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Van Damme J, Dal Bello-Haas V, Kuspinar A, Strachan P, Peters N, Nguyen KT, Bolger G. Guiding Documents for Engaging with Remote Chronic Disease Management Programs as a Healthcare Provider: A Scoping Review. Int J Telerehabil 2023; 15:e6583. [PMID: 38162933 PMCID: PMC10754241 DOI: 10.5195/ijt.2023.6583] [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] [Indexed: 01/03/2024] Open
Abstract
Introduction Chronic disease management programs (CDMP) that include education and exercise enhance outcomes and reduce healthcare costs. Remote CDMP have the potential to provide convenient, cost-effective, and accessible options for individuals, but it is unclear how to best implement programs that include education and exercise. This review identified and synthesized resources for implementing remote CDMP programs that incorporate education and exercise. Methods Peer-reviewed and grey literature were systematically searched from January 1998 to May 2022. Covidence software was used for screening and extraction. The data were synthesized and presented in a narrative and tabular format. Results Six peer-reviewed manuscripts and six grey literature documents published between 2006-2022 were included. All resources described individual programs targeting various chronic conditions. Provider training, consent, participant screening, and safety considerations were identified. Conclusions Guidelines for remote CFMP programs are lacking. Additional work is needed to design remote CDMP guidelines incorporating education and exercise.
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Affiliation(s)
- Jill Van Damme
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario
| | | | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario
| | | | - Nicole Peters
- School of Rehabilitation Science, Western University, London, Ontario
| | - Khang Trong Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario
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Poitras ME, Couturier Y, Doucet E, T. Vaillancourt V, Poirier MD, Gauthier G, Hudon C, Delli-Colli N, Gagnon D, Careau E, Duhoux A, Gaboury I, Charif AB, Ashcroft R, Lukewich J, Ramond-Roquin A, Massé S. Co-design, implementation, and evaluation of an expanded train-the-trainer strategy to support the sustainability of evidence-based practice guides for registered nurses and social workers in primary care clinics: a developmental evaluation protocol. BMC PRIMARY CARE 2022; 23:84. [PMID: 35436845 PMCID: PMC9016936 DOI: 10.1186/s12875-022-01684-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/31/2022] [Indexed: 11/12/2022]
Abstract
Background The implementation of evidence-based innovations is incentivized as part of primary care reform in Canada. In the Province of Québec, it generated the creation of interprofessional care models involving registered nurses and social workers as members of primary care clinics. However, the scope of practice for these professionals remains variable and suboptimal. In 2019, expert committees co-designed and published two evidence-based practice guides, but no clear strategy has been identified to support their assimilation. This project’s goal is to support the implementation and deployment of practice guides for both social workers and registered nurses using a train-the-trainer educational intervention. Methods/design This three-phase project is a developmental evaluation using a multiple case study design across 17 primary care clinics. It will involve trainers in healthcare centers, patients, registered nurses and social workers. The development and implementation of an expanded train-the-trainer strategy will be informed by a patient-oriented research approach, the Kirkpatrick learning model, and evidence-based practice guides. For each case and phase, the qualitative and quantitative data will be analyzed using a convergent design method and will be integrated through assimilation. Discussion This educational intervention model will allow us to better understand the complex context of primary care clinics, involving different settings and services offered. This study protocol, based on reflective practice, patient-centered research and focused on the needs of the community in collaboration with partners and patients, may serve as an evidence based educational intervention model for further study in primary care.
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Hao R, Zhang M, Jin H, Zuo J, Hu J. Construction of the health risk assessment index system for assessing the chronic diseases based on the general health. J Family Med Prim Care 2022; 11:5527-5534. [PMID: 36505657 PMCID: PMC9731059 DOI: 10.4103/jfmpc.jfmpc_2110_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 11/07/2022] Open
Abstract
Aims This study aimed to construct a standardized health risk assessment index system (HRAIS) under the guidance of general health and facilitate the family doctors to carry out chronic disease management. Methods Available chronic disease surveillance systems and indexes were reviewed to identify potential indexes. The Delphi method was performed to establish the HRAIS, and the analytic hierarchy process was used to calculate the index weight. Results HRAIS included four first-level indexes and 38 second-level indexes. The authority coefficient was 0.86. The Kendall's W for the two rounds of Delphi consultation were 0.202 and 0.210 (p < 0.001). The weights of the first-level indexes from high to low were physiological health (0.409), psychosocial health (0.290), health-related behaviors (0.205), and environment (0.097). Thus, HRAIS is a multi-dimension and multi-index tool, which can be used as a guideline for family doctors in early screening, early intervention, and classified management of main chronic diseases.
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Affiliation(s)
- Ran Hao
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Meng Zhang
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China,Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Haoyu Jin
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jinfan Zuo
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China
| | - Jie Hu
- Department of Clinical Humanistic Care and Nursing Research Center, School of Nursing, Hebei Medical University, Shijiazhuang, Hebei, China,Department of Science and Technology, Hebei Medical University, Shijiazhuang, Hebei, China,Address for correspondence: Prof. Jie Hu, Department of Science and Technology, Hebei Medical University, Shijiazhuang, Hebei, China. E-mail:
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Improvement Strategies for the Challenging Collaboration of General Practitioners and Specialists for Patients with Complex Chronic Conditions: A Scoping Review. Int J Integr Care 2022; 22:4. [PMID: 36043030 PMCID: PMC9374013 DOI: 10.5334/ijic.5970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Coordination of healthcare professionals seems to be particularly important for patients with complex chronic disease, as they present a challenging interplay of conditions and symptoms. As one solution, to counteract or prevent this, improving collaboration between general practitioners (GPs) and specialists has been the aim of studies by linking or coordinating their services along the continuum of care. This scoping review summarises role distributions and components of this collaboration that have potential for improvement for the care of patients with complex chronic conditions. Methods: Scoping review as a knowledge synthesis for components of collaboration and role distributions between medical specialists and GPs in intervention studies. The PubMed database was searched for literature from 2010–2020. Results: Literature search and reference screening generated 2,174 articles. 30 articles originating from 22 unique projects were included in our synthesis. In the interventions to improve collaboration, the GP is most commonly in charge of patient management and extends the scope of practice. The specialist provides support when needed. Clear definition of roles, resources for knowledge transfer and education from specialists are commonly utilised interventions. Typically, combinations of process and system changes addressing communication and coordination issues are applied. Most interventions improve provider and patient satisfaction, health outcomes, and reduce care fragmentation. Conclusion: This review showed that interventions to improve collaboration between GPs and medical specialists seem promising. Further efforts should be made to test and apply the findings systematically in broad clinical practice.
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Cross AJ, Thomas D, Liang J, Abramson MJ, George J, Zairina E. Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care. Cochrane Database Syst Rev 2022; 5:CD012652. [PMID: 35514131 PMCID: PMC9073270 DOI: 10.1002/14651858.cd012652.pub2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable health condition. COPD is associated with substantial burden on morbidity, mortality and healthcare resources. OBJECTIVES To review existing evidence for educational interventions delivered to health professionals managing COPD in the primary care setting. SEARCH METHODS We searched the Cochrane Airways Trials Register from inception to May 2021. The Register includes records from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and PsycINFO. We also searched online trial registries and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs. Eligible studies tested educational interventions aimed at any health professionals involved in the management of COPD in primary care. Educational interventions were defined as interventions aimed at upskilling, improving or refreshing existing knowledge of health professionals in the diagnosis and management of COPD. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data and assessed the risk of bias of included studies. We conducted meta-analyses where possible and used random-effects models to yield summary estimates of effect (mean differences (MDs) with 95% confidence intervals (CIs)). We performed narrative synthesis when meta-analysis was not possible. We assessed the overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were: 1) proportion of COPD diagnoses confirmed with spirometry; 2) proportion of patients with COPD referred to, participating in or completing pulmonary rehabilitation; and 3) proportion of patients with COPD prescribed respiratory medication consistent with guideline recommendations. MAIN RESULTS We identified 38 studies(22 cluster-RCTs and 16 RCTs) involving 4936 health professionals (reported in 19/38 studies) and 71,085 patient participants (reported in 25/38 studies). Thirty-six included studies evaluated interventions versus usual care; seven studies also reported a comparison between two or more interventions as part of a three- to five-arm RCT design. A range of simple to complex interventions were used across the studies, with common intervention features including education provided to health professionals via training sessions, workshops or online modules (31 studies), provision of practice support tools, tool kits and/or algorithms (10 studies), provision of guidelines (nine studies) and training on spirometry (five studies). Health professionals targeted by the interventions were most commonly general practitioners alone (20 studies) or in combination with nurses or allied health professionals (eight studies), and the majority of studies were conducted in general practice clinics. We identified performance bias as high risk for 33 studies. We also noted risk of selection, detection, attrition and reporting biases, although to a varying extent across studies. The evidence of efficacy was equivocal for all the three primary endpoints evaluated: 1) proportion of COPD diagnoses confirmed with spirometry (of the four studies that reported this outcome, two supported the intervention); 2) proportion of patients with COPD who are referred to, participate in or complete pulmonary rehabilitation (of the four studies that reported this outcome, two supported the intervention); and 3) proportion of patients with COPD prescribed respiratory medications consistent with guideline recommendations (12 studies reported this outcome, the majority evaluated multiple drug classes and reported a mixed effect). Additionally, the low quality of evidence and potential risk of bias make the interpretation more difficult. Moderate-quality evidence (downgraded due to risk of bias concerns) suggests that educational interventions for health professionals probably improve the proportion of patients with COPD vaccinated against influenza (three studies) and probably have little impact on the proportion of patients vaccinated against pneumococcal infection (two studies). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on the frequency of COPD exacerbations (10 studies). There was a high degree of heterogeneity in the reporting of health-related quality of life (HRQoL). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on HRQoL overall, and when using the COPD-specific HRQoL instrument, the St George's Respiratory Questionnaire (at six months MD 0.87, 95% CI -2.51 to 4.26; 2 studies, 406 participants, and at 12 months MD -0.43, 95% CI -1.52 to 0.67, 4 studies, 1646 participants; reduction in score indicates better health). Moderate-quality evidence suggests that educational interventions for health professionals may improve patient satisfaction with care (one study). We identified no studies that reported adverse outcomes. AUTHORS' CONCLUSIONS The evidence of efficacy was equivocal for educational interventions for health professionals in primary care on the proportion of COPD diagnoses confirmed with spirometry, the proportion of patients with COPD who participate in pulmonary rehabilitation, and the proportion of patients prescribed guideline-recommended COPD respiratory medications. Educational interventions for health professionals may improve influenza vaccination rates among patients with COPD and patient satisfaction with care. The quality of evidence for most outcomes was low or very low due to heterogeneity and methodological limitations of the studies included in the review, which means that there is uncertainty about the benefits of any currently published educational interventions for healthcare professionals to improve COPD management in primary care. Further well-designed RCTs are needed to investigate the effects of educational interventions delivered to health professionals managing COPD in the primary care setting.
