- Department of MedicineUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Karen L. Then
- Faculty of NursingUniversity of CalgaryCalgaryAlbertaCanada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- McCaig Institute for Bone and Joint HealthCalgaryAlbertaCanada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- McCaig Institute for Bone and Joint HealthCalgaryAlbertaCanada
| | - Steven Katz
- Department of MedicineUniversity of AlbertaEdmontonAlbertaCanada
| | - Jason Sutherland
- Centre for Health Services and Policy ResearchUniversity of British ColumbiaVancouverBritish ColumbiaCanada
| | - Erika Dempsey
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
| | - Claire E. H. Barber
- Department of Medicine, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Department of Community Health Sciences, Cumming School of MedicineUniversity of CalgaryCalgaryAlbertaCanada
- Arthritis Research CanadaVancouverBritish ColumbiaCanada
- McCaig Institute for Bone and Joint HealthCalgaryAlbertaCanada
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13
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Naik H, Murray TM, Khan M, Daly-Grafstein D, Liu G, Kassen BO, Onrot J, Sutherland JM, Staples JA. Population-Based Trends in Complexity of Hospital Inpatients. JAMA Intern Med 2024; 184:183-192. [PMID: 38190179 PMCID: PMC10775081 DOI: 10.1001/jamainternmed.2023.7410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/11/2023] [Indexed: 01/09/2024]
Abstract
Importance Clinical experience suggests that hospital inpatients have become more complex over time, but few studies have evaluated this impression. Objective To assess whether there has been an increase in measures of hospital inpatient complexity over a 15-year period. Design, Setting and Participants This cohort study used population-based administrative health data from nonelective hospitalizations from April 1, 2002, to January 31, 2017, to describe trends in the complexity of inpatients in British Columbia, Canada. Hospitalizations were included for individuals 18 years and older and for which the most responsible diagnosis did not correspond to pregnancy, childbirth, the puerperal period, or the perinatal period. Data analysis was performed from July to November 2023. Exposure The passage of time (15-year study interval). Main Outcomes and Measures Measures of complexity included patient characteristics at the time of admission (eg, advanced age, multimorbidity, polypharmacy, recent hospitalization), features of the index hospitalization (eg, admission via the emergency department, multiple acute medical problems, use of intensive care, prolonged length of stay, in-hospital adverse events, in-hospital death), and 30-day outcomes after hospital discharge (eg, unplanned readmission, all-cause mortality). Logistic regression was used to estimate the relative change in each measure of complexity over the entire 15-year study interval. Results The final study cohort included 3 367 463 nonelective acute care hospital admissions occurring among 1 272 444 unique individuals (median [IQR] age, 66 [48-79] years; 49.1% female and 50.8% male individuals). Relative to the beginning of the study interval, inpatients at the end of the study interval were more likely to have been admitted via the emergency department (odds ratio [OR], 2.74; 95% CI, 2.71-2.77), to have multimorbidity (OR, 1.50; 95% CI, 1.47-1.53) and polypharmacy (OR, 1.82; 95% CI, 1.78-1.85) at presentation, to receive treatment for 5 or more acute medical issues (OR, 2.06; 95% CI, 2.02-2.09), and to experience an in-hospital adverse event (OR, 1.20; 95% CI, 1.19-1.22). The likelihood of an intensive care unit stay and of in-hospital death declined over the study interval (OR, 0.96; 95% CI, 0.95-0.97, and OR, 0.81; 95% CI, 0.80-0.83, respectively), but the risks of unplanned readmission and death in the 30 days after discharge increased (OR, 1.14; 95% CI, 1.12-1.16, and OR, 1.28; 95% CI, 1.25-1.31, respectively). Conclusions and Relevance By most measures, hospital inpatients have become more complex over time. Health system planning should account for these trends.
