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Naik AD, Shanahan ML, Dindo L, Mecca MC, Arney J, Amspoker AB, Wydermyer S, Banks J, Street RL, Kiefer L, Zenoni M, Rosen T, Gonzalez RD, Catic A, Fried TR. An innovative approach to aligning healthcare with what matters most to patients: A hybrid type 1 trial protocol of patient priorities care for older adults with multiple chronic conditions. Contemp Clin Trials 2024; 143:107613. [PMID: 38914308 DOI: 10.1016/j.cct.2024.107613] [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: 02/01/2024] [Revised: 06/17/2024] [Accepted: 06/21/2024] [Indexed: 06/26/2024]
Abstract
BACKGROUND Providing healthcare for older adults with multiple chronic conditions (MCC) is challenging. Polypharmacy and complex treatment plans can lead to high treatment burden and risk for adverse events. For clinicians, managing the complexities of patients with MCC leaves little room to identify what matters and align care options with patients' health priorities. New care approaches are needed to navigate these challenges. In this clinical trial, we evaluate implementation and effectiveness outcomes of an innovative, structured, patient-centered care approach (Patient Priorities Care; PPC) for reducing treatment burden and aligning health care decisions with the health priorities of older adults with MCC. METHODS This is a multisite, assessor-blind, two-arm, parallel hybrid type 1 randomized controlled trial. We are enrolling 396 older (65+) Veterans with MCC who receive primary care at the Veterans Affairs Medical Center. Veterans are randomly assigned to either PPC or usual care. In the PPC arm, Veterans have a brief telephone call with a study facilitator to identify their personal health priorities. Then, primary care providers use this information to align healthcare with Veteran priorities during their established clinic appointments. Data are collected at baseline and 4-month follow up to assess for changes in treatment burden and use of home and community services. Formative and summative evaluations are also collected to assess for implementation outcomes according to Proctor's implementation framework. CONCLUSIONS This work has the potential to significantly improve the standard of care by personalizing healthcare and helping patients achieve what is most important to them.
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Affiliation(s)
- Aanand D Naik
- Institute on Aging, University of Texas Health Science Center, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, United States of America.
| | - Mackenzie L Shanahan
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America
| | - Lilian Dindo
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Marcia C Mecca
- Center for Innovation for Pain Research, Informatics, Multi-morbidities, and Education, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Jennifer Arney
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Sociology, University of Houston-Clear Lake, Houston, TX, United States of America
| | - Amber B Amspoker
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Sheena Wydermyer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Jack Banks
- Institute on Aging, University of Texas Health Science Center, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, United States of America
| | - Richard L Street
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Communication and Journalism, Texas A&M University, College Station, TX, United States of America
| | - Lea Kiefer
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Maria Zenoni
- Center for Innovation for Pain Research, Informatics, Multi-morbidities, and Education, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
| | - Tracey Rosen
- Institute on Aging, University of Texas Health Science Center, Houston, TX, United States of America; Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America; Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center, Houston, TX, United States of America
| | - Raquel D Gonzalez
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Angela Catic
- Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, United States of America; Department of Medicine, Section of Health Services Research, Baylor College of Medicine, Houston, TX, United States of America
| | - Terri R Fried
- Center for Innovation for Pain Research, Informatics, Multi-morbidities, and Education, VA Connecticut Healthcare System, West Haven, CT, United States of America; Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
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Mustafa SS, Anagnostou A, Greenhawt M, Lieberman JA, Shaker M. Patient partnerships and minimally disruptive medicine. Ann Allergy Asthma Immunol 2024; 132:671-673. [PMID: 38190962 DOI: 10.1016/j.anai.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Revised: 01/02/2024] [Accepted: 01/03/2024] [Indexed: 01/10/2024]
Affiliation(s)
- S Shahzad Mustafa
- Division of Allergy, Immunology, and Rheumatology, Department of Medicine, Rochester Regional Health, Rochester, New York; Division of Allergy, Immunology, and Rheumatology, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York
| | - Aikaterini Anagnostou
- Division of Allergy and Immunology, Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Matthew Greenhawt
- Section of Allergy and Clinical Immunology, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, Colorado
| | - Jay A Lieberman
- Department of Pediatrics, The University of Tennessee Health Sciences Center, Memphis, Tennessee
| | - Marcus Shaker
- Departments of Medicine and Pediatrics, Geisel School of Medicine at Dartmouth, Hanover, New Hampshire; Section of Allergy and Immunology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
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Lim WC, Dhesi JK. It Is Time to Prioritize Treatment Burden If We Want to Deliver Truly Patient-Centered Perioperative Care. Anesth Analg 2024:00000539-990000000-00785. [PMID: 38451862 DOI: 10.1213/ane.0000000000006777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Wan Chin Lim
- From the Management and Innovation for Longevity in Elderly Surgical Patients (MILES), Department of Surgery, National University of Singapore
- Quality, Innovation & Improvement and Department of Surgery, Ng Teng Fong General Hospital & Jurong Community Hospital
| | - Jugdeep K Dhesi
- Perioperative Medicine for Older People Undergoing Surgery (POPS), Department of Ageing and Health, Guy's and St Thomas' National Health Service Foundation Trust, London, United Kingdom
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, United Kingdom
- Division of Surgery and Interventional Science, University College London, London, United Kingdom
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Tinetti ME, Hashmi A, Ng H, Doyle M, Goto T, Esterson J, Naik AD, Dindo L, Li F. Patient Priorities-Aligned Care for Older Adults With Multiple Conditions: A Nonrandomized Controlled Trial. JAMA Netw Open 2024; 7:e2352666. [PMID: 38261319 PMCID: PMC10807252 DOI: 10.1001/jamanetworkopen.2023.52666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/01/2023] [Indexed: 01/24/2024] Open
Abstract
Importance Older adults with multiple conditions receive health care that may be burdensome, of uncertain benefit, and not focused on what matters to them. Identifying and aligning care with patients' health priorities may improve outcomes. Objective To assess the association of receiving patient priorities care (PPC) vs usual care (UC) with relevant clinical outcomes. Design, Setting, and Participants In this nonrandomized controlled trial with propensity adjustment, enrollment occurred between August 21, 2020, and May 14, 2021, with follow-up continuing through February 26, 2022. Patients who were aged 65 years or older and with 3 or more chronic conditions were enrolled at 1 PPC and 1 UC site within the Cleveland Clinic primary care multisite practice. Data analysis was performed from March 2022 to August 2023. Intervention Health professionals at the PPC site guided patients through identification of values, health outcome goals, health care preferences, and top priority (ie, health problem they most wanted to focus on because it impeded their health outcome goal). Primary clinicians followed PPC decisional strategies (eg, use patients' health priorities as focus of communication and decision-making) to decide with patients what care to stop, start, or continue. Main Outcomes and Measures Main outcomes included perceived treatment burden, Patient-Reported Outcomes Measurement Information System (PROMIS) social roles and activities, CollaboRATE survey scores, the number of nonhealthy days (based on healthy days at home), and shared prescribing decision quality measures. Follow-up was at 9 months for patient-reported outcomes and 365 days for nonhealthy days. Results A total of 264 individuals participated, 129 in the PPC group (mean [SD] age, 75.3 [6.1] years; 66 women [48.9%]) and 135 in the UC group (mean [SD] age, 75.6 [6.5] years; 55 women [42.6%]). Characteristics between sites were balanced after propensity score weighting. At follow-up, there was no statistically significant difference in perceived treatment burden score between groups in multivariate models (difference, -5.2 points; 95% CI, -10.9 to -0.50 points; P = .07). PPC participants were almost 2.5 times more likely than UC participants to endorse shared prescribing decision-making (adjusted odds ratio, 2.40; 95% CI, 0.90 to 6.40; P = .07), and participants in the PPC group experienced 4.6 fewer nonhealthy days (95% CI, -12.9 to -3.6 days; P = .27) compared with the UC participants. These differences were not statistically significant. CollaboRATE and PROMIS Social Roles and Activities scores were similar in the 2 groups at follow-up. Conclusions and Relevance This nonrandomized trial of priorities-aligned care showed no benefit for social roles or CollaboRATE. While the findings for perceived treatment burden and shared prescribing decision-making were not statistically significant, point estimates for the findings suggested that PPC may hold promise for improving these outcomes. Randomized trials with larger samples are needed to determine the effectiveness of priorities-aligned care. Trial Registration ClinicalTrials.gov Identifier: NCT04510948.
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Affiliation(s)
- Mary E. Tinetti
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Ardeshir Hashmi
- Center for Geriatric Medicine, Cleveland Clinic, Cleveland, Ohio
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Henry Ng
- Department of Internal Medicine, Cleveland Clinic, Cleveland, Ohio
| | - Margaret Doyle
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Toyomi Goto
- Center for Value-Based Care Research, Cleveland Clinic, Cleveland, Ohio
| | - Jessica Esterson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Aanand D. Naik
- Institute on Aging, University of Texas Health Science Center, Houston
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas
| | - Lilian Dindo
- Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas
- Department of Medicine, Health Services Research, Baylor College of Medicine, Houston, Texas
| | - Fan Li
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut
- Center for Methods in Implementation and Prevention Science, Yale School of Public Health, New Haven, Connecticut
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Mroz EL, Hernandez-Bigos K, Esterson J, Kiwak E, Naik A, Tinetti ME. Acceptability and use of an online health priorities self-identification tool for older adults: A qualitative investigation. PEC INNOVATION 2023; 3:100242. [PMID: 38161685 PMCID: PMC10757242 DOI: 10.1016/j.pecinn.2023.100242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 10/11/2023] [Accepted: 12/02/2023] [Indexed: 01/03/2024]
Abstract
Objective To examine the use of a web-based, self-directed health priorities identification tool for older adults with multiple chronic conditions (MCCs). Methods We recruited a gender- and racially-diverse, highly educated sample of older adults with MCCs to engage with our My Health Priorities tool, then complete a semi-structured interview. Thematic analysis was used to examine interview transcripts. Results Twenty-one participants shared perspectives on the acceptability and use of the tool. Three themes (with eleven subthemes) were generated to describe: website user experience feedback, the content of the health priorities identification process, and the tool's capacity to empower communication and decision making. Conclusion Participants found this tool acceptable and easy to use, describing a variety of benefits of the priorities self-identification process and offered suggestions for refinement and broader implementation. Older adults with limited internet navigation abilities or misconceptions about the self-directed process may benefit from clinicians clarifying the purpose of the process or initiating priorities-aligned discussions. Innovation This novel tool can help older adults with MCCs define what matters most for their health and healthcare, informing a variety of health decisions. This tool may enable and motivate patients to lead health priorities decision-making discussions with clinicians and care partners.
