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Duncan P, Scott LJ, Dawson S, Munas M, Pyne Y, Chaplin K, Gaunt D, Guenette L, Salisbury C. Further development and validation of the Multimorbidity Treatment Burden Questionnaire (MTBQ). BMJ Open 2024; 14:e080096. [PMID: 38604632 PMCID: PMC11015253 DOI: 10.1136/bmjopen-2023-080096] [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: 09/21/2023] [Accepted: 01/24/2024] [Indexed: 04/13/2024] Open
Abstract
OBJECTIVES To undertake further psychometric testing of the Multimorbidity Treatment Burden Questionnaire (MTBQ) and examine whether reversing the scale reduced floor effects. DESIGN Survey. SETTING UK primary care. PARTICIPANTS Adults (≥18 years) with three or more long-term conditions randomly selected from four general practices and invited by post. MEASURES Baseline survey: sociodemographics, MTBQ (original or version with scale reversed), Treatment Burden Questionnaire (TBQ), four questions (from QQ-10) on ease of completing the questionnaires. Follow-up survey (1-4 weeks after baseline): MTBQ, TBQ and QQ-10. Anonymous data collected from electronic GP records: consultations (preceding 12 months) and long-term conditions. The proportion of missing data and distribution of responses were examined for the original and reversed versions of the MTBQ and the TBQ. Intraclass correlation coefficient (ICC) and Spearman's rank correlation (Rs) assessed test-retest reliability and construct validity, respectively. Ease of completing the MTBQ and TBQ was compared. Interpretability was assessed by grouping global MTBQ scores into 0 and tertiles (>0). RESULTS 244 adults completed the baseline survey (consent rate 31%, mean age 70 years) and 225 completed the follow-up survey. Reversing the scale did not reduce floor effects or data skewness. The global MTBQ scores had good test-retest reliability (ICC for agreement at baseline and follow-up 0.765, 95% CI 0.702 to 0.816). Global MTBQ score was correlated with global TBQ score (Rs 0.77, p<0.001), weakly correlated with number of consultations (Rs 0.17, p=0.010), and number of different general practitioners consulted (Rs 0.23, p<0.001), but not correlated with number of long-term conditions (Rs -0.063, p=0.330). Most participants agreed that both the MTBQ and TBQ were easy to complete and included aspects they were concerned about. CONCLUSION This study demonstrates test-retest reliability and ease of completion of the MTBQ and builds on a previous study demonstrating good content validity, construct validity and internal consistency reliability of the questionnaire.
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Affiliation(s)
- Polly Duncan
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Lauren J Scott
- National Institute for Health Research Applied Research Collaboration West, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Muzrif Munas
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Yvette Pyne
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katherine Chaplin
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Daisy Gaunt
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Line Guenette
- Faculty of Pharmacy and CHU de Québec Research Center, Université Laval, Quebec city, Quebec, Canada
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
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Eton DT, Yost KJ, Ridgeway JL, Bucknell B, Wambua M, Erbs NC, Allen SV, Rogers EA, Anderson RT, Linzer M. Development and acceptability of PETS-Now, an electronic point-of-care tool to monitor treatment burden in patients with multiple chronic conditions: a multi-method study. BMC PRIMARY CARE 2024; 25:77. [PMID: 38429702 PMCID: PMC10908048 DOI: 10.1186/s12875-024-02316-5] [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: 05/23/2023] [Accepted: 02/20/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND The aim of this study was to develop a web-based tool for patients with multiple chronic conditions (MCC) to communicate concerns about treatment burden to their healthcare providers. METHODS Patients and providers from primary-care clinics participated. We conducted focus groups to identify content for a prototype clinical tool to screen for treatment burden by reviewing domains and items from a previously validated measure, the Patient Experience with Treatment and Self-management (PETS). Following review of the prototype, a quasi-experimental pilot study determined acceptability of using the tool in clinical practice. The study protocol was modified to accommodate limitations due to the Covid-19 pandemic. RESULTS Fifteen patients with MCC and 18 providers participated in focus groups to review existing PETS content. The pilot tool (named PETS-Now) consisted of eight domains (Living Healthy, Health Costs, Monitoring Health, Medicine, Personal Relationships, Getting Healthcare, Health Information, and Medical Equipment) with each domain represented by a checklist of potential concerns. Administrative burden was minimized by limiting patients to selection of one domain. To test acceptability, 17 primary-care providers first saw 92 patients under standard care (control) conditions followed by another 90 patients using the PETS-Now tool (intervention). Each treatment burden domain was selected at least once by patients in the intervention. No significant differences were observed in overall care quality between patients in the control and intervention conditions with mean care quality rated high in both groups (9.3 and 9.2, respectively, out of 10). There were no differences in provider impressions of patient encounters under the two conditions with providers reporting that patient concerns were addressed in 95% of the visits in both conditions. Most intervention group patients (94%) found that the PETS-Now was easy to use and helped focus the conversation with the provider on their biggest concern (98%). Most providers (81%) felt they had learned something new about the patient from the PETS-Now. CONCLUSION The PETS-Now holds promise for quickly screening and monitoring treatment burden in people with MCC and may provide information for care planning. While acceptable to patients and clinicians, integration of information into the electronic medical record should be prioritized.