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Affiliation(s)
- Hiten Naik
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Tyler M. Murray
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Mayesha Khan
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Daniel Daly-Grafstein
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Department of Statistics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Guiping Liu
- Center for Health Services and Policy Research (CHSPR), School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Barry O. Kassen
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jake Onrot
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jason M. Sutherland
- Center for Health Services and Policy Research (CHSPR), School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Advancing Health Outcomes, Vancouver, British Columbia, Canada
| | - John A. Staples
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
- Centre for Clinical Epidemiology & Evaluation (C2E2), Vancouver, British Columbia, Canada
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14
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Sehgal A, Scott S, Murry A, Henderson R, Barnabe C, Crowshoe LL. Critically examining health complexity experienced by urban Indigenous peoples in Canada by exploring the factors that allow health complexity to persist: a qualitative study of Indigenous patients in Calgary, Alberta. BMJ Open 2023; 13:e073184. [PMID: 37903604 PMCID: PMC10619072 DOI: 10.1136/bmjopen-2023-073184] [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: 03/01/2023] [Accepted: 10/05/2023] [Indexed: 11/01/2023] Open
Abstract
OBJECTIVES This study aims to identify and critically examine the components of health complexity, and explore the factors that allow it to exist, among urban Indigenous peoples in Canada. DESIGN Qualitative exploration with relational conversations. SETTING Calgary, Alberta, Canada. PARTICIPANTS A total of nine urban Indigenous patients were recruited from a multidisciplinary primary healthcare clinic that serves First Nations, Métis and Inuit peoples. Recruitment and data collection took place between September and November 2021. RESULTS Thematic analysis revealed three main themes, namely: sources of health complexity, psychological responses to adversity, and resilience, strengths, and protective factors. Key sources of health complexity arose from material resource disparities and adverse interpersonal interactions within the healthcare environment, which manifest into psychological distress while strengths and resilience emerged as protective factors. CONCLUSION The healthcare system remains inapt to address complexity among urban Indigenous peoples in Canada. Healthcare violence experienced by Indigenous peoples only further perpetuates health complexity. Future clinical tools to collect information about health complexity among urban Indigenous patients should include questions about the factors defined in this study.
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Affiliation(s)
- Anika Sehgal
- Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sara Scott
- Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Adam Murry
- Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Rita Henderson
- Family Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Medicine and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lynden Lindsay Crowshoe
- Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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15
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McCracken RK, Hedden L. What can publicly funded schools teach us about how to fix the family doctor shortage? Healthc Manage Forum 2023; 36:322-326. [PMID: 37335553 PMCID: PMC10447178 DOI: 10.1177/08404704231183175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023]
Abstract
Recent estimates suggest that up to 22% of Canadians over 18 do not have regular access to a family doctor or nurse practitioner. This lack of access is often characterized as a "family doctor shortage" and has been making headlines for decades. However, we have more family doctors than ever before, and in fact, the lack of primary care access is less about a shortage of physicians and more a need to develop a modern infrastructure and new way of funding and organizing care. Real change will require a paradigm shift from doctor- to clinic-organized care. The example of how schools are organized for public education may hold answers about how to make that paradigm shift and with investment in infrastructure see improvements in access to care across the country.
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Affiliation(s)
- Rita K. McCracken
- The University of British Columbia, Vancouver, British Columbia, Canada
| | - Lindsay Hedden
- Simon Fraser University, Burnaby, British Columbia, Canada
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16