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Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Dennis Thomas
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Jenifer Liang
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Elida Zairina
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
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Lex H, Price P, Clark L. Qualitative study identifies life shifts and stress coping strategies in people with multiple sclerosis. Sci Rep 2022; 12:6536. [PMID: 35444194 PMCID: PMC9021186 DOI: 10.1038/s41598-022-10267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 03/30/2022] [Indexed: 12/02/2022] Open
Abstract
Multiple sclerosis (MS) is an auto-immune disease in which the body’s immune system attacks the central nervous system. The demyelination of the nerve fibers can lead to physical, emotional, and cognitive impairments. We wanted to learn about challenges of living with the illness and how people deal with stress. 128 individuals with MS from Austria and the US participated in the qualitative interviews. We interviewed participants and coded their answers using inductive grounded theory. We asked three open-ended questions to inquire about life since being diagnosed with MS as well as about dealing with stress. Life shifts since diagnosis involved ‘experiencing limitations’ and could be categorized in ‘emotional changes’, ‘changes with work’, ‘changes in social interaction’, ‘physical changes’, ‘changes in the medical context’. For dealing with stress active (strategies and activities) and passive coping strategies (avoid/ignore) were employed. General stress reactions were expressed in areas of emotional, physical and /or lifestyle. We recommend developing interventions in three core areas for the MS population: (1) dealing with life changes and significant experiences with MS, (2) focusing on the areas where life shifts took place, (3) focusing on active coping with stress and discussing consequences of passive coping strategies.
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Affiliation(s)
- Heidemarie Lex
- Department of Psychiatry, University of Utah, 383 Colorow Drive, Salt Lake City, UT, 84108, USA.
| | - Pollie Price
- OTR/L, FAOTA, University of Utah College of Occupational and Recreational Therapies, Salt Lake City, USA
| | - Lauren Clark
- FAAN, University of California at Los Angeles College of Nursing, Los Angeles, USA
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Schrijver J, Lenferink A, Brusse-Keizer M, Zwerink M, van der Valk PD, van der Palen J, Effing TW. Self-management interventions for people with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2022; 1:CD002990. [PMID: 35001366 PMCID: PMC8743569 DOI: 10.1002/14651858.cd002990.pub4] [Citation(s) in RCA: 28] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Self-management interventions help people with chronic obstructive pulmonary disease (COPD) to acquire and practise the skills they need to carry out disease-specific medical regimens, guide changes in health behaviour and provide emotional support to enable them to control their disease. Since the 2014 update of this review, several studies have been published. OBJECTIVES Primary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of health-related quality of life (HRQoL) and respiratory-related hospital admissions. To evaluate the safety of COPD self-management interventions compared to usual care in terms of respiratory-related mortality and all-cause mortality. Secondary objectives To evaluate the effectiveness of COPD self-management interventions compared to usual care in terms of other health outcomes and healthcare utilisation. To evaluate effective characteristics of COPD self-management interventions. SEARCH METHODS We searched the Cochrane Airways Trials Register, CENTRAL, MEDLINE, EMBASE, trials registries and the reference lists of included studies up until January 2020. SELECTION CRITERIA Randomised controlled trials (RCTs) and cluster-randomised trials (CRTs) published since 1995. To be eligible for inclusion, self-management interventions had to include at least two intervention components and include an iterative process between participant and healthcare provider(s) in which goals were formulated and feedback was given on self-management actions by the participant. DATA COLLECTION AND ANALYSIS Two review authors independently selected studies for inclusion, assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. We contacted study authors to obtain additional information and missing outcome data where possible. Primary outcomes were health-related quality of life (HRQoL), number of respiratory-related hospital admissions, respiratory-related mortality, and all-cause mortality. When appropriate, we pooled study results using random-effects modelling meta-analyses. MAIN RESULTS We included 27 studies involving 6008 participants with COPD. The follow-up time ranged from two-and-a-half to 24 months and the content of the interventions was diverse. Participants' mean age ranged from 57 to 74 years, and the proportion of male participants ranged from 33% to 98%. The post-bronchodilator forced expiratory volume in one second (FEV1) to forced vital capacity (FVC) ratio of participants ranged from 33.6% to 57.0%. The FEV1/FVC ratio is a measure used to diagnose COPD and to determine the severity of the disease. Studies were conducted on four different continents (Europe (n = 15), North America (n = 8), Asia (n = 1), and Oceania (n = 4); with one study conducted in both Europe and Oceania). Self-management interventions likely improve HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score (lower score represents better HRQoL) with a mean difference (MD) from usual care of -2.86 points (95% confidence interval (CI) -4.87 to -0.85; 14 studies, 2778 participants; low-quality evidence). The pooled MD of -2.86 did not reach the SGRQ minimal clinically important difference (MCID) of four points. Self-management intervention participants were also at a slightly lower risk for at least one respiratory-related hospital admission (odds ratio (OR) 0.75, 95% CI 0.57 to 0.98; 15 studies, 3263 participants; very low-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over a mean of 9.75 months' follow-up was 15 (95% CI 8 to 399) for participants with high baseline risk and 26 (95% CI 15 to 677) for participants with low baseline risk. No differences were observed in respiratory-related mortality (risk difference (RD) 0.01, 95% CI -0.02 to 0.04; 8 studies, 1572 participants ; low-quality evidence) and all-cause mortality (RD -0.01, 95% CI -0.03 to 0.01; 24 studies, 5719 participants; low-quality evidence). We graded the evidence to be of 'moderate' to 'very low' quality according to GRADE. All studies had a substantial risk of bias, because of lack of blinding of participants and personnel to the interventions, which is inherently impossible in a self-management intervention. In addition, risk of bias was noticeably increased because of insufficient information regarding a) non-protocol interventions, and b) analyses to estimate the effect of adhering to interventions. Consequently, the highest GRADE evidence score that could be obtained by studies was 'moderate'. AUTHORS' CONCLUSIONS Self-management interventions for people with COPD are associated with improvements in HRQoL, as measured with the SGRQ, and a lower probability of respiratory-related hospital admissions. No excess respiratory-related and all-cause mortality risks were observed, which strengthens the view that COPD self-management interventions are unlikely to cause harm. By using stricter inclusion criteria, we decreased heterogeneity in studies, but also reduced the number of included studies and therefore our capacity to conduct subgroup analyses. Data were therefore still insufficient to reach clear conclusions about effective (intervention) characteristics of COPD self-management interventions. As tailoring of COPD self-management interventions to individuals is desirable, heterogeneity is and will likely remain present in self-management interventions. For future studies, we would urge using only COPD self-management interventions that include iterative interactions between participants and healthcare professionals who are competent using behavioural change techniques (BCTs) to elicit participants' motivation, confidence and competence to positively adapt their health behaviour(s) and develop skills to better manage their disease. In addition, to inform further subgroup and meta-regression analyses and to provide stronger conclusions regarding effective COPD self-management interventions, there is a need for more homogeneity in outcome measures. More attention should be paid to behavioural outcome measures and to providing more detailed, uniform and transparently reported data on self-management intervention components and BCTs. Assessment of outcomes over the long term is also recommended to capture changes in people's behaviour. Finally, information regarding non-protocol interventions as well as analyses to estimate the effect of adhering to interventions should be included to increase the quality of evidence.