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Affiliation(s)
- Emily L. Mroz
- Section of Geriatrics, Department of Internal Medicine Yale School of Medicine, New Haven, CT, USA
| | - Kizzy Hernandez-Bigos
- Section of Geriatrics, Department of Internal Medicine Yale School of Medicine, New Haven, CT, USA
| | - Jessica Esterson
- Section of Geriatrics, Department of Internal Medicine Yale School of Medicine, New Haven, CT, USA
| | - Eliza Kiwak
- Section of Geriatrics, Department of Internal Medicine Yale School of Medicine, New Haven, CT, USA
| | - Aanand Naik
- Institute on Aging, University of Texas Health Science Center, Houston, TX, USA
- Houston Center for Innovations in Quality, Effectiveness, and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
| | - Mary E. Tinetti
- Section of Geriatrics, Department of Internal Medicine Yale School of Medicine, New Haven, CT, USA
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA
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Friedmann Z, Kinkel HT, Kühner C, Zsolnai A, Mick I, Binder A. Supervised on-site dosing in injectable opioid agonist treatment-considering the patient perspective. Findings from a cross-sectional interview study in two German cities. Harm Reduct J 2023; 20:162. [PMID: 37915058 PMCID: PMC10619267 DOI: 10.1186/s12954-023-00896-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/24/2023] [Indexed: 11/03/2023] Open
Abstract
BACKGROUND Injectable opioid agonist treatment (iOAT) is an effective option to support people living with opioid use disorder (OUD) who have not sufficiently benefitted from oral OAT. However, iOAT has been criticised based on theoretical and practical grounds for its dosing policies: Current regulations demand supervised, on-site application and require patients to frequently visit their treatment facility. The current study aims to investigate how patients experience on-site application and derive strategies to enhance the acceptability and effectiveness of iOAT-delivery. METHODS This article is based on semi-structured interviews with 27 individuals currently or previously in iOAT in two German outpatient iOAT-clinics. We undertook an inductive qualitative content analysis, which included blinded, independent coding and the analysis of individual cases. RESULTS Comments regarding on-site application and daily visits to the clinic were grouped into positive and negative aspects, iOAT as the best alternative option, facilitators of daily visits, and suggestions for improvement. Positive aspects took the factors stability and social support in regard. Negative aspects ranged from general inconveniences to major impediments to individuals' daily lives and towards achieving psychosocial goals. Participants reported rigorous adherence to iOAT's treatment regime, often due to a perceived lack of alternative options. Meeting iOAT's demands was eased by the patients' coping-strategies and through facilitating measures implemented by iOAT-clinics. Despite acknowledgement of the potential detriments from easing regulations, take-home arrangements were frequently suggested by participants to improve iOAT. CONCLUSIONS Being required to attend the clinic for supervised iOAT-application is not experienced uniformly. While clinics can support their patients to cope with strict regulations, alternative approaches to iOAT-application should be considered to accommodate patients' individual needs. Examples from other treatment modalities (e.g., remote supervision and delivery services) might aid to reconcile individualisation while providing adequate safety measures and improve iOAT in the long term.
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Affiliation(s)
- Zoe Friedmann
- Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany.
| | - Hans-Tilmann Kinkel
- Praxiskombinat Neubau, Schwerpunktpraxis für Suchtmedizin (Outpatient Clinic for Addiction Medicine), Ruschestraße 103, 10365, Berlin, Germany
| | - Claudia Kühner
- Schwerpunktpraxis für Suchtmedizin Stuttgart (Outpatient Clinic for Addiction Medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Andreas Zsolnai
- Schwerpunktpraxis für Suchtmedizin Stuttgart (Outpatient Clinic for Addiction Medicine), Kriegsbergstraße 40, 70174, Stuttgart, Germany
| | - Inge Mick
- Department of Psychiatry and Psychotherapy, Charité Universitätsmedizin Berlin (Medical University Hospital Charité Berlin), Charitéplatz 1, 10117, Berlin, Germany
| | - Annette Binder
- Department of General Psychiatry and Psychotherapy, Addiction Medicine and Addiction Research Section, University Hospital Tuebingen, University of Tuebingen, Calwerstraße 14, 72076, Tuebingen, Germany
- DZPG (German Centre for Mental Health), Tuebingen, Germany
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Shattnawi KK, Al Ali N, Almanasreh AA, Al-Motlaq MA. Caregiver burden among parents of children with chronic diseases: A cross-sectional study. J Clin Nurs 2023; 32:6485-6493. [PMID: 36880224 DOI: 10.1111/jocn.16672] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 01/23/2023] [Accepted: 02/20/2023] [Indexed: 03/08/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to assess the perceived caregiver burden among parents of chronically ill children in Jordan. BACKGROUND Although there are few studies on the accurate prevalence of chronic diseases among Jordanian children, there are a few on the burden of caregiving, which is important because most children with chronic illness rely on their caregivers to perform their daily tasks. In Jordan, little is known about the caregiver burden associated with caring for children with chronic diseases. DESIGN A cross-sectional design was reported in line with the STROBE guidelines. METHODS The Katz Index of Independence was used to determine the children's level of dependence, and the Burden Scale for Family Caregivers was used to measure the caregivers' level of burden. RESULTS Nearly, 49.3% of caregivers had a very severe burden, 31.2% of children had a severe functional impairment, 19.6% had a moderate impairment, and 49.3% had full functionality. Based on their children's dependency, caregivers' subjective burden varied greatly (p < .001). Fully functional children had a far lower disease burden than severely and moderately disabled children (p < .001). The caregiver burden score differed significantly across chronic disease categories (p < .001). Unemployed caregivers had a far higher subjective burden than working caregivers (p = .009), and single (divorced/widowed) caregivers had higher burdens than married caregivers. CONCLUSIONS Various factors can increase caregiver burden. Therefore, healthcare providers must plan holistic and family-centred interventions to reduce the caregiving burden. RELEVANCE TO CLINICAL PRACTICE There is a need to establish support programs to help reduce the level of burden among caregivers of children with chronic diseases.
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Affiliation(s)
- Khulood Kayed Shattnawi
- Maternal & Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Nahla Al Ali
- Community and Mental Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Ala'a Aref Almanasreh
- Maternal & Child Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad A Al-Motlaq
- Department of Maternal Child and Family Health, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Pryce H, Smith SK, Burns-O'Connell G, Shaw R, Hussain S, Banks J, Hall A, Knibb R, Greenwood R, Straus J. Protocol for a qualitative study exploring the lived experience of hearing loss and patient reported experience in the UK: the HeLP study. BMJ Open 2023; 13:e069363. [PMID: 37286313 DOI: 10.1136/bmjopen-2022-069363] [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: 06/09/2023] Open
Abstract
INTRODUCTION Worldwide, hearing loss is a significant public health issue and one of the most common chronic health conditions experienced by older adults. Hearing loss is associated with communication difficulties, social withdrawal, isolation and lower quality of life. Although hearing aid technology has improved significantly, the workload of managing hearing aids has increased. The aim of this qualitative study is to develop a novel theory of people's lived experience of hearing loss across the lifespan. METHODS Eligible participants will be young people and adults aged 16 years and above who have a hearing loss and carers/family members of people with a hearing loss. This study will use individual, in-depth face-to-face or online interviews. With participants' permission, interviews will be audio-recorded and transcribed verbatim. A grounded theory approach to concurrent data gathering and analysis will develop grouped codes and categories and link these to provide a novel theory to describe the experience of hearing loss. ETHICS AND DISSEMINATION The study was approved by the West of Scotland Research Ethics Service (approval date: 6 May 2022 ref: 22/WS/0057) and the Health Research Authority and Health and Care Research Wales Approval (approval date: 14 June 2022; IRAS project ID: 308816). The research will inform the development of a Patient Reported Experience Measure to improve the information and support given to patients. Findings will be disseminated through peer-reviewed articles and at academic conferences, as well as to our patient and public involvement groups, healthcare professionals, audiology services and local commissioners.
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Affiliation(s)
- Helen Pryce
- Department of Audiology, Aston University College of Health and Life Sciences, Birmingham, UK
| | - Sian Karen Smith
- Department of Audiology, Aston University College of Health and Life Sciences, Birmingham, UK
| | | | - Rachel Shaw
- Aston University School of Psychology, Birmingham, UK
- Aston Institute of Health & Neurodevelopment, Aston University College of Health and Life Sciences, Birmingham, UK
| | - Saira Hussain
- Department of Audiology, Aston University College of Health and Life Sciences, Birmingham, UK
| | - Jonathan Banks
- University Hospitals Bristol and Weston NHS Foundation Trust, National Institute for Health Research, Applied Research Collaboration West, Bristol, UK
- Population Health Sciences, University of Bristol Medical School, Bristol, UK
| | - Amanda Hall
- Department of Audiology, Aston University College of Health and Life Sciences, Birmingham, UK
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | - Rebecca Knibb
- Aston University School of Psychology, Birmingham, UK
| | - Rosemary Greenwood
- Psychology Department, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Jean Straus
- Patient and Public Involvement Representative and Lead, HeLP study, London, UK
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Knoth RL, Gupta S, Perkowski K, Costantino H, Inyart B, Ashka L, Clapp K. Understanding the Association between Red Blood Cell Transfusion Utilization and Humanistic and Economic Burden in Patients with β-Thalassemia from the Patients' Perspective. J Clin Med 2023; 12:jcm12020414. [PMID: 36675342 PMCID: PMC9861260 DOI: 10.3390/jcm12020414] [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: 12/12/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
We assessed the humanistic and economic burden of chronic red blood cell (RBC) transfusions on patients with β-thalassemia. This cross-sectional, US-based study included adults (≥18 years) who self-reported a β-thalassemia physician diagnosis and had received ≥1 RBC transfusion in the past 6 months. The outcomes included the Functional Assessment of Cancer Therapy-Anemia (FACT-An), Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, and ad hoc questions about treatment experience, side effects, direct/indirect costs, and psychological burden. Overall, 100 patients completed the survey, of whom 70% experienced "moderate" to "extremely high" burden due to RBC transfusions, 81% reported iron overload, 42% reported compromised social lives. The mean FACT-An score was 132 (higher score indicates better outcomes; 0-188). Mean scores were 33/52 for fatigue and 20/28 for anemia symptoms in the previous 7 days. Health-related quality of life (HRQoL) temporarily improved after RBC transfusion, although patients continued to experience mild-to-severe depression and anxiety, substantial direct costs, compromised employment, and suboptimal quality of life. Over 6 months, patients dedicated a mean of 173 h to transfusion requirements and incurred out-of-pocket costs of USD 2239 for transfusions and USD 896 for additional care costs. These findings highlight the need for new treatment options to improve patient HRQoL and economic outcomes.
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Affiliation(s)
- Russell L Knoth
- Bristol Myers Squibb, 100 Nassau Park Blvd #300, Princeton, NJ 08540, USA
| | - Shaloo Gupta
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Kacper Perkowski
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Halley Costantino
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Brian Inyart
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Lauren Ashka
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
| | - Kelly Clapp
- Cerner Enviza, an Oracle Company, 51 Valley Stream Pkwy, Malvern, PA 19355, USA
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Lambdin-Pattavina C, Pyatak E. Occupational Therapy's Role in Chronic Conditions. Am J Occup Ther 2022; 76:24002. [PMID: 36706303 DOI: 10.5014/ajot.2022.76s3003] [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: 01/28/2023] Open
Abstract
It is the position of the American Occupational Therapy Association (AOTA) that occupational therapy practitioners are distinctly qualified to address the impact of chronic conditions on occupational performance and participation across the life span. The purpose of this position statement is twofold. First, it defines chronic conditions and describes the multiple factors associated with the development of one or more chronic conditions. Second, it provides an overview of how the field of occupational therapy has a distinct impact on improving the health and wellness of persons, groups, and populations with or at risk for chronic conditions through health promotion, disease prevention, and intervention.
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Time Spent Engaging in Health Care Among Patients With Left Ventricular Assist Devices. JACC. HEART FAILURE 2022; 10:321-332. [PMID: 35483794 PMCID: PMC9908068 DOI: 10.1016/j.jchf.2022.01.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 01/12/2022] [Accepted: 01/13/2022] [Indexed: 01/05/2023]
Abstract
OBJECTIVES This study aims to examine a novel patient-centered metric of time spent engaging in left ventricular assist device (LVAD)-related clinical care outside the home. BACKGROUND Although LVAD implantation can improve survival and functional capacity in patients with advanced heart failure, this may occur at the expense of significant time spent engaging in LVAD-related health care activities. METHODS The authors retrospectively assessed consecutive patients at a single center who received a continuous-flow LVAD between May 9, 2008, and December 31, 2019, and queried health care encounters after implantation, including all inpatient encounters and LVAD-related ambulatory encounters. Patient-level time metrics were determined, including the total number of days with any health care encounter, and the total estimated time spent receiving care. The primary outcome was the proportion (%) of days alive with an LVAD spent engaged in at least 1 health care encounter. The secondary outcome was the proportion (%) of total time alive with an LVAD spent receiving care. RESULTS Among 373 patients, the median number of days alive with LVAD was 390 (IQR: 158-840 days). Patients had a median number of 88 (IQR: 45-161) days with ≥1 health care encounter, accounting for 23.2% (IQR: 16.3%-32.4%) of their days alive with an LVAD. A median 6.0% (IQR: 2.1%-14.1%) and 15.0% (IQR: 10.7%-20.0%) of total days alive were spent in inpatient and ambulatory encounters, respectively. Patients spent a median of 592 (IQR: 197-1,257) hours receiving care, accounting for 5.6% (IQR: 2.2%-12.7%) of their total time alive with an LVAD. CONCLUSIONS LVAD patients spent more than 1 of every 5 days engaging in health care. Our findings may inform strategies to improve efficiency of postdischarge care delivery and expectations for post-treatment care.