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Affiliation(s)
- David T Eton
- Outcomes Research Branch, Healthcare Delivery Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 9169 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Kathleen J Yost
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jennifer L Ridgeway
- Division of Health Care Delivery Research, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Bayly Bucknell
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Mike Wambua
- Hennepin Healthcare Research Institute, Minneapolis, MN, USA
| | - Natalie C Erbs
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Summer V Allen
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth A Rogers
- Departments of Medicine and of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - Roger T Anderson
- Department of Public Health Sciences, University of Virginia, Charlottesville, VA, USA
| | - Mark Linzer
- Department of Medicine, Hennepin Healthcare and University of Minnesota, Minneapolis, MN, USA
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Dhafari TB, Pate A, Azadbakht N, Bailey R, Rafferty J, Jalali-Najafabadi F, Martin GP, Hassaine A, Akbari A, Lyons J, Watkins A, Lyons RA, Peek N. A scoping review finds a growing trend in studies validating multimorbidity patterns and identifies five broad types of validation methods. J Clin Epidemiol 2024; 165:111214. [PMID: 37952700 DOI: 10.1016/j.jclinepi.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 10/14/2023] [Accepted: 11/05/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVES Multimorbidity, the presence of two or more long-term conditions, is a growing public health concern. Many studies use analytical methods to discover multimorbidity patterns from data. We aimed to review approaches used in published literature to validate these patterns. STUDY DESIGN AND SETTING We systematically searched PubMed and Web of Science for studies published between July 2017 and July 2023 that used analytical methods to discover multimorbidity patterns. RESULTS Out of 31,617 studies returned by the searches, 172 were included. Of these, 111 studies (64%) conducted validation, the number of studies with validation increased from 53.13% (17 out of 32 studies) to 71.25% (57 out of 80 studies) in 2017-2019 to 2022-2023, respectively. Five types of validation were identified: assessing the association of multimorbidity patterns with clinical outcomes (n = 79), stability across subsamples (n = 26), clinical plausibility (n = 22), stability across methods (n = 7) and exploring common determinants (n = 2). Some studies used multiple types of validation. CONCLUSION The number of studies conducting a validation of multimorbidity patterns is clearly increasing. The most popular validation approach is assessing the association of multimorbidity patterns with clinical outcomes. Methodological guidance on the validation of multimorbidity patterns is needed.