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Affiliation(s)
- Jade Schrijver
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
| | - Anke Lenferink
- Department of Pulmonary Medicine, Medisch Spectrum Twente, Enschede, Netherlands
- Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
| | - Marjolein Brusse-Keizer
- Section Health Technology and Services Research, Faculty of Behavioural, Management and Social sciences, Technical Medical Centre, University of Twente, Enschede, Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Marlies Zwerink
- Value-Based Health Care, Medisch Spectrum Twente, Enschede, Netherlands
| | | | - Job van der Palen
- Section Cognition, Data and Education, Faculty of Behavioural, Management and Social Sciences, University of Twente, Enschede, Netherlands
- Medical School Twente, Medisch Spectrum Twente, Enschede, Netherlands
| | - Tanja W Effing
- College of Medicine and Public Health, School of Medicine, Flinders University, Adelaide, Australia
- School of Psychology, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
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Nursing Care Coordination for Patients with Complex Needs in Primary Healthcare: A Scoping Review. Int J Integr Care 2021; 21:16. [PMID: 33776605 PMCID: PMC7977020 DOI: 10.5334/ijic.5518] [Citation(s) in RCA: 39] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Introduction: Millions of people worldwide have complex health and social care needs. Care coordination for these patients is a core dimension of integrated care and a key responsibility for primary healthcare. Registered nurses play a substantial role in care coordination. This review draws on previous theoretical work and provides a synthesis of care coordination interventions as operationalized by nurses for complex patient populations in primary healthcare. Methodology: We followed Arksey and O’Malley’s methodological framework for scoping reviews. We carried out a systematic search across CINAHL, MEDLINE, Scopus and ProQuest. Only empirical studies were included. We performed a thematic analysis using deductive (the American Nurses Association Framework) and inductive approaches. Findings were discussed with a group of experts. Results: Thirty-four articles were included in the synthesis. Overall, nursing care coordination activities were synthesized into three categories: those targeting the patient, family and caregivers; those targeting health and social care teams; and those bringing together patients and professionals. Interpersonal communication and information transfer emerged as cross-cutting activities that support every other activity. Our results also brought to light the nurses’ contribution to care coordination efforts for patients with complex needs as well as critical components that should be present in every care coordination intervention for this clientele. These include an increased intensity and frequency of activities, relational continuity of care, and home visits. Conclusion: With the growing complexity of patient’s needs, efforts must be directed towards enabling the primary healthcare level to effectively play its substantial role in care coordination. This includes finding primary care employment models that would facilitate multidisciplinary teamwork and the delivery of integrated care, and guarantee the delivery of intensive yet efficient coordinated care.
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Fortin M, Stewart M, Ngangue P, Almirall J, Bélanger M, Brown JB, Couture M, Gallagher F, Katz A, Loignon C, Ryan BL, Sampalli T, Wong ST, Zwarenstein M. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med 2021; 19:126-134. [PMID: 33685874 PMCID: PMC7939717 DOI: 10.1370/afm.2650] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. SECONDARY OUTCOMES health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.
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Affiliation(s)
- Martin Fortin
- CORRESPONDING AUTHOR Martin Fortin Department of Family Medicine and Emergency Medicine Université de Sherbrooke 3001 12e Ave N Quebec, Canada, J1H 5N4
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Audétat MC, Cairo Notari S, Sader J, Ritz C, Fassier T, Sommer JM, Nendaz M, Caire-Fon N. Understanding the clinical reasoning processes involved in the management of multimorbidity in an ambulatory setting: study protocol of a stimulated recall research. BMC MEDICAL EDUCATION 2021; 21:31. [PMID: 33413342 PMCID: PMC7792096 DOI: 10.1186/s12909-020-02459-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Accepted: 12/16/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND Primary care physicians are at the very heart of managing patients suffering from multimorbidity. However, several studies have highlighted that some physicians feel ill-equipped to manage these kinds of complex clinical situations. Few studies are available on the clinical reasoning processes at play during the long-term management and follow-up of patients suffering from multimorbidity. This study aims to contribute to a better understanding on how the clinical reasoning of primary care physicians is affected during follow-up consultations with these patients. METHODS A qualitative research project based on semi-structured interviews with primary care physicians in an ambulatory setting will be carried out, using the video stimulated recall interview method. Participants will be filmed in their work environment during a standard consultation with a patient suffering from multimorbidity using a "button camera" (small camera) which will be pinned to their white coat. The recording will be used in a following semi-structured interview with physicians and the research team to instigate a stimulated recall. Stimulated recall is a research method that allows the investigation of cognitive processes by inviting participants to recall their concurrent thinking during an event when prompted by a video sequence recall. During this interview, participants will be prompted by different video sequence and asked to discuss them; the aim will be to encourage them to make their clinical reasoning processes explicit. Fifteen to twenty interviews are planned to reach data saturation. The interviews will be transcribed verbatim and data will be analysed according to a standard content analysis, using deductive and inductive approaches. CONCLUSION Study results will contribute to the scientific community's overall understanding of clinical reasoning. This will subsequently allow future generation of primary care physicians to have access to more adequate trainings to manage patients suffering from multimorbidity in their practice. As a result, this will improve the quality of the patient's care and treatments.
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Affiliation(s)
- M-C Audétat
- Primary Care Institut (iuMFE), Faculty of Medicine, University of Geneva, CMU 5-6, Rue Michel-Servet 1, 1211, Geneva, Switzerland.
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland.
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada.
| | - S Cairo Notari
- Primary Care Institut (iuMFE), Faculty of Medicine, University of Geneva, CMU 5-6, Rue Michel-Servet 1, 1211, Geneva, Switzerland
- Faculty of Psychology and Educational Sciences, University of Geneva, Geneva, Switzerland
| | - J Sader
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - C Ritz
- Primary Care Institut (iuMFE), Faculty of Medicine, University of Geneva, CMU 5-6, Rue Michel-Servet 1, 1211, Geneva, Switzerland
| | - T Fassier
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
- Division of Internal Medicine for the elderly, University Hospitals of Geneva, Geneva, Switzerland
| | - J M Sommer
- Primary Care Institut (iuMFE), Faculty of Medicine, University of Geneva, CMU 5-6, Rue Michel-Servet 1, 1211, Geneva, Switzerland
| | - M Nendaz
- Unit of Development and Research in Medical Education (UDREM), Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - N Caire-Fon
- Department of Family and Emergency Medicine, Faculty of Medicine, Université de Montréal, Montreal, Canada
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11
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Keller S, Dy S, Wilson R, Dukhanin V, Snyder C, Wu A. Selecting Patient-Reported Outcome Measures to Contribute to Primary Care Performance Measurement: a Mixed Methods Approach. J Gen Intern Med 2020; 35:2687-2697. [PMID: 32495096 PMCID: PMC7459066 DOI: 10.1007/s11606-020-05811-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 03/17/2020] [Indexed: 01/11/2023]
Abstract
New models of primary care include patient-reported outcome measures (PROMs) to promote patient-centered care. PROMs provide information on patient functional status and well-being, can be used to enhance care quality, and are proposed for use in assessing performance. Our objective was to identify a short list of candidate PROMs for use in primary care practice and to serve as a basis for performance measures (PMs). We used qualitative and quantitative methods to identify relevant patient-reported outcome (PRO) domains for use in performance measurement (PRO-PM) and their associated PROMs. We collected data from key informant groups: patients (n = 13; one-on-one and group interviews; concept saturation analysis), clinical thought leaders (n = 9; group discussions; thematic analysis), primary care practices representatives (n = 37; six focus groups; thematic analysis), and primary care payer representatives (n = 10; 12-question survey; frequencies of responses). We merged the key informant group information with findings from environmental literature scans. We conducted a targeted evidence review of measurement properties for candidate PROMs. We used a scoping review and key informant groups to identify PROM evaluation criteria, which were linked to the National Quality Forum measure evaluation criteria. We developed a de novo schema to score candidate PROMs against our criteria. We identified four PRO domains and 10 candidate PROMs: 3 for depressive symptoms, 2 for physical function, 3 for self-efficacy, 2 for ability to participate. Five PROMs met ≥ 70% of the evidence criteria for three PRO domains: PHQ-9 or PROMIS Depression (depression), PF-10 or PROMIS-PF (physical functioning), and PROMIS Self-Efficacy for Managing Treatments and Medications (self-efficacy). The PROMIS Ability to Participate in Social Roles and Activities met 68% of our criteria and might be considered for inclusion. Existing evidence and key informant data identified 5 candidate PROMs to use in primary care. These instruments can be used to develop PRO-PMs.
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Affiliation(s)
- San Keller
- American Institutes for Research in the Behavioral and Social Sciences, Chapel Hill, NC, USA.
| | - Sydney Dy
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Renee Wilson
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vadim Dukhanin
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Claire Snyder
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Albert Wu
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Johns Hopkins School of Medicine, Baltimore, MD, USA
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12
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Pozza A, Osborne RH, Elsworth GR, Gualtieri G, Ferretti F, Coluccia A. Evaluation of the Health Education Impact Questionnaire (heiQ), a Self-Management Skill Assessment Tool, in Italian Chronic Patients. Psychol Res Behav Manag 2020; 13:459-471. [PMID: 32547268 PMCID: PMC7246315 DOI: 10.2147/prbm.s245063] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Accepted: 02/27/2020] [Indexed: 11/23/2022] Open
Abstract
Background The Health Education Impact Questionnaire (heiQ) aims to evaluate eight self-management skills in people with chronic conditions. Knowledge about the relations between these self-management skills and different quality of life (QoL) outcomes has received little attention. It is also important to provide further evidence on its properties in non-English healthcare contexts, as the questionnaire is being used in cross-cultural research. Furthermore, in the Italian healthcare context, the relationship between the medical staff and the patients remains asymmetrical, with the latter having the role of passive recipients of medical prescriptions and services. The current study provided further evidence about the psychometric properties of the heiQ among Italian people with chronic conditions, specifically by assessing the factor structure, reliability, convergent/divergent and criterion validity (ie, the specific contribution of each of the self-management skills to QoL outcomes). Methods Two hundred ninety-nine individuals with a chronic condition (mean age = 61.4 years, 50% females) completed the heiQ and the Medical Outcomes Study-Short Form (MOS SF-36). Confirmatory factor analyses, Composite Reliability Indices (CRI), bivariate correlations and linear regression analyses were computed. Results A model with 8 correlated factors showed good fit, in a similar way to previous studies. CRI values were acceptable to good for all the subscales. Associations between some of the heiQ subscales and some of the MOS SF-36 subscales supported criterion validity. In particular, it was confirmed by the moderate associations between the constructive attitudes and approaches subscale and the MOS SF-36 vitality and perceived mental health and by the moderate correlations between the health directed activities subscale and the MOS SF-36 Vitality. In linear regressions, higher emotional distress predicted higher physical and mental QoL, while higher mental QoL was also associated with stronger constructive attitudes and approaches. Conclusion The heiQ has robust properties across translations and it can also be used routinely in Italian healthcare contexts. The evidence that all the other self-management skills did not predict either physical or mental QoL could suggest that the self-management model of chronic diseases is still not sufficiently developed in the Italian context, where patients are passive recipients of medical instructions.