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Thompson DM, Booth L, Moore D, Mathers J. Peer support for people with chronic conditions: a systematic review of reviews. BMC Health Serv Res 2022; 22:427. [PMID: 35361215 PMCID: PMC8973527 DOI: 10.1186/s12913-022-07816-7] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Accepted: 03/08/2022] [Indexed: 01/23/2023] Open
Abstract
Background People with chronic conditions experience functional impairment, lower quality of life, and greater economic hardship and poverty. Social isolation and loneliness are common for people with chronic conditions, with multiple co-occurring chronic conditions predicting an increased risk of loneliness. Peer support is a socially driven intervention involving people with lived experience of a condition helping others to manage the same condition, potentially offering a sense of connectedness and purpose, and experiential knowledge to manage disease. However, it is unclear what outcomes are important to patients across the spectrum of chronic conditions, what works and for whom. The aims of this review were to (1) collate peer support intervention components, (2) collate the outcome domains used to evaluate peer support, (3) synthesise evidence of effectiveness, and (4) identify the mechanisms of effect, for people with chronic conditions. Methods A systematic review of reviews was conducted. Reviews were included if they reported on formal peer support between adults or children with one or more chronic condition. Data were analysed using narrative synthesis. Results The search identified 6222 unique publications. Thirty-one publications were eligible for inclusion. Components of peer support were organised into nine categories: social support, psychological support, practical support, empowerment, condition monitoring and treatment adherence, informational support, behavioural change, encouragement and motivation, and physical training. Fifty-five outcome domains were identified. Quality of life, and self-efficacy were the most measured outcome domains identified. Most reviews reported positive but non-significant effects. Conclusions The effectiveness of peer support is unclear and there are inconsistencies in how peers are defined, a lack of clarity in research design and intervention reporting, and widely variable outcome measurement. This review presents a range of components of peer support interventions that may be of interest to clinicians developing new support programmes. However, it is unclear precisely what components to use and with whom. Therefore, implementation of support in different clinical settings may benefit from participatory action research so that services may reflect local need. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-07816-7.
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Affiliation(s)
- Dean M Thompson
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
| | | | - David Moore
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Jonathan Mathers
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
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Laryionava K, Schönstein A, Heußner P, Hiddemann W, Winkler EC, Wahl HW. Experience of Time and Subjective Age When Facing a Limited Lifetime: The Case of Older Adults with Advanced Cancer. J Aging Health 2021; 34:736-749. [PMID: 34967672 PMCID: PMC9446453 DOI: 10.1177/08982643211063162] [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] [Indexed: 11/25/2022]
Abstract
Objectives We addressed two questions: (1) Does advanced cancer in later life affect a person’s
awareness of time and their subjective age? (2) Are awareness of time and subjective age
associated with distress, perceived quality of life, and depression? Methods We assessed patients suffering terminal cancer (OAC, n = 91) and older
adults free of any life-threatening disease (OA, n = 89), all subjects
being aged 50 years or older. Results Older adults with advanced cancer perceived time more strongly as being a finite
resource and felt significantly older than OA controls. Feeling younger was meaningfully
related with better quality of life and less distress. In the OA group, feeling younger
was also associated to reduced depression. Perceiving time as a finite resource was
related to higher quality of life in the OA group. Discussion Major indicators of an older person’s awareness of time and subjective aging differ
between those being confronted with advanced cancer versus controls.
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Affiliation(s)
- Katsiaryna Laryionava
- 9144Heidelberg University Hospital, Heidelberg, Germany.,Martin Luther University Halle-Wittenberg (Saale), Germany
| | - Anton Schönstein
- Network Aging Research, 9144Heidelberg University, Heidelberg, Germany
| | - Pia Heußner
- Oncological Center Oberland, Hospital Garmisch-Partenkirchen, Germany
| | | | - Eva C Winkler
- 9144Heidelberg University Hospital, Heidelberg, Germany
| | - Hans-Werner Wahl
- Network Aging Research and Institute of Psychology, 9144Heidelberg University, Heidelberg, Germany
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Suskind AM, Vaittinen T, Gibson W, Hajebrahimi S, Ostaszkiewicz J, Davis N, Dickinson T, Spencer M, Wagg A. International Continence Society white paper on ethical considerations in older adults with urinary incontinence. Neurourol Urodyn 2021; 41:14-30. [PMID: 34558106 DOI: 10.1002/nau.24795] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 08/30/2021] [Indexed: 12/18/2022]
Abstract
Urinary incontinence is a common problem among older adults that is often complicated by many nuanced ethical considerations. Unfortunately, there is a lack of guidance for healthcare professionals on how to navigate such concerns. This International Continence Society white paper aims to provide healthcare professionals with an ethical framework to promote best care practices in the care of older adults with urinary incontinence.
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Affiliation(s)
- Anne M Suskind
- Department of Urology, University of California, San Francisco, California, USA
| | - Tiina Vaittinen
- Department of Social Sciences, Tampere University, Tampere, Finland
| | - William Gibson
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Sakineh Hajebrahimi
- Departments of Urology and Family Medicine, Research Center for Evidence-Based Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | | | - Nina Davis
- Department of Urology, University of Oregon Health Sciences, Portland, Oregon, USA
| | - Tamara Dickinson
- Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Martha Spencer
- Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Adrian Wagg
- Division of Geriatric Medicine, University of Alberta, Edmonton, Alberta, Canada
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Tinetti ME, Costello DM, Naik AD, Davenport C, Hernandez-Bigos K, Van Liew JR, Esterson J, Kiwak E, Dindo L. Outcome Goals and Health Care Preferences of Older Adults With Multiple Chronic Conditions. JAMA Netw Open 2021; 4:e211271. [PMID: 33760091 PMCID: PMC7991967 DOI: 10.1001/jamanetworkopen.2021.1271] [Citation(s) in RCA: 40] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
IMPORTANCE Older adults with multiple chronic conditions (MCCs) vary in their health outcome goals and the health care that they prefer to receive to achieve these goals. OBJECTIVE To describe the outcome goals and health care preferences of this population with MCCs. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study included participants in the Patient Priorities Care study who underwent health priorities identification from February 1, 2017, to August 31, 2018, in a primary care practice. Patients eligible to participate were 65 years or older, English speaking, and had at least 3 chronic conditions; in addition, they used at least 10 medications, saw at least 2 specialists, or had at least 2 emergency department visits or 1 hospitalization during the past year. Of 236 eligible patients, 163 (69%) agreed to participate in this study. Data were analyzed from August 1 to October 31, 2020. EXPOSURES Guided by facilitators, participants identified their core values, as many as 3 actionable and realistic outcome goals, health-related barriers to these goals, and as many as 3 helpful and 3 bothersome health care activities. MAIN OUTCOMES AND MEASURES Frequencies were ascertained for outcome goals and health care preferences. Preferences included health care activities (medications, health care visits, procedures, diagnostic tests, and self-management) reported as either helpful or bothersome. RESULTS Most of the 163 participants were White (158 [96.9%]) and women (109 [66.9%]), with a mean (SD) age of 77.6 (7.6) years. Of 459 goals, the most common encompassed meals and other activities with family and friends (111 [24.2%]), shopping (28 [6.1%]), and exercising (21 [4.6%]). Twenty individuals (12.3%) desired to live independently without specifying necessary activities. Of 312 barriers identified, the most common were pain (128 [41.0%]), fatigue (45 [14.4%]), unsteadiness (42 [13.5%]), and dyspnea (19 [6.1%]). Similar proportions of patients identified at least 1 medication that was helpful (130 [79.8%]) or bothersome (128 [78.5%]). Medications most commonly cited as helpful were pain medications, including nonopiods (36 of 55 users [65.5%]) and opioids (15 of 27 users [55.6%]); sleep medications (27 of 51 users [52.9%]); and respiratory inhalants (19 of 45 [42.2%]). Most often mentioned as bothersome were statins (25 of 97 users [25.8%]) and antidepressants (13 of 40 users [32.5%]). Thirty-two participants (19.6%) reported using too many medications. Health care visits were identified as helpful by 43 participants (26.4%); 15 (9.2%) reported too many visits. Procedures were named helpful by 38 participants (23.3%); 24 (14.7%) cited unwanted procedures. Among 48 participants with diabetes, monitoring of glucose levels was doable for 18 (37.5%) and too bothersome for 9 (18.8%). CONCLUSIONS AND RELEVANCE Participants identified realistic and actionable goals while varying in health care activities deemed helpful or bothersome. The goals and health care preferences of more diverse populations must be explored. Previous work suggests that clinicians can use this information in decision-making.
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Affiliation(s)
- Mary E. Tinetti
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Darcé M. Costello
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Aanand D. Naik
- Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Baylor College of Medicine, Houston, Texas
| | - Claire Davenport
- Brookdale Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York
| | | | - Julia R. Van Liew
- Department of Behavioral Medicine, Medical Humanities, and Bioethics, Des Moines University, Des Moines, Iowa
| | - Jessica Esterson
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Eliza Kiwak
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Lilian Dindo
- Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Baylor College of Medicine, Houston, Texas
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LaBond C, Banwell C, Pescud M, Doan T, Strazdins L. Blue collar timescapes: work, health, and pension eligibility age for mature age Australian bus drivers. CRITICAL PUBLIC HEALTH 2020. [DOI: 10.1080/09581596.2020.1846684] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christine LaBond
- National Centre for Epidemiology & Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Cathy Banwell
- National Centre for Epidemiology & Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Melanie Pescud
- National Centre for Epidemiology & Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Tinh Doan
- National Centre for Epidemiology & Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
| | - Lyndall Strazdins
- National Centre for Epidemiology & Population Health, Research School of Population Health, College of Health and Medicine, The Australian National University, Canberra, Australia
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Patient- and Caregiver-Reported Burden of Transfusion-Dependent β-Thalassemia Measured Using a Digital Application. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:197-208. [PMID: 33123986 PMCID: PMC7884594 DOI: 10.1007/s40271-020-00473-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Abstract
Background and Objective Transfusion-dependent β-thalassemia (TDT) is a rare genetic disease characterized by a deficiency of functional β-globin, ultimately leading to lifelong dependence on blood transfusions. There is little patient- and caregiver-reported data with which to understand the holistic and societal impact of TDT. The objective of this study was to evaluate the patient- and caregiver-reported disease-management, symptom, and quality-of-life burden of TDT. Methods We conducted a prospective, observational, real-world study of adults with TDT and caregivers of adolescents with TDT, in Italy, the UK, and the USA. Over 90 days, participants used a smartphone application to respond to surveys about their or their dependent’s TDT, including bespoke background and disease-management surveys, the Brief Fatigue Inventory (BFI), the Transfusion-dependent Quality of life questionnaire (TranQol), and the Brief Pain Inventory Short Form (BPI-SF). Results Eighty-five individuals participated. Mean BFI and TranQol scores on enrollment were 5.0 (0–10 scale; 10 = worst symptoms) and 51 (0–100 scale; 100 = best quality of life), respectively. Mean transfusion frequency was every 3.2 weeks. Mean time spent on TDT management was 592 min on transfusion days and 91 min on non-transfusion days (11 h per week). Mean BFI and BPI-SF “worst fatigue” and “worst pain” scores were higher in the 5 days pre-transfusion than in the 5 days post-transfusion (fatigue 5.05 vs 4.29; pain 4.33 vs 3.85; 0–10 scale; 10 = worst symptoms). Conclusions The patient- and caregiver-reported burden of TDT is high, influenced by disease-management time, fatigue, pain, and quality-of-life impairment. Electronic supplementary material The online version of this article (10.1007/s40271-020-00473-0) contains supplementary material, which is available to authorized users.