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Viladot M, Gallardo-Martínez JL, Hernandez-Rodríguez F, Izcara-Cobo J, Majó-LLopart J, Peguera-Carré M, Russinyol-Fonte G, Saavedra-Cruz K, Barrera C, Chicote M, Barreto TD, Carrera G, Cimerman J, Font E, Grafia I, Llavata L, Marco-Hernandez J, Padrosa J, Pascual A, Quera D, Zamora-Martínez C, Bozzone AM, Font C, Tuca A. Validation Study of the PALCOM Scale of Complexity of Palliative Care Needs: A Cohort Study in Advanced Cancer Patients. Cancers (Basel) 2023; 15:4182. [PMID: 37627210 PMCID: PMC10453100 DOI: 10.3390/cancers15164182] [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: 07/13/2023] [Revised: 08/04/2023] [Accepted: 08/18/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND In a patient-centred model of care, referral to early palliative care (EPC) depends on both the prognosis and the complexity of care needs. The PALCOM scale is a 5-domain multidimensional assessment tool developed to identify the level of complexity of palliative care needs of cancer patients. The aim of this study was to validate the PALCOM scale. PATIENT AND METHODS We conducted a prospective cohort study of cancer patients to compare the PALCOM scale and expert empirical assessment (EA) of the complexity of palliative care needs. The EA had to categorise patients according to their complexity, considering that medium to high levels required priority attention from specialist EPC teams, while those with low levels could be managed by non-specialist teams. Systematically collected multidimensional variables were recorded in an electronic report form and stratified by level of complexity and rating system (PALCOM scale versus EA). The correlation rank (Kendall's tau test) and accuracy test (F1-score) between the two rating systems were analysed. ROC curve analysis was used to determine the predictive power of the PALCOM scale. RESULTS A total of 283 advanced cancer patients were included. There were no significant differences in the frequency of the levels of complexity between the EA and the PALCOM scale (low 22.3-23.7%; medium 57.2-59.0%; high 20.5-17.3%). The prevalence of high symptom burden, severe pain, functional impairment, socio-familial risk, existential/spiritual problems, 6-month mortality and in-hospital death was significantly higher (p < 0.001) at the high complexity levels in both scoring systems. Comparative analysis showed a high correlation rank and accuracy between the two scoring systems (Kendall's tau test 0.81, F1 score 0.84). The predictive ability of the PALCOM scale was confirmed by an area under the curve in the ROC analysis of 0.907 for high and 0.902 for low complexity. CONCLUSIONS In a patient-centred care model, the identification of complexity is a key point to appropriate referral and management of shared care with EPC teams. The PALCOM scale is a high precision tool for determining the level of complexity of palliative care needs.
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Affiliation(s)
- Margarita Viladot
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Jose-Luís Gallardo-Martínez
- Home Care Support Teams Program (PADES) Group Mutuam, 08025 Barcelona, Spain; (J.-L.G.-M.); (J.I.-C.); (M.P.-C.); (K.S.-C.)
| | | | - Jessica Izcara-Cobo
- Home Care Support Teams Program (PADES) Group Mutuam, 08025 Barcelona, Spain; (J.-L.G.-M.); (J.I.-C.); (M.P.-C.); (K.S.-C.)
| | | | - Marta Peguera-Carré
- Home Care Support Teams Program (PADES) Group Mutuam, 08025 Barcelona, Spain; (J.-L.G.-M.); (J.I.-C.); (M.P.-C.); (K.S.-C.)
| | - Giselle Russinyol-Fonte
- Mutuam Güell Social Health Care Hospital, 08024 Barcelona, Spain; (F.H.-R.); (G.R.-F.); (D.Q.)
| | - Katia Saavedra-Cruz
- Home Care Support Teams Program (PADES) Group Mutuam, 08025 Barcelona, Spain; (J.-L.G.-M.); (J.I.-C.); (M.P.-C.); (K.S.-C.)
| | - Carmen Barrera
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Manoli Chicote
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Tanny-Daniela Barreto
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Gemma Carrera
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Jackeline Cimerman
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Elena Font
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Ignacio Grafia
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Lucia Llavata
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Javier Marco-Hernandez
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Joan Padrosa
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Anais Pascual
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
| | - Dolors Quera
- Mutuam Güell Social Health Care Hospital, 08024 Barcelona, Spain; (F.H.-R.); (G.R.-F.); (D.Q.)
| | - Carles Zamora-Martínez
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | | | - Carme Font
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
| | - Albert Tuca
- Unit of Supportive and Palliative Care in Cancer, Medical Oncology Department, Hospital Clínic de Barcelona, University of Barcelona, 08036 Barcelona, Spain; (M.V.); (C.B.); (M.C.); (T.-D.B.); (G.C.); (J.C.); (E.F.); (I.G.); (L.L.); (J.M.-H.); (J.P.); (A.P.); (C.Z.-M.); (C.F.)