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Affiliation(s)
- Andrea Pozza
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Richard H Osborne
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Gerald R Elsworth
- Centre for Global Health and Equity, Swinburne University of Technology, Melbourne, Australia
| | - Giacomo Gualtieri
- Legal Medicine Unit, Santa Maria alle Scotte University Hospital, Siena, Siena, Italy
| | - Fabio Ferretti
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
| | - Anna Coluccia
- Department of Medical Sciences, Surgery and Neurosciences, University of Siena, Siena, Italy
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13
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Trankle SA, Usherwood T, Abbott P, Roberts M, Crampton M, Girgis CM, Riskallah J, Chang Y, Saini J, Reath J. Integrating health care in Australia: a qualitative evaluation. BMC Health Serv Res 2019; 19:954. [PMID: 31829215 PMCID: PMC6907151 DOI: 10.1186/s12913-019-4780-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 11/26/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND With aging populations, a growing prevalence of chronic illnesses, higher expectations for quality care and rising costs within limited health budgets, integration of healthcare is seen as a solution to these challenges. Integrated healthcare aims to overcome barriers between primary and secondary care and other disconnected patient services to improve access, continuity and quality of care. Many people in Australia are admitted to hospital for chronic illnesses that could be prevented or managed in the community. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health has implemented key strategies through the Western Sydney Integrated Care Program (WSICP) to enhance primary care and the outcomes and experiences of patients with these illnesses. METHODS We aimed to investigate the WSICP's effectiveness through a qualitative evaluation focused on the 10 WSICP strategies using a framework analysis. We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners (GPs) and primary care nurses, and program managers. Most participants (71%) were interviewed twice. We analysed data within a framework describing how strategies were implemented and used, the experiences around these, their perceived value, facilitators and barriers, and participant-identified suggestions for improvement. RESULTS Care facilitators helped patients access services within the hospital and in primary care and connected general practices with hospital specialists and services. Rapid access and stabilisation clinics with their patient hotlines assisted patients and carers to self-manage chronic illness while connecting GPs to specialists through the GP support-line. Action plans from the hospital informed GPs and their shared care plans which could be accessed by other community health professionals and patients. HealthPathways provided GPs with local, evidence-based guidelines for managing patients. Difficulties persisted in effective widespread access to shared records and electronic communication across sectors. CONCLUSIONS The combined WSICP strategies improved patient and carer experience of healthcare and capacity of GPs to provide care in the community. Information sharing required longer-term investment and support, though benefits were evident by the end of our research.
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Affiliation(s)
- Steven A Trankle
- School of Medicine, Department General Practice, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Tim Usherwood
- School of Medicine, Sydney University, Sydney, Australia.,George Institute for Global Health, Sydney, Australia
| | - Penny Abbott
- School of Medicine, Department General Practice, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Mary Roberts
- Western Sydney Local Health District (Westmead Hospital), North Parramatta, Australia
| | | | - Christian M Girgis
- School of Medicine, Sydney University, Sydney, Australia.,Western Sydney Local Health District (Westmead Hospital), North Parramatta, Australia.,Royal North Shore Hospital, Leonards, Australia
| | - John Riskallah
- Western Sydney Local Health District (Blacktown Hospital), Parramatta, Australia
| | - Yashu Chang
- School of Medicine, Department General Practice, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Western Sydney Local Health District (Blacktown Hospital), Parramatta, Australia
| | - Jaspreet Saini
- Western Sydney Primary Health Network, Blacktown, Australia
| | - Jennifer Reath
- School of Medicine, Department General Practice, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
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14
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Contant É, Loignon C, Bouhali T, Almirall J, Fortin M. A multidisciplinary self-management intervention among patients with multimorbidity and the impact of socioeconomic factors on results. BMC FAMILY PRACTICE 2019; 20:53. [PMID: 31010425 PMCID: PMC6477711 DOI: 10.1186/s12875-019-0943-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/04/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Limited studies exist on successful interventions for patients with multimorbidity. Even more limited is the knowledge on how socioeconomic factors have an impact on these interventions. The objective of this study was to analyze the effect of a multidisciplinary self-management intervention among patients with multimorbidity and the impact of socioeconomic factors on the results. METHODS Secondary data analysis limited to multimorbid patients from of a pragmatic randomized trial evaluating an intervention that included patients (18 to 75 yrs.) from eight primary care practices in Quebec, Canada. The intervention included self-management support and patient-centred motivational approaches. Self-management was evaluated using the Health Education Impact Questionnaire (heiQ) which measures eight different domains. Changes in heiQ were analyzed following the three-month intervention with univariate and multivariate logistic regressions. RESULTS Participants with three or more chronic conditions (n = 281), randomized to intervention or control groups, were included in this analysis. The effect of the intervention on the likelihood of an improvement in self-management was significant in six heiQ domains in the univariate analysis (Odd ratio; 95% CI): Health-directed behaviour (2.03; 1.16-3.55), Emotional well-being (1.97; 1.05-3.68), Self-monitoring and insight (2.35; 1.02-5.40), Constructive attitudes and approaches (2.91; 1.45-5.84), Skill and technique acquisition (1.96; 1.13-3.39), and Health services navigation (2.52; 1.21-5.21). After controlling for age and gender the results remained essentially the same. After additional adjustments for family income, education and self-perceived financial status, the likelihood of an improvement was no longer significant in the domains Emotional well-being and Self-monitoring and insight. CONCLUSIONS The intervention produced significant improvements in multimorbid patients for most domains of self-management. Socioeconomic factors had a minor impact on the results. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01319656.
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Affiliation(s)
- Éric Contant
- Postgraduate student, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
| | - Christine Loignon
- Family Medicine Department, Université de Sherbrooke, Quebec, Canada
| | - Tarek Bouhali
- Family Medicine Department, Université de Sherbrooke, Quebec, Canada
| | - José Almirall
- Family Medicine Department, Université de Sherbrooke, Quebec, Canada
| | - Martin Fortin
- Professor, Family Medicine Department, Université de Sherbrooke, Quebec, Canada. .,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, 305 St-Vallier, Chicoutimi (Québec), G7H 5H6, Canada.
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15
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Fortin M, Chouinard MC, Diallo BB, Bouhali T. Integration of chronic disease prevention and management services into primary care (PR1MaC): findings from an embedded qualitative study. BMC FAMILY PRACTICE 2019; 20:7. [PMID: 30626313 PMCID: PMC6325817 DOI: 10.1186/s12875-018-0898-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/27/2018] [Indexed: 01/08/2023]
Abstract
Background The PR1MaC study was conducted to evaluate the integration of Chronic Disease Prevention and Management services into primary care practices and was reported effective. The aim of this study was to further explore the effects of the PR1MaC intervention on patients and their family. Methods We conducted a qualitative study embedded in a randomized controlled trial. The trial was implemented in eight primary health care practices in the Saguenay region, Quebec, Canada. The interdisciplinary patient-centred team-based intervention included self-management support and a motivational approach. We conducted focus groups and semi-directed individual interviews with patients, family members and healthcare professionals. Results Perceived positive effects can be grouped into six major themes: awareness, improved knowledge, improved motivation and empowerment, adoption of healthy behaviours, improvement of health status and improvement of quality of life. On the negative side, some participants reported lack of sustainability of newly acquired benefits in the months following the intervention. Conclusions Integrating chronic disease prevention and management services into primary care settings had impacts on patients and their family members. These findings are consistent with findings that were reported in the quantitative study. Further studies should address longterm sustainabilility in terms of benefits for the patients. Trial registration ClinicalTrials.gov, no.: NCT01319656. Electronic supplementary material The online version of this article (10.1186/s12875-018-0898-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Martin Fortin
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke 3001, 12e avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada. .,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Chicoutimi, 305, Saint-Vallier, Chicoutimi, Quebec, G7H 5H6, Canada.
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boulevard de l'Université, Chicoutimi, Québec, G7H 2B1, Canada
| | - Bayero Boubacar Diallo
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke 3001, 12e avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Tarek Bouhali
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke 3001, 12e avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
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16
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Ramond-Roquin A, Stewart M, Ryan BL, Richards M, Sussman J, Brown JB, Bouhali T, Bestard-Denommé L, Fortin M. The "Patient-centered coordination by a care team" questionnaire achieves satisfactory validity and reliability. J Interprof Care 2018; 33:558-569. [PMID: 30557065 DOI: 10.1080/13561820.2018.1554633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Increasing prevalence of chronic conditions and multimorbidity challenges health care systems and calls for patient-centered coordination of care. Implementation and evaluation of health policies focusing on the development of patient-centered coordination of care needs valid instruments measuring this dimension of care. The aim of this validation study was to assess the psychometric properties of the French version of the 14-item Patient-Centered Coordination by a Care Team (PCCCT) questionnaire in a primary care setting. PCCCT provides a total score from 0 (worst coordination) to 42 (best coordination). 165 adult patients consulting in primary care with one or more chronic condition(s) completed questionnaires (including PCCCT) at recruitment. After three weeks, participants completed PCCCT again, either by mail (group A) or during a telephone interview (group B). At recruitment, the mean (SD) PCCCT score was 33.3 (7.7). Exploratory factor analysis revealed a 2-dimension structure, 8 items relating to patient involvement and 6 items relating to coordination (factors loadings ranging from 0.34 to 0.88). PCCCT score correlated significantly with subscales of Haggerty's continuity questionnaire, Spearman correlation coefficients (95% confidence interval) ranging from 0.40 (0.22-0.57) to 0.52 (0.38-0.63). Internal consistency was excellent: Cronbach alpha 0.90 (0.79-0.92). Reliability was good, with an intraclass correlation coefficient of 0.68 (0.55-0.78) for test-retest reliability (group A) and of 0.65 (0.46-0.79) for reliability between the self-administered and the interviewer-administered versions of the questionnaire (group B,). The PCCCT questionnaire presents satisfactory validity and reliability; it can be used for the evaluation of health organizations involving team work in primary care.