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Potpara TS, Mihajlovic M, Zec N, Marinkovic M, Kovacevic V, Simic J, Kocijancic A, Vajagic L, Jotic A, Mujovic N, Stankovic GR. Self-reported treatment burden in patients with atrial fibrillation: quantification, major determinants, and implications for integrated holistic management of the arrhythmia. Europace 2020; 22:1788-1797. [DOI: 10.1093/europace/euaa210] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/04/2020] [Indexed: 02/06/2023] Open
Abstract
Abstract
Aims
Treatment burden (TB) refers to self-perceived cumulative work patients do to manage their health. Using validated tools, TB has been documented in several chronic conditions, but not atrial fibrillation (AF). We measured TB and analysed its determinants and impact on quality of life (QoL) in an AF cohort.
Methods and results
A single-centre study prospectively included consecutive adult AF patients and non-AF controls managed from 1 April to 21 June 2019, who voluntarily and anonymously answered the TB questionnaire (TBQ) and 5-item EQ-5D QoL questionnaire; TB was calculated as a sum of TBQ points (maximum 170) and expressed as proportion of the maximum value. Of 514 participants, 331 (64.4%) had AF. The mean self-reported TB was 27.6% among AF patients and 24.3% among controls, P = 0.011. The mean TB was significantly higher in patients taking vitamin K antagonists (VKAs) vs. those taking non-VKA antagonist oral anticoagulants (NOAC; 29.5% vs. 24.7%, P = 0.006). The highest item-specific TB was reported for healthcare system organization-related items (e.g. visit appointment), diet, and physical activity modifications. On multivariable analyses, female sex, younger age, and permanent AF were associated with a higher TB, whereas NOACs and electrical AF cardioversion exhibited an inverse association; TB was an independent predictor of decreased QoL (all P < 0.05).
Conclusion
Our study provided clinically relevant insights into self-perceived TB among AF patients. Approximately one in four patients with AF have a high TB. Specific AF treatments and optimization of healthcare system-required patient activities may reduce the self-perceived TB in AF patients.
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Affiliation(s)
- Tatjana S Potpara
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Miroslav Mihajlovic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
| | - Nevena Zec
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
| | | | | | - Jelena Simic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
| | | | - Leona Vajagic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
| | - Aleksandra Jotic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
- Endocrinology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Nebojsa Mujovic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
| | - Goran R Stankovic
- School of Medicine, Belgrade University, Dr Subotica 8, 11 000 Belgrade, Serbia
- Cardiology Clinic, Clinical Centre of Serbia, Belgrade, Serbia
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Weir KR. Preferences around communication and decision‐making in deprescribing. JOURNAL OF PHARMACY PRACTICE AND RESEARCH 2020. [DOI: 10.1002/jppr.1675] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Kristie Rebecca Weir
- Faculty of Medicine and Health Sydney School of Public Health University of Sydney Sydney Australia
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20
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Tinetti ME, Naik AD, Dindo L, Costello DM, Esterson J, Geda M, Rosen J, Hernandez-Bigos K, Smith CD, Ouellet GM, Kang G, Lee Y, Blaum C. Association of Patient Priorities-Aligned Decision-Making With Patient Outcomes and Ambulatory Health Care Burden Among Older Adults With Multiple Chronic Conditions: A Nonrandomized Clinical Trial. JAMA Intern Med 2019; 179:1688-1697. [PMID: 31589281 PMCID: PMC6784811 DOI: 10.1001/jamainternmed.2019.4235] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Accepted: 08/03/2019] [Indexed: 01/14/2023]
Abstract
Importance Health care may be burdensome and of uncertain benefit for older adults with multiple chronic conditions (MCCs). Aligning health care with an individual's health priorities may improve outcomes and reduce burden. Objective To evaluate whether patient priorities care (PPC) is associated with a perception of more goal-directed and less burdensome care compared with usual care (UC). Design, Setting, and Participants Nonrandomized clinical trial with propensity adjustment conducted at 1 PPC and 1 UC site of a Connecticut multisite primary care practice that provides care to almost 15% of the state's residents. Participants included 163 adults aged 65 years or older who had 3 or more chronic conditions cared for by 10 primary care practitioners (PCPs) trained in PPC and 203 similar patients who received UC from 7 PCPs not trained in PPC. Participant enrollment occurred between February 1, 2017, and March 31, 2018; follow-up extended for up to 9 months (ended September 30, 2018). Interventions Patient priorities care, an approach to decision-making that includes patients' identifying their health priorities (ie, specific health outcome goals and health care preferences) and clinicians aligning their decision-making to achieve these health priorities. Main Outcomes and Measures Primary outcomes included change in patients' Older Patient Assessment of Chronic Illness Care (O-PACIC), CollaboRATE, and Treatment Burden Questionnaire (TBQ) scores; electronic health record documentation of decision-making based on patients' health priorities; medications and self-management tasks added or stopped; and diagnostic tests, referrals, and procedures ordered or avoided. Results Of the 366 patients, 235 (64.2%) were female and 350 (95.6%) were white. Compared with the UC group, the PPC group was older (mean [SD] age, 74.7 [6.6] vs 77.6 [7.6] years) and had lower physical and mental health scores. At follow-up, PPC participants reported a 5-point greater decrease in TBQ score than those who received UC (ß [SE], -5.0 [2.04]; P = .01) using a weighted regression model with inverse probability of PCP assignment weights; no differences were seen in O-PACIC or CollaboRATE scores. Health priorities-based decisions were mentioned in clinical visit notes for 108 of 163 (66.3%) PPC vs 0 of 203 (0%) UC participants. Compared with UC patients, PPC patients were more likely to have medications stopped (weighted comparison, 52.0% vs 33.8%; adjusted odds ratio [AOR], 2.05; 95% CI, 1.43-2.95) and less likely to have self-management tasks (57.5% vs 62.1%; AOR, 0.59; 95% CI, 0.41-0.84) and diagnostic tests (80.8% vs 86.4%; AOR, 0.22; 95% CI, 0.12-0.40) ordered. Conclusions and Relevance This study's findings suggest that patient priorities care may be associated with reduced treatment burden and unwanted health care. Care aligned with patients' priorities may be feasible and effective for older adults with MCCs. Trial Registration ClinicalTrials.gov identifier: NCT03600389.
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Affiliation(s)
- Mary E. Tinetti
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - Aanand D. Naik
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Medicine (Health Services Research and Geriatrics), Baylor College of Medicine, Houston, Texas
| | - Lilian Dindo
- Houston Center for Innovations in Quality, Effectiveness, and Safety (IQuESt), Michael E. DeBakey VA Medical Center, Houston, Texas
- Department of Medicine (Health Services Research and Geriatrics), Baylor College of Medicine, Houston, Texas
| | - Darce M. Costello
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jessica Esterson
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Mary Geda
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Jonathan Rosen
- Connecticut Center for Primary Care, Farmington, Connecticut
| | | | - Cynthia Daisy Smith
- American College of Physicians, Philadelphia, Pennsylvania
- Department of Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia
| | | | - Gina Kang
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yungah Lee
- Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Caroline Blaum
- Department of Medicine, New York University School of Medicine, New York
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Icks A, Haastert B, Arend W, Konein J, Thorand B, Holle R, Laxy M, Schunk M, Neumann A, Wasem J, Chernyak N. Time spent on self-management by people with diabetes: results from the population-based KORA survey in Germany. Diabet Med 2019; 36:970-981. [PMID: 30267540 DOI: 10.1111/dme.13832] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/26/2018] [Indexed: 11/26/2022]
Abstract
AIMS Time needed for health-related activities in people with diabetes is assumed to be substantial, yet available data are limited. Time spent on self-management and associated factors was analysed using cross-sectional data from people with diagnosed diabetes enrolled in a population-based study. METHODS Mean total time spent on self-management activities was estimated using a questionnaire for all participants with diagnosed diabetes in the KORA FF4 study (n = 227, 57% men, mean age 69.7, sd 9.9 years). Multiple two-part regression models were fitted to evaluate associated factors. Multiple imputation was performed to adjust for bias due to missing values. RESULTS Some 86% of participants reported spending time on self-management activities during the past week. Over the entire sample, a mean of 149 (sd 241) min/week were spent on self-management-activities. People with insulin or oral anti-hyperglycaemic drug treatment, better diabetes education, HbA1c 48 to < 58 mmol/mol (6.5% to < 7.5%) or lower quality of life, spent more time on self-management activities. For example, people without anti-hyperglycaemic medication invested 66 min/week in self-management, whereas those taking insulin and oral anti-hyperglycaemic drugs invested 269 min/week (adjusted ratio 4.34, 95% confidence interval 1.85-10.18). CONCLUSIONS Time spent on self-management activities by people with diabetes was substantial and varied with an individual's characteristics. Because of the small sample size and missing values, the results should be interpreted in an explorative manner. Nevertheless, time needed for self-management activities should be routinely considered because it may affect diabetes self-care and quality of life.
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Affiliation(s)
- A Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University
- Institute for Health Services Research and Health Economics, German Diabetes Center at Heinrich-Heine-University, Leibniz-Center for Diabetes Research, Düsseldorf
- German Center for Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - B Haastert
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University
- mediStatistica, Neuenrade, Germany
| | - W Arend
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University
| | - J Konein
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University
| | - B Thorand
- German Center for Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
- Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - R Holle
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - M Laxy
- German Center for Diabetes Research, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - M Schunk
- Institute of Health Economics and Health Care Management, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Neuherberg
| | - A Neumann
- Institute for Health Care Management and Research, Essen University of Duisburg-Essen, Essen
| | - J Wasem
- Institute for Health Care Management and Research, Essen University of Duisburg-Essen, Essen
| | - N Chernyak
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University
- Institute for Health Services Research and Health Economics, German Diabetes Center at Heinrich-Heine-University, Leibniz-Center for Diabetes Research, Düsseldorf
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22
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Portrait F, Hoozemans M, van den Berg B. The total value of time of children undergoing treatment: A contingent valuation from the perspective of parents in the orthopaedic department of a Dutch hospital. J Paediatr Child Health 2019; 55:539-547. [PMID: 30311326 PMCID: PMC7379632 DOI: 10.1111/jpc.14236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 07/10/2018] [Accepted: 08/28/2018] [Indexed: 11/27/2022]
Abstract
AIM Children spend substantial amounts of time receiving medical care (patients' time), and this patients' time plays an important role in parental choices for paediatric care. However, it is usually ignored in economic evaluations. This is a concern because economic evaluations are increasingly being used to inform child health policy decision-making. This study aims to quantify the time children spend receiving medical care and attach a monetary value to it for use in economic evaluations. It applied the parents' perspective. Consequently, the derived money values are the time values for both child and the accompanying parent. METHODS We used the contingent valuation methodology. We collected data on 83 children undergoing orthopaedic treatment in a Dutch hospital. Accompanying parents were asked to quantify and value the patients' time of their children. We separately explored travel, waiting and treatment time. We also checked whether the monetary valuation varied across parents' financial situation, children's health and level of pain. RESULTS Parents were willing to pay about €33 (confidence interval (CI) 21.2-48.1) for a 1-day reduction in treatment time; about €11.5 (CI 4.2-19.1) for an hour's reduction in waiting time; and about €4.5 (CI 1.5-7.4) for an hour's reduction in travel time. In addition, respondents with better financial conditions have, on average higher, willingness to pays. CONCLUSIONS To our knowledge, this is the first instance that patients' time of children has been monetarily valued. This methodology can be used to further develop economic evaluations of paediatric care and could be applied to larger samples with varying clinical conditions.