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Affiliation(s)
- Thamer Ba Dhafari
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, M13 9PL Manchester, UK
| | - Alexander Pate
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, M13 9PL Manchester, UK
| | - Narges Azadbakht
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, M13 9PL Manchester, UK
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Singleton Park, SA2 8PP Swansea, UK
| | - James Rafferty
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Singleton Park, SA2 8PP Swansea, UK
| | - Farideh Jalali-Najafabadi
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, M13 9PL Manchester, UK
| | - Glen P Martin
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, M13 9PL Manchester, UK
| | - Abdelaali Hassaine
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, M13 9PL Manchester, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Singleton Park, SA2 8PP Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Singleton Park, SA2 8PP Swansea, UK
| | - Alan Watkins
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Singleton Park, SA2 8PP Swansea, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Faculty of Medicine, Health & Life Science, Swansea University, Singleton Park, SA2 8PP Swansea, UK
| | - Niels Peek
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, The University of Manchester, M13 9PL Manchester, UK; NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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Yang C, Zhu S, Hui Z, Mo Y. Psychosocial factors associated with medication burden among community-dwelling older people with multimorbidity. BMC Geriatr 2023; 23:741. [PMID: 37964196 PMCID: PMC10648314 DOI: 10.1186/s12877-023-04444-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 10/30/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Older people with multimorbidity are often prescribed multiple medication treatments, leading to difficulties in self-managing their medications and negative experiences in medication use. The perceived burden arising from the process of undertaking medication self-management practices has been described as medication burden. Preliminary evidence has suggested that patients' demographic and clinical characteristics may impact their medication burden. Little is known regarding how psychosocial factors affect medication burden in older people with multimorbidity. The aim of this study was to identify psychosocial factors associated with medication burden among community-dwelling older people with multimorbidity. METHODS This is a secondary analysis of a cross-sectional study. A total of 254 older people with three or more chronic conditions were included in the analysis. Participants were assessed for demographics, medication burden, psychosocial variables (depression, medication-related knowledge, beliefs, social support, self-efficacy, and satisfaction), disease burden, and polypharmacy. Medication burden was measured using items from the Treatment Burden Questionnaire. Univariate and multivariate linear regression models explored factors associated with medication burden. RESULTS The mean age of participants was 70.90 years. Participants had an average of 4.40 chronic conditions, and over one-third had polypharmacy. Multivariate analysis showed that the participants' satisfaction with medication treatments (β = -0.32, p < 0.001), disease burden (β = 0.25, p = 0.009), medication self-efficacy (β = -0.21, p < 0.001), polypharmacy (β = 0.15, p = 0.016), and depression (β = 0.14, p = 0.016) were independently associated with medication burden. Other factors, including demographic characteristics, medication knowledge, medication beliefs, medication social support, and the number or specific types of chronic conditions, were not independently associated with medication burden. CONCLUSIONS Poor medication treatment satisfaction, great disease burden, low medication self-efficacy, polypharmacy, and depression may increase individuals' medication burden. Understanding psychosocial aspects associated with medication burden provides an important perspective for identifying older people who are overburdened by their medication treatments and offering individualised treatments to relieve their burden.
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Affiliation(s)
- Chen Yang
- School of Nursing, Sun Yat-sen University, Guangzhou, China.
| | - Song Zhu
- Department of Thoracic Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhaozhao Hui
- School of Public Health, Xi'an Jiaotong University Health Science Centre, Xi'an, China
- Shaanxi Health Culture Research Center, Xianyang, China
| | - Yihan Mo
- Cicely Saunders Institute of Palliative Care, Policy & Rehabilitation, King's College London, London, UK
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Rhudy LM, Hines EA, Farr EM, Esterov D, Chesak SS. Feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor and their family caregivers. NeuroRehabilitation 2023; 52:123-135. [PMID: 36617758 DOI: 10.3233/nre-220127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
BACKGROUND Practice guidelines and research results emphasize the need for dyadic interventions targeting psychosocial outcomes such as depression, anxiety, social function, physical function, and health-related quality of life. Resilience interventions have been proposed as one strategy to influence these outcomes. OBJECTIVE The objective of this observational pilot study was to determine the feasibility and acceptability of the Resilient Living program among persons with stroke or brain tumor (BT) admitted for comprehensive acute inpatient rehabilitation and/or their family caregivers. A secondary aim was to gather preliminary data to assess the effects of the program on quality of life, stress, anxiety, physical function, sleep disturbance, fatigue, resilience, dyadic coping, and caregiver role overload. METHODS The Resilient Living program is a psychosocial intervention with a focus on building resilience skills. Feasibility and acceptability outcomes were assessed at the end of the study. Quantitative outcome measures were collected at baseline, 12 weeks, and 6 months post the intervention. RESULTS Eight patients and eight caregivers completed the study. The intervention was feasible with this population. Participants found the intervention useful and appreciated the flexibility of an online program; however, finding time to engage in it was challenging. Recruitment of eligible patients with acquired brain disorders and their caregivers as a dyad was challenging. CONCLUSION The study confirms prior research suggesting that interventions targeting resilience are feasible, but larger studies with more rigorous methods are needed to appreciate the influence of resilience interventions in persons with brain disorders and their caregivers. Further research is needed to identify the characteristics of those most likely to benefit from resilience interventions and the optimal timing of such interventions.