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Affiliation(s)
- Aline Ramond-Roquin
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke , Sherbrooke , Quebec , Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac St-Jean , Quebec , Quebec , Canada.,Département de Médecine Générale, Université d'Angers , Angers , France.,Laboratoire d'Ergonomie et d'Épidémiologie en Santé au Travail, Université d'Angers , Angers , France
| | - Moira Stewart
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University , London , Ontario , Canada
| | - Bridget L Ryan
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University , London , Ontario , Canada
| | - Maude Richards
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke , Sherbrooke , Quebec , Canada
| | - Jonathan Sussman
- Department of Oncology, McMaster University , Hamilton , Ontario , Canada
| | - Judith B Brown
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University , London , Ontario , Canada
| | - Tarek Bouhali
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke , Sherbrooke , Quebec , Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac St-Jean , Quebec , Quebec , Canada
| | - Louisa Bestard-Denommé
- Centre for Studies in Family Medicine, Schulich School of Medicine and Dentistry, Western University , London , Ontario , Canada
| | - Martin Fortin
- Département de Médecine de Famille et de Médecine d'Urgence, Université de Sherbrooke , Sherbrooke , Quebec , Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac St-Jean , Quebec , Quebec , Canada
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17
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Leijten FR, Struckmann V, van Ginneken E, Czypionka T, Kraus M, Reiss M, Tsiachristas A, Boland M, de Bont A, Bal R, Busse R, Rutten-van Mölken M. The SELFIE framework for integrated care for multi-morbidity: Development and description. Health Policy 2018; 122:12-22. [DOI: 10.1016/j.healthpol.2017.06.002] [Citation(s) in RCA: 96] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 05/31/2017] [Accepted: 06/12/2017] [Indexed: 12/17/2022]
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18
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Muller-Juge V, Pereira Miozzari AC, Rieder A, Hasselgård-Rowe J, Sommer J, Audétat MC. A medical student in private practice for a 1-month clerkship: a qualitative exploration of the challenges for primary care clinical teachers. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 9:17-26. [PMID: 29344003 PMCID: PMC5749380 DOI: 10.2147/amep.s145449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
PURPOSE The predicted shortage of primary care physicians emphasizes the need to increase the family medicine workforce. Therefore, Swiss universities develop clerkships in primary care physicians' private practices. The objective of this research was to explore the challenges, the stakes, and the difficulties of clinical teachers who supervised final year medical students in their primary care private practice during a 1-month pilot clerkship in Geneva. METHODS Data were collected via a focus group using a semistructured interview guide. Participants were asked about their role as a supervisor and their difficulties and positive experiences. The text of the focus group was transcribed and analyzed qualitatively, with a deductive and inductive approach. RESULTS The results show the nature of pressures felt by clinical teachers. First, participants experienced the difficulty of having dual roles: the more familiar one of clinician, and the new challenging one of teacher. Second, they felt compelled to fill the gap between the academic context and the private practice context. Clinical teachers were surprised by the extent of the adaptive load, cognitive load, and even the emotional load involved when supervising a trainee in their clinical practice. The context of this rotation demonstrated its utility and its relevance, because it allowed the students to improve their knowledge about the outpatient setting and to develop their professional autonomy and their maturity by taking on more clinical responsibilities. CONCLUSION These findings show that future training programs will have to address the needs of clinical teachers as well as bridge the gap between students' academic training and the skills needed for outpatient care. Professionalizing the role of clinical teachers should contribute to reaching these goals.
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Affiliation(s)
| | | | | | | | | | - Marie-Claude Audétat
- Correspondence: Marie-Claude Audétat, Unit of Primary Care, Faculty of Medicine, University of Geneva, Rue Michel-Servet 1, 1211 Geneva, Switzerland, Tel +41 22 379 4389, Fax +41 22 379 4948, Email
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19
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Tremblay D, Prady C, Bilodeau K, Touati N, Chouinard MC, Fortin M, Gaboury I, Rodrigue J, L'Italien MF. Optimizing clinical and organizational practice in cancer survivor transitions between specialized oncology and primary care teams: a realist evaluation of multiple case studies. BMC Health Serv Res 2017; 17:834. [PMID: 29246224 PMCID: PMC5732430 DOI: 10.1186/s12913-017-2785-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 12/06/2017] [Indexed: 01/22/2023] Open
Abstract
Background Cancer is now viewed as a chronic disease, presenting challenges to follow-up and survivorship care. Models to shift from haphazard, suboptimal and fragmented episodes of care to an integrated cancer care continuum must be developed, tested and implemented. Numerous studies demonstrate improved care when follow-up is assured by both oncology and primary care providers rather than either group alone. However, there is little data on the roles assumed by specialized oncology teams and primary care providers and the extent to which they work together. This study aims to develop, pilot test and measure outcomes of an innovative risk-based coordinated cancer care model for patients transitioning from specialized oncology teams to primary care providers. Methods/design This multiple case study using a sequential mixed-methods design rests on a theory-driven realist evaluation approach to understand how transitions might be improved. The cases are two health regions in Quebec, Canada, defined by their geographic territory. Each case includes a Cancer Centre and three Family Medicine Groups selected based on differences in their determining characteristics. Qualitative data will be collected from document review (scientific journal, grey literature, local documentation), semi-directed interviews with key informants, and observation of care coordination practices. Qualitative data will be supplemented with a survey to measure the outcome of the coordinated model among providers (scope of practice, collaboration, relational coordination, leadership) and patients diagnosed with breast, colorectal or prostate cancer (access to care, patient-centredness, communication, self-care, survivorship profile, quality of life). Results from descriptive and regression analyses will be triangulated with thematic analysis of qualitative data. Qualitative, quantitative, and mixed methods data will be interpreted within and across cases in order to identify context-mechanism associations that explain outcomes. Discussion The study will provide empirical data on a risk-based coordinated model of cancer care to guide actions at different levels in the health system. This in-depth multiple case study using a realist approach considers both the need for context-specific intervention research and the imperative to address research gaps regarding coordinated models of cancer care. Electronic supplementary material The online version of this article (10.1186/s12913-017-2785-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Dominique Tremblay
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada. .,Campus de Longueuil - Université de Sherbrooke - Faculté de médecine et des sciences de la santé, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.