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Affiliation(s)
- France Portrait
- Department of Health SciencesVU University AmsterdamAmsterdamNetherlands
| | - Marco Hoozemans
- Department of Health SciencesVU University AmsterdamAmsterdamNetherlands,Coral ‐Center for Orthopaedic Research, Medical Centre AlkmaarAlkmaarNetherlands
| | - Bernard van den Berg
- Department of Economics, Macquarie University Centre for the Health Economy, Macquarie UniversitySydneyNew South WalesAustralia
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23
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Boyd C, Smith CD, Masoudi FA, Blaum CS, Dodson JA, Green AR, Kelley A, Matlock D, Ouellet J, Rich MW, Schoenborn NL, Tinetti ME. Decision Making for Older Adults With Multiple Chronic Conditions: Executive Summary for the American Geriatrics Society Guiding Principles on the Care of Older Adults With Multimorbidity. J Am Geriatr Soc 2019; 67:665-673. [DOI: 10.1111/jgs.15809] [Citation(s) in RCA: 112] [Impact Index Per Article: 22.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 01/16/2019] [Indexed: 01/21/2023]
Affiliation(s)
- Cynthia Boyd
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | | | - Frederick A. Masoudi
- Department of Medicine (Cardiology); University of Colorado Anschutz Medical Campus; Aurora Colorado
| | - Caroline S. Blaum
- Department of Medicine; New York University School of Medicine; New York New York
| | - John A. Dodson
- Department of Medicine; New York University School of Medicine; New York New York
| | - Ariel R. Green
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Amy Kelley
- Department of Geriatrics and Palliative Medicine; Icahn School of Medicine at Mount Sinai; New York New York
| | - Daniel Matlock
- Department of Medicine (General Internal Medicine); University of Colorado School of Medicine; Denver Colorado
| | - Jennifer Ouellet
- Department of Internal Medicine; Yale School of Medicine, Yale School of Public Health; New Haven Connecticut
| | - Michael W. Rich
- Department of Internal Medicine; Washington University School of Medicine; St Louis Missouri
| | - Nancy L. Schoenborn
- Department of Medicine; Johns Hopkins University School of Medicine; Baltimore Maryland
| | - Mary E. Tinetti
- Department of Internal Medicine; Yale School of Medicine, Yale School of Public Health; New Haven Connecticut
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24
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Tran VT, Mama Djima M, Messou E, Moisan J, Grégoire JP, Ekouevi DK. Avoidable workload of care for patients living with HIV infection in Abidjan, Côte d'Ivoire: A cross-sectional study. PLoS One 2018; 13:e0202911. [PMID: 30142165 PMCID: PMC6108500 DOI: 10.1371/journal.pone.0202911] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 08/10/2018] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE People living with HIV infection (PLWHIV) in Sub-Saharan Africa cope with an increasing workload of care (doctor visits, lab tests, medication management, refills, etc.) in a context of poor health service organization. We aimed to describe the workload of care for PLWHIV in Sub-Saharan Africa and assess to what extent simple adjustments in care organization could reduce this workload of care. METHODS Adult PLWHIV under antiretroviral treatment for at least 1 year were recruited in three centers (two public, one private) in Abidjan, Côte d'Ivoire. Using methods inspired from sociology, we precisely described all health-related activities (HRAs) performed by patients, in 1 month, in terms of time, money and opportunity costs. Then, we assessed the theoretical avoidable workload of care if patients' visits and tests had been grouped on the same days. RESULTS We enrolled 476 PLWHIV in the study. Patients devoted 6.7 hours (SD = 6.3), on average, in HRAs per month and spent 5% (SD = 11) of their monthly revenue, on average, on health activities. However, we found great inter-patient heterogeneity in the mixture of activities performed (managing medications; dietary recommendations; visits, tests, support groups; administrative tasks; etc.) and their time allocation, temporal dispersion and opportunity costs (personal, familial, social or professional costs). For 22% of patients, grouping activities on the same days could reduce both time and cost requirements by 20%. CONCLUSION PLWHIV in Côte d'Ivoire have a heavy workload of care. Grouping visits and tests on the same days may be a simple and feasible way to reduce patients' investment of time and money in their care.
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Affiliation(s)
- Viet-Thi Tran
- Programme PAC-CI, Abidjan, Côte d’Ivoire
- METHODS Team, Centre de recherche en Epidémiologie et Statistiques Sorbonne Paris Cité (CRESS, UMR1153), Paris, France
- * E-mail:
| | - Mariam Mama Djima
- Programme PAC-CI, Abidjan, Côte d’Ivoire
- Institut Pasteur, Abidjan, Côte d’Ivoire
- Faculty of Pharmacy of Laval University, Québec, Canada
| | | | | | | | - Didier K. Ekouevi
- Programme PAC-CI, Abidjan, Côte d’Ivoire
- Bordeaux Population Health (UMR1219), Bordeaux, France
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25
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Timonet-Andreu E, Canca-Sanchez JC, Sepulveda-Sanchez J, Ortiz-Tomé C, Rivas-Ruiz F, Toribio-Toribio JC, Mora-Banderas A, Morales-Asencio JM. Overestimation of hours dedicated to family caregiving of persons with heart failure. J Adv Nurs 2018; 74:2312-2321. [PMID: 29808478 DOI: 10.1111/jan.13727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 03/19/2018] [Indexed: 12/28/2022]
Abstract
AIMS The aim of this study is to profile the family caregivers of people living with heart failure, to determine the perceived and real time devoted to daily care and to identify the factors associated with caregivers' overestimation of time dedicated to care. BACKGROUND The time spent by family caregivers on daily care is related to overload, but there are differences between real and perceived time spent. The reason for this difference is unknown, as is its impact on the caregiver. DESIGN Multicentre, cross-sectional study. METHODS This study forms part of a longitudinal, multicentre, ambispective cohort investigation. The study population was composed of 478 patient-family caregiver dyads and the data were collected over 2 years from 2014 - 2016. RESULTS The mean time perceived to be spent on daily care was 8.79 hr versus a real value of 4.41 hr. These values were positively correlated. A significant correlation was also found between the overestimation of hours spent and the age of the caregiver, the duration of the caregiving relationship and the number of people providing support and with the patient's level of dependence and self-care. CONCLUSION The overestimation of time dedicated to care seems to be related to patients' and caregivers' characteristics, such as functional status, caregiver burden, age and cohabitation. These patterns should be considered by nurses when carrying out assessment and care planning with these patients and their caregivers.
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Affiliation(s)
| | - José Carlos Canca-Sanchez
- Nursing Unit, Costa del Sol Public Health Agency, Marbella, Spain.,School of Health Sciences, Universidad de Málaga, Málaga, Spain
| | | | - Celia Ortiz-Tomé
- Nursing Unit, Costa del Sol Public Health Agency, Marbella, Spain
| | | | | | | | - José Miguel Morales-Asencio
- Department of Nursing and Podiatry, Faculty of Health Sciences, University of Málaga, Málaga, Spain.,Research and Evidence-Based Practice, School of Health Sciences, Universidad de Málaga, Málaga, Spain
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26
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The Adaptation and Psychometric Properties of the Kid-KINDL R for Hospitalized Children in Chile. J Pediatr Nurs 2018; 41:e8-e15. [PMID: 29477451 DOI: 10.1016/j.pedn.2018.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 11/23/2022]
Abstract
PURPOSE The impact of hospitalization on a child's well-being leads one to consider the health-related quality of life (HRQoL) measure as a fundamental aspect of pediatric care. The aims of the study were to adapt the Spanish version of the Kid-KINDL® to hospitalized children in Chile, to obtain a reduced version of the instrument and to analyze the psychometric properties of the reduced version. DESIGN AND METHODS An expert committee and interviews were carried out for the cross-cultural adaptation process. An exploratory factor analysis was conducted to examine the validity of the construct and to select the items for the reduced version. Cronbach's alpha was used to estimate the internal consistency of the adapted version of the Kid-KINDL® and the reliability of each component. Convergent validity was based on correlations with a pain scale. RESULTS This adapted and shorter instrument, similar to the original version, comprises five components that include the principal dimensions of HRQoL. Evaluating the School dimension in hospitalized children was considered inappropriate in Chilean public hospitals. The study replicates the relationship found between a child with high pain and low reported HRQoL. CONCLUSIONS The hospitalization process impacted the children's perceptions of their HRQoL. The reduced version of the Kid-KINDL® was found to be a valid instrument for assessing children's HRQoL in hospital units. PRACTICE IMPLICATIONS Finding effective ways to measure HRQoL and ultimately mitigate barriers and foster resilience are important clinical and research priorities in the pursuit of HRQoL for hospitalized children and their families.
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27
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Schwartz CE, Zhang J, Michael W, Eton DT, Rapkin BD. Reserve-building activities attenuate treatment burden in chronic illness: The mediating role of appraisal and social support. Health Psychol Open 2018; 5:2055102918773440. [PMID: 29785278 PMCID: PMC5954584 DOI: 10.1177/2055102918773440] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
This study examines the importance of four psychosocial factors—personality,
cognitive appraisal of quality of life, social support, and current
reserve-building—in predicting treatment burden in chronically ill patients.
Chronically ill patients (n = 446) completed web-based
measures. Structural equation modeling was used to investigate psychosocial
factors predicting treatment burden. Reserve-building activities indirectly
reduced treatment burden by: (1) reducing health worries appraisals, (2)
reducing financial difficulties, (3) increasing calm and peaceful appraisals,
and (4) increasing perceived social support. These findings point to key
behaviors that chronically ill people can use to attenuate their treatment
burden.
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Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, Inc., USA.,Tufts University School of Medicine, USA
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28
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Turney K, Hardie JH. Health Limitations among Mothers and Fathers: Implications for Parenting. JOURNAL OF MARRIAGE AND THE FAMILY 2018; 80:219-238. [PMID: 38045484 PMCID: PMC10691852 DOI: 10.1111/jomf.12425] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 05/18/2017] [Indexed: 12/05/2023]
Abstract
Despite good reasons to expect that poor health could impede parenting, relatively little research considers this possibility. This study uses data from the Fragile Families and Child Well-being Study (N=3,376) and propensity score matching to examine the relationship between maternal and paternal health limitations-health conditions that limit the amount or type of work one can do-and mother- and father-reported parenting stress, cooperation in parenting, and engagement with children. First, we find that mothers' and fathers' health limitations are associated with greater parenting stress. Second, we find evidence of spillover associations; compared to their counterparts, parents with health limitations report that their child's other parent exhibit less cooperation. Third, we find that the associations between health and parenting are not moderated by parents' co-residential status. Taken together, these findings inform the stress process perspective and its implications for family life.