- Psychosocial Support Team, “La Caixa” Foundation (EAPS), Hospital Clínic de Barcelona, 08036 Barcelona, Spain
- Chair of Palliative Care, University of Barcelona, 08036 Barcelona, Spain
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17
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Mutai R, Sugiyama Y, Aoki T, Matsushima M. Key characteristics of patient complexity and patient complexity conceptual models/measurement tools: a scoping review protocol. BMJ Open 2023; 13:e063982. [PMID: 37164460 PMCID: PMC10173976 DOI: 10.1136/bmjopen-2022-063982] [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: 05/12/2023] Open
Abstract
INTRODUCTION The social determinants of health have been gaining recognition, confirming that multidimensional biopsychosocial assessment is essential to improving the health of individuals. This trend has led to the development of conceptual models and measurement tools assessing 'patient complexity', understood as a complex interplay of biopsychosocial factors, to improve the efficiency and effectiveness of care; however, the variety of meanings encompassed by the term has led to confusion in the interpretation of patient complexity such that there is no consensus regarding the definition or conceptualisation of patient complexity. The primary objective of this scoping review is to identify and map what is known about the key characteristics of patient complexity through multiple database searches. METHODS AND ANALYSIS This study will follow an established framework for conducting scoping reviews. The data will be extracted through searches of MEDLINE, Cumulative Index to Nursing and Allied Health Literature, Embase, PsycINFO, The Cochrane Library and Google Scholar. Included articles will have: investigated participants aged 19 years or older, with any health condition; described patient complexity, a model for patient complexity, or a measurement tool for patient complexity; and been published in English from 1 January 1970 to April 2022. Article selection and data extraction will be conducted independently by two reviewers and if necessary for consensus, a third reviewer. A descriptive summary will be prepared to explain how the results apply to the scoping review questions. The findings will be a detailed mapping of the health dimensions that emerge from the classification of the extracted data. Subsequently, a definition of patient complexity will be developed. ETHICS AND DISSEMINATION This review does not require ethical approval, as we will use publicly available data. The study findings will be disseminated through a relevant conference presentation and a peer-reviewed journal. This protocol is registered on the Open Science Framework (www.osf.io/hpa3c).
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Affiliation(s)
- Rieko Mutai
- Department of Adult Nursing, The Jikei University School of Nursing, Chofu, Tokyo, Japan
| | - Yoshifumi Sugiyama
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
- Division of Community Health and Primary Care, Center for Medical Education, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Takuya Aoki
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
| | - Masato Matsushima
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, Minato-ku, Tokyo, Japan
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18
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Proietti M, Romiti GF, Corica B, Mei DA, Bonini N, Vitolo M, Imberti JF, Boriani G, Lip GYH. Features of Clinical Complexity in European Patients with Atrial Fibrillation: A Report from a European Observational Prospective AF Registry. Curr Probl Cardiol 2023; 48:101752. [PMID: 37087078 DOI: 10.1016/j.cpcardiol.2023.101752] [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: 04/10/2023] [Accepted: 04/17/2023] [Indexed: 04/24/2023]
Abstract
There is increasing concern regarding impact of clinical complexity in patients with atrial fibrillation (AF). We explored the impact of different clinical complexity features in AF patients. We analyzed patients from a prospective, observational, multicentre Europe-wide AF registry. Features of clinical complexity among patients with CHA2DS2-VASc ≥2 were: i) history of bleeding; ii) frailty; iii) chronic kidney disease (CKD); iv) ≥2 features. A total of 10,169 patients were analysed. Of these, 141 (1.4%) had history of bleeding, 954 (9.4%) were frail, 1,767 (17.4%) had CKD and 1,253 (12.3%) had ≥2 features. All features of clinical complexity were less treated with OAC. History of bleeding (HR 1.94, 95% CI 1.32-2.85), frailty (HR 1.38, 95% CI 1.11-1.71), CKD (HR 1.50, 95% 1.28-1.75) and ≥2 features (HR 2.08, 95% CI 1.73-2.51) were associated with outcomes. Presence of features of clinical complexity is associated with lower use of OAC and higher risk of outcomes.
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Affiliation(s)
- Marco Proietti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Division of Subacute Care, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
| | - Giulio Francesco Romiti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Bernadette Corica
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Department of Translational and Precision Medicine, Sapienza - University of Rome, Italy
| | - Davide Antonio Mei
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Niccolò Bonini
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Marco Vitolo
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Jacopo Francesco Imberti
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy
| | - Giuseppe Boriani
- Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy
| | - Gregory Y H Lip
- Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; Danish Center for Clinical Health Services Research, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark..