| | - Catherine Prady
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Campus de Longueuil - Université de Sherbrooke - Faculté de médecine et des sciences de la santé, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Centre intégré de santé et de services sociaux de la Montérégie-Centre, 3120 Boulevard Taschereau, Greenfield Park, Québec, (J4V 2H1), Canada
| | - Karine Bilodeau
- Université de Montréal - Faculté des sciences infirmières et Centre d'innovation en formation infirmière, 2375 Chemin Côte-Ste-Catherine, Montréal, Québec, (H3T 1A8), Canada
| | - Nassera Touati
- École Nationale d'Administration Publique, 4750 Avenue Henri-Julien, 5è étage, Montréal, Québec, (H2T 3E5), Canada
| | - Maud-Christine Chouinard
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Université du Québec à Chicoutimi - Département des sciences de la santé, 555 Boulevard de l'Université, Chicoutimi, Québec, (G7H 2B1), Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Chicoutimi, 305 St-Vallier, Chicoutimi, Québec, (G7H 5H6), Canada
| | - Martin Fortin
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Chicoutimi, 305 St-Vallier, Chicoutimi, Québec, (G7H 5H6), Canada.,Université de Sherbrooke - Département de médecine de famille et de médecine d'urgence, 3001 12e Avenue Nord, Sherbrooke, Québec, (J1H 5N4), Canada
| | - Isabelle Gaboury
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Campus de Longueuil - Université de Sherbrooke - Faculté de médecine et des sciences de la santé, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada
| | - Jean Rodrigue
- Centre intégré de santé et de services sociaux de la Montérégie-Centre, 3120 Boulevard Taschereau, Greenfield Park, Québec, (J4V 2H1), Canada
| | - Marie-France L'Italien
- Centre de recherche - Hôpital Charles-Le Moyne, Centre intégré de santé et de services sociaux de la Montérégie-Centre, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada.,Campus de Longueuil - Université de Sherbrooke - Faculté de médecine et des sciences de la santé, 150 Place Charles-Le Moyne, Longueuil, Québec, (J4K 0A8), Canada
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Lex H, Weisenbach S, Sloane J, Syed S, Rasky E, Freidl W. Social-emotional aspects of quality of life in multiple sclerosis. PSYCHOL HEALTH MED 2017; 23:411-423. [DOI: 10.1080/13548506.2017.1385818] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Heidemarie Lex
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
- Beth Israel Medical Center Neurology, Boston, MA, USA
- Department of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Sara Weisenbach
- Department of Psychiatry, University of Utah, Salt Lake City, UT, USA
| | - Jacob Sloane
- Beth Israel Medical Center Neurology, Boston, MA, USA
| | - Sana Syed
- Beth Israel Medical Center Neurology, Boston, MA, USA
- Tufts Medical Center, Boston, MA, USA
| | - Eva Rasky
- Department of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
| | - Wolfgang Freidl
- Department of Social Medicine and Epidemiology, Medical University of Graz, Graz, Austria
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Struckmann V, Leijten FRM, van Ginneken E, Kraus M, Reiss M, Spranger A, Boland MRS, Czypionka T, Busse R, Rutten-van Mölken M. Relevant models and elements of integrated care for multi-morbidity: Results of a scoping review. Health Policy 2017; 122:23-35. [PMID: 29031933 DOI: 10.1016/j.healthpol.2017.08.008] [Citation(s) in RCA: 84] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Revised: 08/19/2017] [Accepted: 08/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In order to provide adequate care for the growing group of persons with multi-morbidity, innovative integrated care programmes are appearing. The aims of the current scoping review were to i) identify relevant models and elements of integrated care for multi-morbidity and ii) to subsequently identify which of these models and elements are applied in integrated care programmes for multi-morbidity. METHODS A scoping review was conducted in the following scientific databases: Cochrane, Embase, PubMed, PsycInfo, Scopus, Sociological Abstracts, Social Services Abstracts, and Web of Science. A search strategy encompassing a) models, elements and programmes, b) integrated care, and c) multi-morbidity was used to identify both models and elements (aim 1) and implemented programmes of integrated care for multi-morbidity (aim 2). Data extraction was done by two independent reviewers. Besides general information on publications (e.g. publication year, geographical region, study design, and target group), data was extracted on models and elements that publications refer to, as well as which models and elements are applied in recently implemented programmes in the EU and US. RESULTS In the review 11,641 articles were identified. After title and abstract screening, 272 articles remained. Full text screening resulted in the inclusion of 92 articles on models and elements, and 50 articles on programmes, of which 16 were unique programmes in the EU (n=11) and US (n=5). Wagner's Chronic Care Model (CCM) and the Guided Care Model (GCM) were most often referred to (CCM n=31; GCM n=6); the majority of the other models found were only referred to once (aim 1). Both the CCM and GCM focus on integrated care in general and do not explicitly focus on multi-morbidity. Identified elements of integrated care were clustered according to the WHO health system building blocks. Most elements pertained to 'service delivery'. Across all components, the five elements referred to most often are person-centred care, holistic or needs assessment, integration and coordination of care services and/or professionals, collaboration, and self-management (aim 1). Most (n=10) of the 16 identified implemented programmes for multi-morbidity referred to the CCM (aim 2). Of all identified programmes, the elements most often included were self-management, comprehensive assessment, interdisciplinary care or collaboration, person-centred care and electronic information system (aim 2). CONCLUSION Most models and elements found in the literature focus on integrated care in general and do not explicitly focus on multi-morbidity. In line with this, most programmes identified in the literature build on the CCM. A comprehensive framework that better accounts for the complexities resulting from multi-morbidity is needed.
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Affiliation(s)
- Verena Struckmann
- Berlin University of Technology, Department of Health Care Management, Germany.
| | - Fenna R M Leijten
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | - Ewout van Ginneken
- WHO Observatory on Health Systems and Policies, Berlin University of Technology, Department of Health Care Management, Germany
| | | | | | - Anne Spranger
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Melinde R S Boland
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands
| | | | - Reinhard Busse
- Berlin University of Technology, Department of Health Care Management, Germany
| | - Maureen Rutten-van Mölken
- Institute of Health Policy and Management, Erasmus University Rotterdam, The Netherlands; Institute for Medical Technology Assessment, Erasmus University Rotterdam, The Netherlands
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Lenferink A, Brusse‐Keizer M, van der Valk PDLPM, Frith PA, Zwerink M, Monninkhof EM, van der Palen J, Effing TW. Self-management interventions including action plans for exacerbations versus usual care in patients with chronic obstructive pulmonary disease. Cochrane Database Syst Rev 2017; 8:CD011682. [PMID: 28777450 PMCID: PMC6483374 DOI: 10.1002/14651858.cd011682.pub2] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chronic Obstructive Pulmonary Disease (COPD) self-management interventions should be structured but personalised and often multi-component, with goals of motivating, engaging and supporting the patients to positively adapt their behaviour(s) and develop skills to better manage disease. Exacerbation action plans are considered to be a key component of COPD self-management interventions. Studies assessing these interventions show contradictory results. In this Cochrane Review, we compared the effectiveness of COPD self-management interventions that include action plans for acute exacerbations of COPD (AECOPD) with usual care. OBJECTIVES To evaluate the efficacy of COPD-specific self-management interventions that include an action plan for exacerbations of COPD compared with usual care in terms of health-related quality of life, respiratory-related hospital admissions and other health outcomes. SEARCH METHODS We searched the Cochrane Airways Group Specialised Register of trials, trials registries, and the reference lists of included studies to May 2016. SELECTION CRITERIA We included randomised controlled trials evaluating a self-management intervention for people with COPD published since 1995. To be eligible for inclusion, the self-management intervention included a written action plan for AECOPD and an iterative process between participant and healthcare provider(s) in which feedback was provided. We excluded disease management programmes classified as pulmonary rehabilitation or exercise classes offered in a hospital, at a rehabilitation centre, or in a community-based setting to avoid overlap with pulmonary rehabilitation as much as possible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial quality and extracted data. We resolved disagreements by reaching consensus or by involving a third review author. Study authors were contacted to obtain additional information and missing outcome data where possible. When appropriate, study results were pooled using a random-effects modelling meta-analysis. The primary outcomes of the review were health-related quality of life (HRQoL) and number of respiratory-related hospital admissions. MAIN RESULTS We included 22 studies that involved 3,854 participants with COPD. The studies compared the effectiveness of COPD self-management interventions that included an action plan for AECOPD with usual care. The follow-up time ranged from two to 24 months and the content of the interventions was diverse.Over 12 months, there was a statistically significant beneficial effect of self-management interventions with action plans on HRQoL, as measured by the St. George's Respiratory Questionnaire (SGRQ) total score, where a lower score represents better HRQoL. We found a mean difference from usual care of -2.69 points (95% CI -4.49 to -0.90; 1,582 participants; 10 studies; high-quality evidence). Intervention participants were at a statistically significant lower risk for at least one respiratory-related hospital admission compared with participants who received usual care (OR 0.69, 95% CI 0.51 to 0.94; 3,157 participants; 14 studies; moderate-quality evidence). The number needed to treat to prevent one respiratory-related hospital admission over one year was 12 (95% CI 7 to 69) for participants with high baseline risk and 17 (95% CI 11 to 93) for participants with low baseline risk (based on the seven studies with the highest and lowest baseline risk respectively).There was no statistically significant difference in the probability of at least one all-cause hospital admission in the self-management intervention group compared to the usual care group (OR 0.74, 95% CI 0.54 to 1.03; 2467 participants; 14 studies; moderate-quality evidence). Furthermore, we observed no statistically significant difference in the number of all-cause hospitalisation days, emergency department visits, General Practitioner visits, and dyspnoea scores as measured by the (modified) Medical Research Council questionnaire for self-management intervention participants compared to usual care participants. There was no statistically significant effect observed from self-management on the number of COPD exacerbations and no difference in all-cause mortality observed (RD 0.0019, 95% CI -0.0225 to 0.0263; 3296 participants; 16 studies; moderate-quality evidence). Exploratory analysis showed a very small, but significantly higher respiratory-related mortality rate in the self-management intervention group compared to the usual care group (RD 0.028, 95% CI 0.0049 to 0.0511; 1219 participants; 7 studies; very low-quality evidence).Subgroup analyses showed significant improvements in HRQoL in self-management interventions with a smoking cessation programme (MD -4.98, 95% CI -7.17 to -2.78) compared to studies without a smoking cessation programme (MD -1.33, 95% CI -2.94 to 0.27, test for subgroup differences: Chi² = 6.89, df = 1, P = 0.009, I² = 85.5%). The number of behavioural change techniques clusters integrated in the self-management intervention, the duration of the intervention and adaptation of maintenance medication as part of the action plan did not affect HRQoL. Subgroup analyses did not detect any potential variables to explain differences in respiratory-related hospital admissions among studies. AUTHORS' CONCLUSIONS Self-management interventions that include a COPD exacerbation action plan are associated with improvements in HRQoL, as measured with the SGRQ, and lower probability of respiratory-related hospital admissions. No excess all-cause mortality risk was observed, but exploratory analysis showed a small, but significantly higher respiratory-related mortality rate for self-management compared to usual care.For future studies, we would like to urge only using action plans together with self-management interventions that meet the requirements of the most recent COPD self-management intervention definition. To increase transparency, future study authors should provide more detailed information regarding interventions provided. This would help inform further subgroup analyses and increase the ability to provide stronger recommendations regarding effective self-management interventions that include action plans for AECOPD. For safety reasons, COPD self-management action plans should take into account comorbidities when used in the wider population of people with COPD who have comorbidities. Although we were unable to evaluate this strategy in this review, it can be expected to further increase the safety of self-management interventions. We also advise to involve Data and Safety Monitoring Boards for future COPD self-management studies.