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Affiliation(s)
- Kristin Turney
- Department of Sociology, University of California-Irvine, 3151 Social Science Plaza, Irvine, CA 92697
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29
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Chernyak N, Jülich F, Kasperidus J, Stephan A, Begun A, Kaltheuner M, Icks A. Time cost of diabetes: Development of a questionnaire to assess time spent on diabetes self-care. J Diabetes Complications 2017; 31:260-266. [PMID: 27411888 DOI: 10.1016/j.jdiacomp.2016.06.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Revised: 06/15/2016] [Accepted: 06/16/2016] [Indexed: 11/18/2022]
Abstract
BACKGROUND Methods to measure patient time spent on health-related activities are currently not well elaborated or standardized. AIM The purpose of this study was to develop a recall questionnaire measuring patient time devoted to diabetes self-care and to examine its feasibility and validity under field conditions. METHODS The initial questionnaire was developed on the basis of instruments frequently used to assess self-care behavior in patients with diabetes, evaluated in two focus groups with patients with type 2 diabetes (N=15) and tested in a random sample of patients with type 2 diabetes (N=178). To assess the validity of the questionnaire, four hypotheses about expected differences in self-care time across various patient sub-groups were tested. RESULTS The final questionnaire includes thirteen items estimating time spent on regular diabetes-related activities undertaken in the previous seven days. 78% of respondents completed the questionnaire without item non-response or other evident problems. As hypothesized, respondents receiving insulin treatment, those with poor self-rated health and those with diabetes-related emotional distress (PAID-5 score ≥8) reported spending more time on diabetes self-care than the rest of the sample. Contrary to our assumption, no differences in time spent on diabetes self-care between employed and retired individuals were detected by the questionnaire. CONCLUSION The recall questionnaire measuring patient time devoted to a broad range of regular diabetes self-care activities was developed and its feasibility was proved under field conditions. Ideally, the questionnaire should be further validated within a variety of populations. Exploration of the convergent validity between the recall method and prospective diary may be also useful.
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Affiliation(s)
- Nadja Chernyak
- Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany.
| | - Fabian Jülich
- Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany.
| | - Julia Kasperidus
- Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany.
| | - Astrid Stephan
- Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany.
| | - Alexander Begun
- German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Duesseldorf, Germany.
| | | | - Andrea Icks
- Heinrich-Heine-University Düsseldorf, Faculty of Medicine, Institute of Health Services Research and Health Economics, Mooren Straße 5, 40225 Duesseldorf, Germany; German Diabetes Center at the Heinrich-Heine-University Duesseldorf, Institute of Biometrics and Epidemiology, Auf'm Hennekamp 65, 40225 Duesseldorf, Germany; German Center for Diabetes Research (DZD e.V.), Partner Düsseldorf, Düsseldorf, Germany.
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30
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Buck HG, Harkness K, Ali MU, Carroll SL, Kryworuchko J, McGillion M. The Caregiver Contribution to Heart Failure Self-Care (CACHS): Further Psychometric Testing of a Novel Instrument. Res Nurs Health 2016; 40:165-176. [DOI: 10.1002/nur.21775] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Harleah G. Buck
- Associate Professor; College of Nursing; University of South Florida; 12901 Bruce B. Downs Blvd. MDC22; Tampa FL 33612-4766
| | - Karen Harkness
- Assistant Clinical Professor; Faculty of Health Sciences; School of Nursing; McMaster University; Hamilton ON
- Nurse Clinician; Heart Function Clinic; Hamilton Health Sciences; Hamilton ON
| | - Muhammad Usman Ali
- Clinical Epidemiologist; Department of Clinical Epidemiology & Biostatistics; Faculty of Health Sciences; McMaster University; Hamilton ON
| | - Sandra L. Carroll
- Associate Professor; Faculty of Health Sciences; School of Nursing; McMaster University; Hamilton ON
- Associate Scientist; Population Health Research Institute; Hamilton ON
| | - Jennifer Kryworuchko
- Associate Professor; School of Nursing; And Centre for Health Services and Policy Research; University of British Columbia; Vancouver BC
- Research Scientist; British Columbia Centre for Palliative Care; Vancouver BC
| | - Michael McGillion
- Associate Professor; Faculty of Health Sciences; School of Nursing; McMaster University; Hamilton ON
- Heart and Stoke Foundation/Michael G. DeGroote; Endowed Chair of Cardiovascular Nursing; Associate Scientist; Population Health Research Institute; Hamilton ON
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31
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Barley E, Lawson V. Health psychology: supporting the self-management of long-term conditions. ACTA ACUST UNITED AC 2016; 25:1102-1107. [DOI: 10.12968/bjon.2016.25.20.1102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Elizabeth Barley
- Professor in Health and Wellbeing, College of Nursing, Midwifery and Healthcare, University of West London
| | - Victoria Lawson
- Principal Health Psychologist, Southwark Talking Therapies Service, London
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32
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Miller JE, Nugent CN, Russell LB. How Much Time Do Families Spend on the Health Care of Children with Diabetes? Diabetes Ther 2016; 7:497-509. [PMID: 27350546 PMCID: PMC5014787 DOI: 10.1007/s13300-016-0181-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2016] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Family time caring for children with diabetes is an overlooked component of the overall burden of the condition. We document and analyze risk factors for time family members spend providing health care at home and arranging/coordinating health care for children with diabetes. METHODS Data for 755 diabetic children and 16,161 non-diabetic children whose chronic conditions required only prescription (Rx) medication were from the 2009-2010 United States National Survey of Children with Special Health Care Needs (NS-CSHCN). We used generalized ordered logistic regressions to estimate adjusted odds ratios (AORs) of time burden by diabetes, insulin use, and stability of the child's health care needs, controlling for health and socioeconomic status. RESULTS Nearly one-quarter of diabetic children had family members who spent 11+ h/week providing health care at home, and 8% spent 11+ h/week arranging/coordinating care, compared with 3.3% and 1.9%, respectively, of non-diabetic Rx-only children. Time providing care at home for insulin-using children was concentrated in the higher time categories: AORs for insulin-using diabetic compared to non-diabetic Rx-only children were 4.4 for 1+ h/week compared with <1 h/week, 9.7 for 6+ vs. <6 h, and 12.4 for 11+ vs. <11 h (all P < 0.05); the pattern was less pronounced for non-insulin-using children. AORs for arranging/coordinating care did not vary by time contrast: AOR = 4.2 for insulin-using, 3.0 for non-insulin-using children. CONCLUSION Health care providers, school personnel, and policymakers need to work with family members to improve care coordination and identify other ways to reduce family time burdens caring for children with diabetes.
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Affiliation(s)
- Jane E Miller
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Bloustein School of Planning and Public Policy, Rutgers University, New Brunswick, NJ, USA
| | - Colleen N Nugent
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA.
| | - Louise B Russell
- Institute for Health, Health Care Policy, and Aging Research, Rutgers University, New Brunswick, NJ, USA
- Department of Economics, Rutgers University, New Brunswick, NJ, USA
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33
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Forbes H, Sutton M, Richardson G, Rogers A. The determinants of time spent on self-care. Chronic Illn 2016; 12:98-115. [PMID: 26661332 DOI: 10.1177/1742395315614380] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 08/27/2015] [Indexed: 11/16/2022]
Abstract
PURPOSE More input from the individual into the management of their health has the potential to reduce demand on the formal care system and improve health outcomes. A variety of interventions have been developed to encourage such 'self-care', particularly for populations with long-term conditions. However the equity consequences of such initiatives are relatively unknown as there is little evidence on the social and economic determinants of time spent on self-care. KEY METHODS We estimate the social and economic determinants of time spent on self-care. We also examine whether patients spend time on self-care because they are compensating for lack of access to formal health care. We undertook regression analyses of eight self-care and formal care measures from a dedicated survey of 300 patients with long-term conditions. MAIN RESULTS We found that higher income is associated with less time spent on self-care. Various measures of access to formal health care are found to not be associated with time spent on self-care. MAIN CONCLUSION People from a lower socioeconomic position spend more time managing their condition even when there is universal entitlement to health care.
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Affiliation(s)
- Hannah Forbes
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Matt Sutton
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | | | - Anne Rogers
- NIHR CLAHRC Wessex, Faculty of Health Sciences, University of Southampton, Southampton, UK
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Abstract
Multimorbidity is common among older adults with heart failure and creates diagnostic and management challenges. Diagnosis of heart failure may be difficult, as many conditions commonly found in older persons produce dyspnea, exercise intolerance, fatigue, and weakness; no singular pathognomonic finding or diagnostic test differentiates them from one another. Treatment may also be complicated, as multimorbidity creates high potential for drug-disease and drug-drug interactions in settings of polypharmacy. The authors suggest that management of multimorbid older persons with heart failure be patient, rather than disease-focused, to best meet patients' unique health goals and minimize risk from excessive or poorly-coordinated treatments.
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Brief encounters: what do primary care professionals contribute to peoples' self-care support network for long-term conditions? A mixed methods study. BMC FAMILY PRACTICE 2016; 17:21. [PMID: 26888411 PMCID: PMC4756522 DOI: 10.1186/s12875-016-0417-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Accepted: 02/04/2016] [Indexed: 11/10/2022]
Abstract
Background Primary care professionals are presumed to play a central role in delivering long-term condition management. However the value of their contribution relative to other sources of support in the life worlds of patients has been less acknowledged. Here we explore the value of primary care professionals in people’s personal communities of support for long-term condition management. Methods A mixed methods survey with nested qualitative study designed to identify relationships and social network member’s (SNM) contributions to the support work of managing a long-term condition conducted in 2010 in the North West of England. Through engagement with a concentric circles diagram three hundred participants identified 2544 network members who contributed to illness management. Results The results demonstrated how primary care professionals are involved relative to others in ongoing self-care management. Primary care professionals constituted 15.5 % of overall network members involved in chronic illness work. Their contribution was identified as being related to illness specific work providing less in terms of emotional work than close family members or pets and little to everyday work. The qualitative accounts suggested that primary care professionals are valued mainly for access to medication and nurses for informational and monitoring activities. Overall primary care is perceived as providing less input in terms of extended self-management support than the current literature on policy and practice suggests. Thus primary care professionals can be described as providing ‘minimally provided support’. This sense of a ‘minimally’ provided input reinforces limited expectations and value about what primary care professionals can provide in terms of support for long-term condition management. Conclusions Primary care was perceived as having an essential but limited role in making a contribution to support work for long-term conditions. This coalesces with evidence of a restricted capacity of primary care to take on the work load of self-management support work. There is a need to prioritise exploring the means by which extended self-care support could be enhanced out-with primary care. Central to this is building a system capable of engaging network capacity to mobilise resources for self-management support from open settings and the broader community. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0417-z) contains supplementary material, which is available to authorized users.
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36
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Dunlay SM, Chamberlain AM. Multimorbidity in Older Patients with Cardiovascular Disease. CURRENT CARDIOVASCULAR RISK REPORTS 2016; 10. [PMID: 27274775 DOI: 10.1007/s12170-016-0491-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Multimorbidity affects more than two thirds of older individuals and the vast majority of patients with chronic cardiovascular disease. Patients with multimorbidity have high resource utilization, poor mobility, and poor health status and are at an increased risk for death. The presence of multimorbidity imposes numerous management challenges in caring for patients with chronic cardiovascular disease. It complicates decision-making, promotes fragmented care, and imposes an immense burden on the patient and their social support system. Novel models of care, such as the cardiovascular patient-centered medical home, are needed to provide high-quality, efficient, effective care to this growing population.
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Affiliation(s)
- Shannon M Dunlay
- Division of Cardiovascular Diseases, Department of Medicine, 200 First Street SW, Rochester, MN 55905, USA; Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Alanna M Chamberlain
- Department of Health Sciences Research, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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Boehmer KR, Shippee ND, Beebe TJ, Montori VM. Pursuing minimally disruptive medicine: disruption from illness and health care-related demands is correlated with patient capacity. J Clin Epidemiol 2016; 74:227-36. [PMID: 26780257 DOI: 10.1016/j.jclinepi.2016.01.006] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Revised: 11/06/2015] [Accepted: 01/03/2016] [Indexed: 01/22/2023]
Abstract
BACKGROUND Chronic conditions burden patients with illness and treatments. We know little about the disruption of life by the work of dialysis in relation to the resources patients can mobilize, that is, their capacity, to deal with such demands. We sought to determine the disruption of life by dialysis and its relation to patient capacity to cope. METHODS We administered a survey to 137 patients on dialysis at an academic medical center. We captured disruption from illness and treatment, and physical, mental, personal, social, financial, and environmental aspects of patient capacity using validated scales. Covariates included number of prescriptions, hours spent on health care, existence of dependents, age, sex, and income level. RESULTS On average, patients reported levels of capacity and disruption comparable to published levels. In multivariate regression models, limited physical, financial, and mental capacity were significantly associated with greater disruption. Patients in the top quartile of disruption had lower-than-expected physical, financial, and mental capacity. CONCLUSIONS Our sample generally had capacity comparable to other populations and may be able to meet the demands imposed by treatment. Those with reduced physical, financial, and mental capacity reported higher disruption and represent a vulnerable group that may benefit from innovations in minimally disruptive medicine.