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19
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Džakula A, Lončarek K, Vočanec D. Complex patients - an academism or reality? Croat Med J 2023; 64:61-63. [PMID: 36864820 PMCID: PMC10028566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023] Open
Affiliation(s)
| | | | - Dorja Vočanec
- Dorja Vočanec, Department of Social Medicine and Organization of Health Care, Andrija Štampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia,
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20
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Džakula A, Lončarek K, Vočanec D. Complex patients - an academism or reality? Croat Med J 2023. [PMID: 36864820 PMCID: PMC10028566 DOI: 10.3325/cmj.2023.64.61] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023] Open
Affiliation(s)
| | | | - Dorja Vočanec
- Dorja Vočanec, Department of Social Medicine and Organization of Health Care, Andrija Štampar School of Public Health, University of Zagreb School of Medicine, Zagreb, Croatia,
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21
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Geese F, Schmitt KU. Interprofessional Collaboration in Complex Patient Care Transition: A Qualitative Multi-Perspective Analysis. Healthcare (Basel) 2023; 11:359. [PMID: 36766934 PMCID: PMC9914692 DOI: 10.3390/healthcare11030359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/16/2023] [Accepted: 01/23/2023] [Indexed: 01/31/2023] Open
Abstract
Healthcare professionals often feel challenged by complex patients and the associated care needs during care transition. Interprofessional collaboration (IPC) is considered an effective approach in such situations. However, a fragmented healthcare system can limit IPC. This study explored experiences of Swiss healthcare professionals regarding complex patient care transition and the potential of IPC. Professionals from nursing, medicine, psychology, physiotherapy, dietetics and nutrition, social service, occupational therapy, and speech therapy were included. A qualitative between-method triangulation design was applied, with two focus group discussions and ten individual interviews. The combination of different data-collection methods allowed us to explore complex patient care transition and to systematically add perspectives of healthcare professionals from different care settings. Three main themes were identified: (1) Participants described their vision of an ideal complex patient care transition, i.e., the status they would like to see implemented; (2) participants reported challenges in complex patient care transition as experienced today; and (3) participants suggested ways to improve complex patient care transition by IPC. This study highlighted that healthcare professionals regarded IPC as an effective intervention to improve complex patient care transition. It emerged that sustainable implementation of IPC across care organizations is currently limited in Switzerland. In the absence of strong and direct promotion of IPC by the healthcare system, professionals in clinical practice can further promote IPC by finding hands-on solutions to overcome organizational boundaries.
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Affiliation(s)
| | - Kai-Uwe Schmitt
- Academic-Practice-Partnership, School of Health Professions, Bern University of Applied Sciences, 3008 Bern, Switzerland
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22
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Kaneko H, Hanamoto A, Yamamoto-Kataoka S, Kataoka Y, Aoki T, Shirai K, Iso H. Evaluation of Complexity Measurement Tools for Correlations with Health-Related Outcomes, Health Care Costs and Impacts on Healthcare Providers: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16113. [PMID: 36498188 PMCID: PMC9741446 DOI: 10.3390/ijerph192316113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 11/24/2022] [Accepted: 11/24/2022] [Indexed: 06/17/2023]
Abstract
Various tools to measure patient complexity have been developed. Primary care physicians often deal with patient complexity. However, their usefulness in primary care settings is unclear. This study explored complexity measurement tools in general adult and patient populations to investigate the correlations between patient complexity and outcomes, including health-related patient outcomes, healthcare costs, and impacts on healthcare providers. We used a five-stage scoping review framework, searching MEDLINE and CINAHL, including reference lists of identified studies. A total of 21 patient complexity management tools were found. Twenty-five studies examined the correlation between patient complexity and health-related patient outcomes, two examined healthcare costs, and one assessed impacts on healthcare providers. No studies have considered sharing information or action plans with multidisciplinary teams while measuring outcomes for complex patients. Of the tools, eleven used face-to-face interviews, seven extracted data from medical records, and three used self-assessments. The evidence of correlations between patient complexity and outcomes was insufficient for clinical implementation. Self-assessment tools might be convenient for conducting further studies. A multidisciplinary approach is essential to develop effective intervention protocols. Further research is required to determine these correlations in primary care settings.