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Affiliation(s)
- Anke Lenferink
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineEnschedeNetherlands
- University of TwenteDepartment of Health Technology and Services Research, Faculty of Behavioural SciencesEnschedeNetherlands
- Flinders UniversitySchool of MedicineAdelaideAustralia
| | | | | | - Peter A Frith
- Flinders UniversitySchool of MedicineAdelaideAustralia
- Repatriation General HospitalDepartment of Respiratory MedicineAdelaideAustralia
| | - Marlies Zwerink
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineEnschedeNetherlands
| | - Evelyn M Monninkhof
- University Medical Center UtrechtJulius Center for Health Sciences and Primary CarePO Box 85500UtrechtNetherlands
| | - Job van der Palen
- Medisch Spectrum TwenteDepartment of Pulmonary MedicineEnschedeNetherlands
- University of TwenteDepartment of Research Methodology, Measurement, and Data‐Analysis, Faculty of Behavioral SciencesHaaksbergerstraat 55EnschedeNetherlands
| | - Tanja W Effing
- Flinders UniversitySchool of MedicineAdelaideAustralia
- Repatriation General HospitalDepartment of Respiratory MedicineAdelaideAustralia
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Poplas Susič T. The family medicine reference clinic: an example of interprofessional collaboration within a healthcare team. OBZORNIK ZDRAVSTVENE NEGE 2017. [DOI: 10.14528/snr.2017.51.2.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Since being introduced in 2011, family medicine reference clinics (FMRCs) have created several advantages in the treatment of patients, but have also drawn attention to areas where improvements could be made (Poplas Susič, et al., 2013). Consistent with competencies and experts, each chronic patient care protocol as well as the prevention protocol strictly follows guidelines or recommendations that define diagnostic and treatment as well as education pathways for patient care in a family medicine practice. They are harmonised and agreed with experts at different levels of healthcare (primary, secondary and tertiary) (Vodopivec Jamšek, 2013).
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Evaluation of a Specialized Yoga Program for Persons Admitted to a Complex Continuing Care Hospital: A Pilot Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2016; 2016:6267879. [PMID: 28115969 PMCID: PMC5223015 DOI: 10.1155/2016/6267879] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 10/07/2016] [Accepted: 11/07/2016] [Indexed: 12/20/2022]
Abstract
Introduction. The purpose of this study was to evaluate a specialized yoga intervention for inpatients in a rehabilitation and complex continuing care hospital. Design. Single-cohort repeated measures design. Methods. Participants (N = 10) admitted to a rehabilitation and complex continuing care hospital were recruited to participate in a 50–60 min Hatha Yoga class (modified for wheelchair users/seated position) once a week for eight weeks, with assigned homework practice. Questionnaires on pain (pain, pain interference, and pain catastrophizing), psychological variables (depression, anxiety, and experiences with injustice), mindfulness, self-compassion, and spiritual well-being were collected at three intervals: pre-, mid-, and post-intervention. Results. Repeated measures ANOVAs revealed a significant main effect of time indicating improvements over the course of the yoga program on the (1) anxiety subscale of the Hospital Anxiety and Depression Scale, F(2,18) = 4.74, p < .05, and ηp2 = .35, (2) Self-Compassion Scale-Short Form, F(2,18) = 3.71, p < .05, and ηp2 = .29, and (3) Magnification subscale of the Pain Catastrophizing Scale, F(2,18) = 3. 66, p < .05, and ηp2 = .29. Discussion. The results suggest that an 8-week Hatha Yoga program improves pain-related factors and psychological experiences in individuals admitted to a rehabilitation and complex continuing care hospital.
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Fortin M, Chouinard MC, Dubois MF, Bélanger M, Almirall J, Bouhali T, Sasseville M. Integration of chronic disease prevention and management services into primary care: a pragmatic randomized controlled trial (PR1MaC). CMAJ Open 2016; 4:E588-E598. [PMID: 28018871 PMCID: PMC5173473 DOI: 10.9778/cmajo.20160031] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Chronic disease prevention and management programs are usually single-disease oriented. Our objective was to evaluate an intervention that targeted multiple chronic conditions and risk factors. METHODS We conducted a pragmatic randomized controlled trial involving patients aged 18-75 years with at least 1 of the targeted chronic conditions or risk factors from 8 primary care practices in the Saguenay region of Quebec, Canada, to evaluate an intervention that included self-management support and patient-centred motivational approaches. Self-management (primary outcome) was evaluated using the Health Education Impact Questionnaire (heiQ). Secondary outcomes included self-efficacy, health-related quality of life, psychological distress and health behaviours. RESULTS Three hundred thirty-two patients were recruited and randomly assigned (n = 166 for both intervention and control groups) and evaluated after 3 months. The intervention group showed improvement in 6 of the 8 heiQ domains: health-directed behaviour (relative risk [RR] 1.71, 95% confidence interval [CI] 1.13 to 2.59), emotional well-being (RR 1.73, 95% CI 1.07 to 2.79), self-monitoring and insight (RR 2.40, 95% CI 1.19 to 4.86), constructive attitudes and approaches (RR 2.40, 95% CI 1.37 to 4.21), skill and technique acquisition (RR 1.70, 95% CI 1.14 to 2.53), and health service navigation (RR 1.93, 95% CI 1.08 to 3.47). Improvement was also observed in the Physical Component Summary (p = 0.017) and the Single Index (p = 0.041) of the 12-Item Short Form Health Survey (version 2). The intervention group improved in fruit and vegetable consumption (odds ratio [OR] 2.36, 95% CI 1.41 to 3.95) and physical activity (OR 3.81, 95% CI 1.65 to 8.76). One-year improvement was maintained in the intervention group for several outcomes. INTERPRETATION It is possible to implement an intervention integrating chronic disease prevention and management services into primary care settings. We obtained positive and promising results using this intervention. Trial registration: ClinicalTrials.gov, no.: NCT01319656.
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Affiliation(s)
- Martin Fortin
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - Maud-Christine Chouinard
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - Marie-France Dubois
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - Martin Bélanger
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - José Almirall
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - Tarek Bouhali
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
| | - Maxime Sasseville
- Département de médecine de famille et de médecine d'urgence (Fortin), Université de Sherbrooke, Sherbrooke, Qué.; Département des sciences de la santé (Chouinard, Dubois), Université du Quebec à Chicoutimi, Chicoutimi, Qué.; Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean (Bélanger), Chicoutimi, Qué.; Département de médecine de famille et médecine d'urgence (Almirall, Bouhali), Université de Sherbrooke, Sherbrooke, Qué.; Facultés de Médecine et sciences de la santé (Sasseville), Université de Sherbrooke, Sherbrooke, Qué
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Roberge P, Hudon C, Pavilanis A, Beaulieu MC, Benoit A, Brouillet H, Boulianne I, De Pauw A, Frigon S, Gaboury I, Gaudreault M, Girard A, Giroux M, Grégoire É, Langlois L, Lemieux M, Loignon C, Vanasse A. A qualitative study of perceived needs and factors associated with the quality of care for common mental disorders in patients with chronic diseases: the perspective of primary care clinicians and patients. BMC FAMILY PRACTICE 2016; 17:134. [PMID: 27620166 PMCID: PMC5020556 DOI: 10.1186/s12875-016-0531-y] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 09/01/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The prevalence of comorbid anxiety and depressive disorders is high among patients with chronic diseases in primary care, and is associated with increased morbidity and mortality rates. The detection and treatment of common mental disorders in patients with chronic diseases can be challenging in the primary care setting. This study aims to explore the perceived needs, barriers and facilitators for the delivery of mental health care for patients with coexisting common mental disorders and chronic diseases in primary care from the clinician and patient perspectives. METHODS In this qualitative descriptive study, we conducted semi-structured interviews with clinicians (family physician, nurse, psychologist, social worker; n = 18) and patients (n = 10) from three primary care clinics in Quebec, Canada. The themes explored included clinician factors (e.g., attitudes, perception of roles, collaboration, management of clinical priorities) and patient factors (e.g., needs, preferences, access to care, communication with health professionals) associated with the delivery of care. Qualitative data analysis was conducted based on an interactive cyclical process of data reduction, data display and conclusion drawing and verification. RESULTS Clinician interviews highlighted a number of needs, barriers and enablers in the provision of patient services, which related to inter-professional collaboration, access to psychotherapy, polypharmacy as well as communication and coordination of services within the primary care clinic and the local network. Two specific facilitators associated with optimal mental health care were the broadening of nurses' functions in mental health care and the active integration of consulting psychiatrists. Patients corroborated the issues raised by the clinicians, particularly in the domains of whole-person care, service accessibility and care management. CONCLUSIONS The results of this project will contribute to the development of quality improvement interventions to increase the uptake of organizational and clinical evidence-based practices for patients with chronic diseases and concurrent common mental disorders, in priority areas including collaborative care, access to psychotherapy and linkages with specialized mental health care.