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Affiliation(s)
- Kasey R Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, USA.
| | - Nathan D Shippee
- Division of Health Policy and Management, School of Public Health, Mayo Mail Code 197, 420 Delaware St. S.E., Minneapolis, MN, USA
| | - Timothy J Beebe
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, USA; Department of Health Science Research, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
| | - Victor M Montori
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, 200 First Street SW, Rochester, MN, USA
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Abstract
PURPOSE This narrative review is concerned with the ways in which the relationships between time and chronic illnesses have been chartered in recent literature. It aims to identify types of time (referred to here as temporal structures) most commonly reported in chronic illness literature and to assess their bearing on people's lived experiences. METHODS Literature searches of three electronic databases (Google Scholar, MEDLINE, and PubMed) were carried out in November 2014 of articles published between 1970 and 2013 using the following search terms (and derivatives): chronic illness AND time AND (patient OR carer). The review followed four procedural steps: (a) comprehensive search, (b) temporal structure appraisal, (c) synthesis of findings, and (d) critical appraisal. RESULTS Forty studies met the inclusion criteria and were included for review. Four types of called temporal structures had a strong presence in the literature: calendar and clocked time, biographical time, past-present-future time, and inner time and rhythms. The first three temporal structures are largely understood socially, and the fourth is predominantly understood in and through the body. Several studies reported more than one temporal structure as informing people's chronic illness experiences. A wide array of chronic illnesses were represented in these studies. Few studies reported on the experiences of people with multi-morbid chronic illnesses. CONCLUSION Chronic illness induces new relationships to time. Drawing on Hyden (Sociol Health Illn 19(1):48-69, 1997), it is suggested that "narrative" storytelling--as a temporally informed analytic device---might prove effective for reconciling the tensions emergent from new and multiple relationships to time that chronic and multiple illnesses create. Opportunities exist for healthcare practitioners and health services to offer patients illness support that is cognisant of their relationships to time.
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Abstract
Effective management of chronic diseases involves sustained changes in health behavior, which often requires substantial effort and patient burden. As treatment burden is associated with reduced adherence across several chronic conditions, its assessment and treatment are important clinical priorities. The balance between patient demands and capacity (e.g., coping resources) may be indexed by patients' subjective experience of treatment fatigue. We present a modified workload-capacity model that incorporates evidence that treatment fatigue may 1) be caused by increased workload due to treatment burden (e.g., intensity, complications) and 2) undermine adherence. Emerging technology-based interventions may be well-suited to reduce treatment burden, prevent treatment fatigue, and increase treatment adherence.
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McQuoid J, Welsh J, Strazdins L, Griffin AL, Banwell C. Integrating paid work and chronic illness in daily life: A space-time approach to understanding the challenges. Health Place 2015; 34:83-91. [PMID: 25968586 DOI: 10.1016/j.healthplace.2015.04.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 04/09/2015] [Accepted: 04/09/2015] [Indexed: 10/23/2022]
Abstract
The upward trend of chronic illness in working age populations calls for better understanding of the difficulties chronically ill people face with workforce participation. Existing research focuses primarily on physical limitations and employer attitudes about chronic illness. Here we use a space-time approach to illuminate the importance of negotiating logistical challenges and embodied rhythms when balancing work and chronic illness. We draw from time geography and rhythmanalysis in analysing interviews from a qualitative case study of 26 individuals living with chronic kidney disease in Australia. Difficulties with paid work arise from: (1) competition for space-time resources by employers and health services; (2) arrhythmias between the body, work and health services; and (3) the absence of workplace rhythms on which to 'hook' health activities. Implications for workplaces and health services design are discussed.
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Affiliation(s)
- Julia McQuoid
- University of New South Wales Canberra, The Australian Defence Force Academy, PO Box 7916, Canberra BC, ACT 2610, Australia.
| | - Jennifer Welsh
- National Centre for Epidemiology & Population Health, Research School of Population Health, The Australian National University, Building 62, Cnr of Eggleston and Mills Roads, Canberra 0200, ACT, Australia.
| | - Lyndall Strazdins
- National Centre for Epidemiology & Population Health, Research School of Population Health, The Australian National University, Building 62, Cnr of Eggleston and Mills Roads, Canberra 0200, ACT, Australia.
| | - Amy L Griffin
- University of New South Wales Canberra, The Australian Defence Force Academy, PO Box 7916, Canberra BC, ACT 2610, Australia.
| | - Cathy Banwell
- National Centre for Epidemiology & Population Health, Research School of Population Health, The Australian National University, Building 62, Cnr of Eggleston and Mills Roads, Canberra 0200, ACT, Australia.
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Islam MM, McRae IS, Yen L, Jowsey T, Valderas JM. Time spent on health-related activities by senior Australians with chronic diseases: what is the role of multimorbidity and comorbidity? Aust N Z J Public Health 2015; 39:277-83. [PMID: 25903449 DOI: 10.1111/1753-6405.12355] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2014] [Revised: 10/01/2014] [Accepted: 11/01/2014] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To examine the effect of various morbidity clusters of chronic diseases on health-related time use and to explore factors associated with heavy time burden (more than 30 hours/month) of health-related activities. METHODS Using a national survey, data were collected from 2,540 senior Australians. Natural clusters were identified using cluster analysis and clinical clusters using clinical expert opinion. We undertook a set of linear regressions to model people's time use, and logistic regressions to model heavy time burden. RESULTS Time use increases with the number of chronic diseases. Six of the 12 diseases are significantly associated with higher time use, with the highest effect for diabetes followed by depression; 18% reported a heavy time burden, with diabetes again being the most significant disease. Clusters and dominant comorbid groupings do not contribute to predicting time use or time burden. CONCLUSIONS Total number of diseases and specific diseases are useful determinants of time use and heavy time burden. Dominant groupings and disease clusters do not predict time use. IMPLICATIONS In considering time demands on patients and the need for care co-ordination, care providers need to be aware of how many and what specific diseases the patient faces.
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Affiliation(s)
- M Mofizul Islam
- Australian Primary Health Care Research Institute, Australian National University, Australian Capital Territory
| | - Ian S McRae
- Australian Primary Health Care Research Institute, Australian National University, Australian Capital Territory
| | - Laurann Yen
- Australian Primary Health Care Research Institute, Australian National University, Australian Capital Territory
| | - Tanisha Jowsey
- Australian Primary Health Care Research Institute, Australian National University, Australian Capital Territory
| | - Jose M Valderas
- Health Services and Policy Research, University of Exeter Medical School, England, UK
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Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions. Healthcare (Basel) 2015; 3:50-63. [PMID: 27417747 PMCID: PMC4934523 DOI: 10.3390/healthcare3010050] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 01/21/2015] [Indexed: 01/21/2023] Open
Abstract
An increasing proportion of healthcare resources in the United States are directed toward an expanding group of complex and multimorbid patients. Federal stakeholders have called for new models of care to meet the needs of these patients. Minimally Disruptive Medicine (MDM) is a theory-based, patient-centered, and context-sensitive approach to care that focuses on achieving patient goals for life and health while imposing the smallest possible treatment burden on patients’ lives. The MDM Care Model is designed to be pragmatically comprehensive, meaning that it aims to address any and all factors that impact the implementation and effectiveness of care for patients with multiple chronic conditions. It comprises core activities that map to an underlying and testable theoretical framework. This encourages refinement and future study. Here, we present the conceptual rationale for and a practical approach to minimally disruptive care for patients with multiple chronic conditions. We introduce some of the specific tools and strategies that can be used to identify the right care for these patients and to put it into practice.
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How Do Working-Age People With Disabilities Spend Their Time? New Evidence From the American Time Use Survey. Demography 2014; 51:1977-98. [DOI: 10.1007/s13524-014-0336-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Abstract
We use the American Time Use Survey to examine the extent to which adults with disabilities—defined using both the new six-question sequence on disability and the traditional work-limitation question—spend more time on health-related activities and less time on other activities than those without disabilities. We find that men and women who both reported a work limitation and responded “yes” to any of the questions in the six-question disability sequence spend approximately 40 to 50 more minutes per week, respectively, on health-related activities. We also find that most working-age men and women who report a disability work fewer hours per day than men and women without disabilities. The largest difference is for men and women who report both types of disability; these individuals spend, on average, 5 fewer hours per day in paid work than men and women without disabilities. On average, most of the decrease in paid work time is offset by more time spent on leisure activities (defined as activities that provide direct utility, such as entertainment, social activities, attending recreational events, and general relaxation) and sleeping, which is likely due to these being default activities for individuals whose medical issues and environment constrain them from participating in other activities.
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MacGregor JCD, Wathen CN. 'My health is not a job': a qualitative exploration of personal health management and imperatives of the 'new public health'. BMC Public Health 2014; 14:726. [PMID: 25030501 PMCID: PMC4223367 DOI: 10.1186/1471-2458-14-726] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 07/01/2014] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND There is an increasing push in Western healthcare for people to 'manage' their health, a key aspect of what has been called the 'new public health'. It has been argued that this 'personal health management' - informal work done to monitor, inform, or influence one's health - may be a burden, with potential to contribute to poor health outcomes. However, there is little research actually examining perceptions of personal health management and the 'burden' of these activities, particularly for generally healthy individuals. METHODS We conducted exploratory qualitative interviews with 30 generally healthy men and women about their perceptions and experiences of personal health management. Questions focused on health behaviours (e.g., information seeking), as well as feelings about these behaviours and perceptions of the time dedicated to health. Audio-recorded interviews were transcribed and analyzed qualitatively using NVivo 10. Where appropriate, quantitative codes were applied and descriptive statistics are reported alongside qualitative findings. RESULTS Participants were generally satisfied with the amount of time spent on their health and few perceived personal health management as a burden. Many participants took issue with the concept of 'work' being associated with health and stressed the importance of taking personal responsibility for health. CONCLUSIONS Our findings suggest that generally healthy people have internalised the notion of the 'new public health' and accepted the imperative of personal health responsibility. On the one hand, this bodes well for healthy individuals; their positive attitude may lead to better health outcomes, and the manageable amount of time spent suggests personal health management is unlikely to cause negative health consequences associated with stress. On the other hand, our findings may indicate that other factors, such as social determinants of health, are ignored in health promotion efforts and that those who cannot manage their own health may fall further behind. Future research should continue to explore the time people spend 'working' for their health, and how they perceive and respond to 'new public health' imperatives.
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Affiliation(s)
- Jennifer C D MacGregor
- Faculty of Information & Media Studies, The University of Western Ontario, 1151 Richmond St,, North Campus Building, Room 240, London ON N6A 5B7, Canada.