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Affiliation(s)
- Lori M Rhudy
- Department of Graduate Nursing, Winona State University, Rochester, Minnesota, USA
| | - Emily A Hines
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Ellen M Farr
- Mayo Clinic School of Graduate Medical Education, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Dmitry Esterov
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota, USA
| | - Sherry S Chesak
- Department of Nursing, Division of Nursing Research, Mayo Clinic, Rochester, Minnesota, USA
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Change in treatment burden among people with multimorbidity: a follow-up survey. Br J Gen Pract 2022; 72:e816-e824. [PMID: 36302680 PMCID: PMC9466958 DOI: 10.3399/bjgp.2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 04/29/2022] [Indexed: 11/23/2022] Open
Abstract
Background Treatment burden is the effort required of patients to look after their health and the impact this has on their functioning and wellbeing. Little is known about change in treatment burden over time for people with multimorbidity. Aim To quantify change in treatment burden, determine factors associated with this change, and evaluate a revised single-item measure for high treatment burden in older adults with multimorbidity. Design and setting A 2.5-year follow-up of a cross-sectional postal survey via six general practices in Dorset, England. Method GP practices identified participants of the baseline survey. Data on treatment burden (measured using the Multimorbidity Treatment Burden Questionnaire; MTBQ), sociodemographics, clinical variables, health literacy, and financial resource were collected. Change in treatment burden was described, and associations assessed using regression models. Diagnostic test performance metrics evaluated the revised single-item measure relative to the MTBQ. Results In total, 300 participants were recruited (77.3% response rate). Overall, there was a mean increase of 2.6 (standard deviation 11.2) points in treatment burden global score. Ninety-eight (32.7%) and 53 (17.7%) participants experienced an increase and decrease, respectively, in treatment burden category. An increase in treatment burden was associated with having >5 long-term conditions (adjusted β 8.26, 95% confidence interval [CI] = 4.20 to 12.32) and living >10 minutes (versus ≤10 minutes) from the GP (adjusted β 3.88, 95% CI = 1.32 to 6.43), particularly for participants with limited health literacy (mean difference: adjusted β 9.59, 95% CI = 2.17 to 17.00). The single-item measure performed moderately (sensitivity 55.7%; specificity 92.4%. Conclusion Treatment burden changes over time. Improving access to primary care, particularly for those living further away from services, and enhancing health literacy may mitigate increases in burden.
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Owen N, Dew L, Logan S, Denegri S, Chappell LC. Research policy for people with multiple long-term conditions and their carers. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2022; 12:26335565221104407. [PMID: 35721799 PMCID: PMC9201348 DOI: 10.1177/26335565221104407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
People with multiple long-term conditions (MLTC) are a growing population, not only in
the United Kingdom but internationally. Health and care systems need to adapt to rise to
this challenge. Policymakers need to better understand how medical education and training,
and service configuration and delivery should change to meet the needs of people with MLTC
and their carers. A series of workshops with people with MLTC and carers across the
life-course identified areas of unmet need including the impact of stigma; poorly
coordinated care designed around single conditions; inadequate communication and
consultations that focus on clinical outcomes rather than patient-oriented goals and
imperfectly integrate mental and physical wellbeing. Research which embeds the patient
voice at its centre, from inception to implementation, can provide the evidence to drive
the change to patient-centred, coordinated care. This should not only improve the lives of
people living with MLTC and their carers but also create a health and care system which is
more effective and efficient. The challenge of MLTC needs to be bought to the fore and it
will require joint effort by policymakers, practitioners, systems leaders, educators, the
third sector and those living with MLTC to design a health and care system from the
perspective of patients and carers, and provide practitioners with the skills and tools
needed to provide the highest quality care.
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Affiliation(s)
- Natalie Owen
- Science, Research & Evidence Directorate, Department of Health and Social Care, London, UK
| | - Leanne Dew
- Science, Research & Evidence Directorate, Department of Health and Social Care, London, UK
| | - Stuart Logan
- NIHR PenARC, University of Exeter Medical School, Exeter, UK
| | | | - Lucy C Chappell
- Science, Research & Evidence Directorate, Department of Health and Social Care, London, UK
- School of Life Course Sciences, King’s College London, London, UK
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