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Affiliation(s)
- Hiromitsu Kaneko
- Faculty of Medicine, Osaka University, Suita, Osaka 565-0871, Japan
| | | | - Sachiko Yamamoto-Kataoka
- Department of Health Informatics, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yuki Kataoka
- Department of Internal Medicine, Kyoto Min-Iren Asukai Hospital, Tanaka Asukai-cho 89, Kyoto 606-8226, Japan
- Scientific Research Works Peer Support Group (SRWS-PSG), Osaka 541-0043, Japan
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Shogoin Kawara-cho 54, Kyoto 606-8507, Japan
- Department of Healthcare Epidemiology, Kyoto University Graduate School of Medicine/School of Public Health, Yoshida Konoe-cho, Kyoto 606-8501, Japan
| | - Takuya Aoki
- Section of Clinical Epidemiology, Department of Community Medicine, Kyoto University Graduate School of Medicine, Shogoin Kawara-cho 54, Kyoto 606-8507, Japan
- Division of Clinical Epidemiology, Research Center for Medical Sciences, The Jikei University School of Medicine, 3-25-8 Nishishimbashi, Minato-ku, Tokyo 105-8461, Japan
| | - Kokoro Shirai
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
| | - Hiroyasu Iso
- Department of Social Medicine, Osaka University Graduate School of Medicine, Osaka 565-0871, Japan
- Institute for Global Health Policy Research, Bureau of International Health Cooperation, National Center for Global Health and Medicine, Tokyo 162-8655, Japan
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23
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García-Hernández M, González de León B, Barreto-Cruz S, Vázquez-Díaz JR. Multicomponent, high-intensity, and patient-centered care intervention for complex patients in transitional care: SPICA program. Front Med (Lausanne) 2022; 9:1033689. [PMID: 36507542 PMCID: PMC9729702 DOI: 10.3389/fmed.2022.1033689] [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: 08/31/2022] [Accepted: 11/01/2022] [Indexed: 11/25/2022] Open
Abstract
Multimorbidity is increasingly present in our environment. Besides, this is accompanied by a deterioration of social and environmental conditions and affects the self-care ability and access to health resources, worsening health outcomes and determining a greater complexity of care. Different multidisciplinary and multicomponent programs have been proposed for the care of complex patients around hospital discharge, and patient-centered coordination models may lead to better results than the traditional ones for this type of patient. However, programs with these characteristics have not been systematically implemented in our country, despite the positive results obtained. Hospital Universitario de Canarias cares for patients from the northern area of Tenerife and La Palma, Spain. In this hospital, a multicomponent and high-intensity care program is carried out by a multidisciplinary team (made up of family doctors and nurses together with social workers) with complex patients in the transition of care (SPICA program). The aim of this program is to guarantee social and family reintegration and improve the continuity of primary healthcare for discharged patients, following the patient-centered clinical method. Implementing multidisciplinary and high-intensity programs would improve clinical outcomes and would be cost-effective. This kind of program is directly related to the current clinical governance directions. In addition, as the SPICA program is integrated into a Family and Community Care Teaching Unit for the training of both specialist doctors and specialist nurses, it becomes a place where the specific methodology of those specialties can be carried out in transitional care. During these 22 years of implementation, its continuous quality management system has allowed it to generate an important learning curve and incorporate constant improvements in its work processes and procedures. Currently, research projects are planned to reevaluate the effectiveness of individualized care plans and the cost-effectiveness of the program.
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Affiliation(s)
- Miguel García-Hernández
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Beatriz González de León
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - Silvia Barreto-Cruz
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain
| | - José Ramón Vázquez-Díaz
- Unidad Docente de Atención Familiar y Comunitaria La Laguna-Tenerife Norte, Gerencia de Atención Primaria del Área de Salud de Tenerife, Santa Cruz de Tenerife, Spain,Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Tenerife, Spain,*Correspondence: José Ramón Vázquez-Díaz
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