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Tran VT, Harrington M, Montori VM, Barnes C, Wicks P, Ravaud P. Adaptation and validation of the Treatment Burden Questionnaire (TBQ) in English using an internet platform. BMC Med 2014; 12:109. [PMID: 24989988 PMCID: PMC4098922 DOI: 10.1186/1741-7015-12-109] [Citation(s) in RCA: 135] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2014] [Accepted: 06/12/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Treatment burden refers to the workload imposed by healthcare on patients, and the effect this has on quality of life. The Treatment Burden Questionnaire (TBQ) aims to assess treatment burden in different condition and treatment contexts. Here, we aimed to evaluate the validity and reliability of an English version of the TBQ, a scale that was originally developed in French. METHODS The TBQ was translated into English by a forward-backward translation method. Wording and possible missing items were assessed during a pretest involving 200 patients with chronic conditions. Measurement properties of the instrument were assessed online with a patient network, using the PatientsLikeMe website. Dimensional structure of the questionnaire was assessed by factor analysis. Construct validity was assessed by associating TBQ global score wıth clinical variables, adherence to medication assessed by Morisky's Medication Adherence Scale (MMAS-8), quality of life (QOL) assessed by the PatientsLikeMe Quality of Life Scale (PLMQOL), and patients' confidence in their knowledge of their conditions and treatments. Reliability was determined by a test-retest method. RESULTS In total, 610 patients with chronic conditions, mainly from the USA, UK, Canada, Australia, or New Zealand, completed the TBQ between September and October 2013. The English TBQ showed a unidimensional structure with Cronbach α of 0.90. The TBQ global score was negatively correlated with the PLMQOL score (rs = -0.50; p < 0.0001). Low rather than moderate or high adherence to medication was associated with high TBQ score (mean [SD] TBQ score 61.8 [30.5] vs. 37.7 [27.5]; P < 0.0001). The treatment burden was higher for patients who had insufficient knowledge compared with those who had sufficient knowledge about their treatments (mean ± SD TBQ score 62.3 ± 31.3 vs. 47.8 ± 30.4; P < 0.0001) and conditions (63.0 ± 31.6 vs. 49.3 ± 30.7; P < 0.0001). The intraclass correlation coefficient for the retest (n = 282) was 0.77 (95% CI 0.70 to 0.82). CONCLUSIONS We found that the English TBQ is a reliable instrument in this population, and provide evidence supporting the construct validity for its use to assess treatment burden for patients with one or more chronic conditions in English-speaking countries.
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Affiliation(s)
- Viet-Thi Tran
- Department of General Medicine, Paris Diderot University, Paris, France
- METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, UMR 1153, INSERM, 1 place du Parvis Notre-Dame, Paris 75181, France
- Centre d'Épidémiologie Clinique, HôpitalHôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Victor M Montori
- Division of Health Care and Policy Research, Department of Health Sciences Research and Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN, USA
| | - Caroline Barnes
- METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, UMR 1153, INSERM, 1 place du Parvis Notre-Dame, Paris 75181, France
- Centre d'Épidémiologie Clinique, HôpitalHôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Paris, France
| | - Paul Wicks
- PatientsLikeMe, Inc., Cambridge, Massachusetts, USA
| | - Philippe Ravaud
- METHODS Team, Epidemiology and Statistics Sorbonne Paris Cité Research Centre, UMR 1153, INSERM, 1 place du Parvis Notre-Dame, Paris 75181, France
- Centre d'Épidémiologie Clinique, HôpitalHôtel-Dieu, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Paris, France
- Department of Epidemiology, Columbia University Mailman School of Public Health, New York, NY, USA
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Stanners MN, Barton CA, Shakib S, Winefield HR. Depression diagnosis and treatment amongst multimorbid patients: a thematic analysis. BMC FAMILY PRACTICE 2014; 15:124. [PMID: 24947875 PMCID: PMC4074384 DOI: 10.1186/1471-2296-15-124] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/12/2013] [Accepted: 06/04/2014] [Indexed: 01/06/2023]
Abstract
BACKGROUND We explored experiences of depression diagnosis and treatment amongst multimorbid patients referred to a metropolitan multidisciplinary outpatient clinic to identify commonalities across this patient group. METHODS Patients with two or more chronic conditions and a diagnosis of depression participated in semi-structured interviews that were digitally recorded and transcribed. Thematic analysis was performed on the transcriptions. RESULTS Multimorbid patients attributed depressive symptoms to the loss of 'normal' roles and functionality and struggled to reconcile the depression diagnosis with their sense of identity. Beliefs about themselves and depression affected their receptivity to diagnosis and intervention strategies. These included prescribed interventions, such as psychotherapy or pharmacotherapy, and patient-developed strategies. CONCLUSIONS Functional and social role losses present a clear context in which GPs should raise the subject of mood, with the situational attribution of depression suggesting that psychotherapy, which is rarely offered, should be prioritised in these circumstances.
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Affiliation(s)
- Melinda N Stanners
- Discipline of General Practice, Flinders University, Bedford Park, South Australia, Australia
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Christopher A Barton
- Social Health Sciences Unit, Flinders University, Bedford Park, South Australia, Australia
| | - Sepehr Shakib
- Department of Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Helen R Winefield
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
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Jowsey T, Yen LE, Bagheri N, McRae IS. Time spent by people managing chronic obstructive pulmonary disease indicates biographical disruption. Int J Chron Obstruct Pulmon Dis 2014; 9:87-97. [PMID: 24477271 PMCID: PMC3896281 DOI: 10.2147/copd.s53887] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Since Bury’s 1982 proposal that chronic illness creates biographical disruption for those who are living with it, there has been no effort to quantitatively measure such disruption. “Biographical disruption” refers to the substantial and directive influence that chronic illness can have over the course of a person’s life. Qualitative research and time use studies have demonstrated that people with chronic illnesses spend considerable amounts of time managing their health, and that these demands may change over time. This study was designed to measure the time that older people with chronic illnesses spend on selected health practices as one indicator of biographical disruption. We look specifically at the time use of people with chronic obstructive pulmonary disease (COPD). As part of a larger time use survey, a recall questionnaire was mailed to 3,100 members of Lung Foundation Australia in 2011. A total of 681 responses were received (22.0% response rate), 611 of which were from people with COPD. Descriptive analyses were undertaken on the amount of time spent on selected health-related activities including personal care, nonclinical health-related care, and activity relating to health services. Almost all people with COPD report spending some time each day on personal or home-based health-related tasks, with a median time of 15 minutes per day spent on these activities. At the median, people also report spending about 30 minutes per day exercising, 2.2 hours per month (the equivalent of 4.4 minutes per day) on nonclinical health-related activities, and 4.1 hours per month (equivalent to 8.2 minutes per day) on clinical activities. Excluding exercise, the median total time spent on health-related activities was 17.8 hours per month (or 35.6 minutes per day). For people in the top 10% of time use, the total amount of time was more than 64.6 hours per month (or 2.2 hours per day) excluding exercise, and 104 hours per month (or 3.5 hours per day) including exercise. The amount of time spent on health-related activity, such as engaging in personal care tasks, may be regular and predictable. The execution of these tasks generally takes relatively small amounts of time, and might be incorporated into daily life (biography) without causing significant disruption. Other activities may require large blocks of time, and they may be disruptive in a practical way that almost inevitably disrupts biography. The amount of time required does not appear to alter in relation to the time since diagnosis. The scale of time needed to manage one’s health could easily be interpreted as disruptive, and for some people, even overwhelming.
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Affiliation(s)
- Tanisha Jowsey
- Australian Primary Health Care Research Institute, Australian National University, Acton, ACT, Australia
| | - Laurann E Yen
- Australian Primary Health Care Research Institute, Australian National University, Acton, ACT, Australia
| | - Nasser Bagheri
- Australian Primary Health Care Research Institute, Australian National University, Acton, ACT, Australia
| | - Ian S McRae
- Australian Primary Health Care Research Institute, Australian National University, Acton, ACT, Australia
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Yen LE, McRae IS, Jowsey T, Bagheri N. Time spent on health related activity by older Australians with diabetes. J Diabetes Metab Disord 2013; 12:33. [PMID: 23815873 DOI: 10.1186/2251-6581-12-33] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 06/29/2013] [Indexed: 01/20/2023]
Abstract
AIMS There is little information available about what people do to look after their health, or how long people spend on health activities. This study identifies key health related activities and time taken as part of self management by people with diabetes. Management planning often lacks information that this study provides that would help clinicians and patients to create manageable and do-able plans that patients can follow. METHODS Data were collected in 2010 using a national survey of people aged 50 years the National Diabetes Services Scheme. Respondents provided recall data on time used for personal health care, non-clinical health activity; and health service interactions. Data were analysed using Stata 12 and SPSS 19. RESULTS While most people with diabetes spend on average less than 30 minutes a day on health-related activities (excluding exercise), the highest decile of respondents averaged over 100 minutes. Time spent increased with the number of co-existent conditions. Taking medication and sitting in waiting rooms were the most frequently reported activities. The greatest amount of time was spent on daily personal health care activities. CONCLUSION The time demands of diabetes for older people can be substantial. Better patient engagement in self management might result from a better match in care planning between the illness demands and the patient time availability, with potential to reduce admissions for hospital care.
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Affiliation(s)
- Laurann E Yen
- Australian Primary Health Care Research Institute, Australian National University, Ian Potter House, Corner of Marcus Clarke and Gordon Street, Canberra, ACT 0200, Australia
| | - Ian S McRae
- Australian Primary Health Care Research Institute, Australian National University, Ian Potter House, Corner of Marcus Clarke and Gordon Street, Canberra, ACT 0200, Australia
| | - Tanisha Jowsey
- Australian Primary Health Care Research Institute, Australian National University, Ian Potter House, Corner of Marcus Clarke and Gordon Street, Canberra, ACT 0200, Australia
| | - Nasser Bagheri
- Australian Primary Health Care Research Institute, Australian National University, Ian Potter House, Corner of Marcus Clarke and Gordon Street, Canberra, ACT 0200, Australia
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Jowsey T, McRae IS, Valderas JM, Dugdale P, Phillips R, Bunton R, Gillespie J, Banfield M, Jones L, Kljakovic M, Yen L. Time's up. descriptive epidemiology of multi-morbidity and time spent on health related activity by older Australians: a time use survey. PLoS One 2013; 8:e59379. [PMID: 23560046 PMCID: PMC3613388 DOI: 10.1371/journal.pone.0059379] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 02/14/2013] [Indexed: 11/18/2022] Open
Abstract
Most Western health systems remain single illness orientated despite the growing prevalence of multi-morbidity. Identifying how much time people with multiple chronic conditions spend managing their health will help policy makers and health service providers make decisions about areas of patient need for support. This article presents findings from an Australian study concerning the time spent on health related activity by older adults (aged 50 years and over), most of whom had multiple chronic conditions. A recall questionnaire was developed, piloted, and adjusted. Sampling was undertaken through three bodies; the Lung Foundation Australia (COPD sub-sample), National Diabetes Services Scheme (Diabetes sub-sample) and National Seniors Australia (Seniors sub-sample). Questionnaires were mailed out during 2011 to 10,600 older adults living in Australia. 2540 survey responses were received and analysed. Descriptive analyses were completed to obtain median values for the hours spent on each activity per month. The mean number of chronic conditions was 3.7 in the COPD sub-sample, 3.4 in the Diabetes sub-sample and 2.0 in the NSA sub-sample. The study identified a clear trend of increased time use associated with increased number of chronic conditions. Median monthly time use was 5-16 hours per month overall for our three sub-samples. For respondents in the top decile with five or more chronic conditions the median time use was equivalent to two to three hours per day, and if exercise is included in the calculations, respondents spent from between five and eight hours per day: an amount similar to full-time work. Multi-morbidity imposes considerable time burdens on patients. Ageing is associated with increasing rates of multi-morbidity. Many older adults are facing high demands on their time to manage their health in the face of decreasing energy and mobility. Their time use must be considered in health service delivery and health system reform.
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Affiliation(s)
- Tanisha Jowsey
- Australian Primary Health Care Research Institute, Australian National University, Canberra, Australian Capital Territory, Australia.
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