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Affiliation(s)
- Pasquale Roberge
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
- Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC J1H 5N4 Canada
| | - Catherine Hudon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
- Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC J1H 5N4 Canada
| | - Alan Pavilanis
- St. Mary’s Hospital Center, 3830 Lacombe Avenue, Montreal, QC Canada
| | - Marie-Claude Beaulieu
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Annie Benoit
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Hélène Brouillet
- CISSS de la Montérégie-Est, 90 Sainte-Foy Boulevard, Longueuil, QC Canada
| | - Isabelle Boulianne
- Université de Sherbrooke, UMF Chicoutimi, 305, St-Vallier, Chicoutimi, QC Canada
| | - Anna De Pauw
- St. Mary’s Hospital Center, 3830 Lacombe Avenue, Montreal, QC Canada
| | - Serge Frigon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Isabelle Gaboury
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
- Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC J1H 5N4 Canada
| | - Martine Gaudreault
- Université de Sherbrooke, UMF Chicoutimi, 305, St-Vallier, Chicoutimi, QC Canada
| | - Ariane Girard
- Université du Québec à Chicoutimi, 555, Boulevard de l’Université, Chicoutimi, QC Canada
| | - Marie Giroux
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Élyse Grégoire
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Line Langlois
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Martin Lemieux
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Christine Loignon
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
| | - Alain Vanasse
- Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC Canada
- Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC J1H 5N4 Canada
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Ranson NE, Terry DR, Glenister K, Adam BR, Wright J. Integrated and consumer-directed care: a necessary paradigm shift for rural chronic ill health. Aust J Prim Health 2016; 22:176-180. [PMID: 27157713 DOI: 10.1071/py15056] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Accepted: 11/05/2015] [Indexed: 11/23/2022]
Abstract
Chronic ill health has recently emerged as the most important health issue on a global scale. Rural communities are disproportionally affected by chronic ill health. Many health systems are centred on the management of acute conditions and are often poorly equipped to deal with chronic ill health. Cardiovascular disease (CVD) is one of the most prominent chronic ill health conditions and the principal cause of mortality worldwide. In this paper, CVD is used as an example to demonstrate the disparity between rural and urban experience of chronic ill health, access to medical care and clinical outcomes. Advances have been made to address chronic ill health through improving self-management strategies, health literacy and access to medical services. However, given the higher incidence of chronic health conditions and poorer clinical outcomes in rural communities, it is imperative that integrated health care emphasises greater collaboration between services. It is also vital that rural GPs are better supported to work with their patients, and that they use consumer-directed approaches to empower patients to direct and coordinate their own care.
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Affiliation(s)
- Nicole E Ranson
- Melbourne Medical School, Level 2 West, Medical Building (181), University of Melbourne, Vic. 3010, Australia
| | - Daniel R Terry
- Department of Rural Health, University of Melbourne, PO Box 6500 Shepparton, Vic. 3632, Australia
| | - Kristen Glenister
- Department of Rural Health, University of Melbourne, PO Box 386 Wangaratta, Vic. 3676, Australia
| | - Bill R Adam
- Department of Rural Health, University of Melbourne, PO Box 6500 Shepparton, Vic. 3632, Australia
| | - Julian Wright
- Department of Rural Health, University of Melbourne, PO Box 6500 Shepparton, Vic. 3632, Australia
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Saunders C, Carter DJ. Is health systems integration being advanced through Local Health District planning? AUST HEALTH REV 2016; 41:154-161. [PMID: 27096436 DOI: 10.1071/ah15191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Accepted: 03/08/2015] [Indexed: 11/23/2022]
Abstract
Objective Delivering genuine integrated health care is one of three strategic directions in the New South Wales (NSW) Government State Health Plan: Towards 2021. This study investigated the current key health service plan of each NSW Local Health District (LHD) to evaluate the extent and nature of health systems integration strategies that are currently planned. Methods A scoping review was conducted to identify common key principles and practices for successful health systems integration to enable the development of an appraisal tool to content assess LHD strategic health service plans. Results The strategies that are planned for health systems integration across LHDs focus most often on improvements in coordination, health care access and care delivery for complex at-risk patients across the care continuum by both state- and commonwealth-funded systems, providers and agencies. The most common reasons given for integrated activities were to reduce avoidable hospitalisation, avoid inappropriate emergency department attendance and improve patient care. Conclusions Despite the importance of health systems integration and finding that all NSW LHDs have made some commitment towards integration in their current strategic health plans, this analysis suggests that health systems integration is in relatively early development across NSW. What is known about the topic? Effective approaches to managing complex chronic diseases have been found to involve health systems integration, which necessitates sound communication and connection between healthcare providers across community and hospital settings. Planning based on current health systems integration knowledge to ensure the efficient use of scarce resources is a responsibility of all health systems. What does this paper add? Appropriate planning and implementation of health systems integration is becoming an increasingly important expectation and requirement of effective health systems. The present study is the first of its kind to assess the planned activity in health systems integration in the NSW public health system. NSW health districts play a central role in health systems integration; each health service plan outlines the strategic directions for the development and delivery of all state-funded services across each district for the coming years, equating to hundreds of millions of dollars in health sector funding. The inclusion of effective health systems integration strategies allows Local Health Districts to lay the foundation for quality patient outcomes and long-term financial sustainability despite projected increases in demand for health services. What are the implications for practice? Establishing robust ongoing mechanisms for effective health systems integration is now a necessary part of health planning. The present study identifies several key areas and strategies that are wide in scope and indicative of efforts towards health systems integration, which may support Local Health Districts and other organisations in systematic planning and implementation.
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Affiliation(s)
- Carla Saunders
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Jones Street, Ultimo, NSW 2007(PO Box 222), Australia. Email
| | - David J Carter
- Centre for Health Services Management, Faculty of Health, University of Technology Sydney, Jones Street, Ultimo, NSW 2007(PO Box 222), Australia. Email
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Maestre-Miquel C, Figueroa C, Santos J, Astasio P, Gil P. [Counseling and preventive action in elderly population in hospitals and residences in Spain]. Aten Primaria 2016; 48:550-556. [PMID: 26920448 PMCID: PMC6877857 DOI: 10.1016/j.aprim.2015.10.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 10/08/2015] [Accepted: 10/25/2015] [Indexed: 12/24/2022] Open
Abstract
Objetivos Conocer el perfil sociosanitario de los pacientes mayores atendidos en consultas; conocer las acciones preventivas que se llevan a cabo, de forma rutinaria, en hospitales, residencias geriátricas y otros centros asistenciales en España. Diseño Estudio descriptivo transversal, basado en un cuestionario a médicos que atienden a población mayor de 65 años en España (2013). Emplazamiento Centros de diferentes comunidades autónomas en España. Participantes: Un total de 420 médicos de hospitales, residencias y otros centros. Se obtuvieron datos de 840 consultas a pacientes geriátricos. Mediciones principales Variables principales de resultados: dependencia, comorbilidad, motivo de consulta, actuación en consulta y recomendación de estilos de vida saludable. Factor asociado, tipo de institución en la que se atendió al paciente. Análisis de prevalencias y diferencias con Chi-cuadrado. Resultados El 66,7% presentaban dependencia, siendo mayor entre las mujeres: 68,9% vs 62,4% (p = 0,055). El 88,6% de mujeres atendidas con 85 o más años presentaban comorbilidad, mientras que en hombres de ese mismo grupo de edad eran un 79,8%. Solo un 6,6% de pacientes con comorbilidad recibieron recomendaciones saludables durante la consulta. El 79,6% de pacientes atendidos en hospitales recibieron recomendaciones de estilo de vida saludable, mientras que en las residencias geriátricas las recibieron el 59,62% de los pacientes (p < 0,001). Conclusiones Se detecta una escasa acción preventiva y de promoción de la salud hacia las personas mayores, con diferencias entre hospitales y residencias geriátricas. Parece necesario incentivar la actitud promotora de salud y las intervenciones preventivas en la práctica clínica gerontológica.
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Affiliation(s)
- Clara Maestre-Miquel
- Departamento de Enfermería y Fisioterapia, Facultad de Terapia Ocupacional, Logopedia y Enfermería, Universidad de Castilla-La Mancha, Talavera de la Reina, Toledo, España.
| | - Carmen Figueroa
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Juana Santos
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Paloma Astasio
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Complutense, Madrid, España
| | - Pedro Gil
- Departamento de Medicina Preventiva y Salud Pública, Facultad de Medicina, Universidad Complutense, Madrid, España; Departamento de Geriatría, Hospital Clínico San Carlos, Madrid, España
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Ahmed S, Ware P, Visca R, Bareil C, Chouinard MC, Desforges J, Finlayson R, Fortin M, Gauthier J, Grimard D, Guay M, Hudon C, Lalonde L, Lévesque L, Michaud C, Provost S, Sutton T, Tousignant P, Travers S, Ware M, Gogovor A. The prevention and management of chronic disease in primary care: recommendations from a knowledge translation meeting. BMC Res Notes 2015; 8:571. [PMID: 26471509 PMCID: PMC4608115 DOI: 10.1186/s13104-015-1514-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 09/21/2015] [Indexed: 12/29/2022] Open
Abstract
Background Seven chronic disease prevention and management programs were implemented across Quebec with funding support from a provincial-private industry funding initiative. Given the complexity of implementing integrated primary care chronic disease management programs, a knowledge transfer meeting was held to share experiences across programs and synthesize common challenges and success factors for implementation. Methods The knowledge translation meeting was held in February 2014 in Montreal, Canada. Seventy-five participants consisting of 15 clinicians, 14 researchers, 31 knowledge users, and 15 representatives from the funding agencies were broken up into groups of 10 or 11 and conducted a strengths, weaknesses, opportunities, and threats analysis on either the implementation or the evaluation of these chronic disease management programs. Results were reported back to the larger group during a plenary and recorded. Audiotapes were transcribed and summarized using pragmatic thematic analysis. Results and discussion Strengths to leverage for the implementation of the seven programs include: (1) synergy between clinical and research teams; (2) stakeholders working together; (3) motivation of clinicians; and (4) the fact that the programs are evidence-based. Weaknesses to address include: (1) insufficient resources; (2) organizational change within the clinical sites; (3) lack of referrals from primary care physicians; and (4) lack of access to programs. Strengths to leverage for the evaluation of these programs include: (1) engagement of stakeholders and (2) sharing of knowledge between clinical sites. Weaknesses to address include: (1) lack of referrals; (2) difficulties with data collection; and (3) difficulties in identifying indicators and control groups. Opportunities for both themes include: (1) fostering new and existing partnerships and stakeholder relations; (2) seizing funding opportunities; (3) knowledge transfer; (4) supporting the transformation of professional roles; (5) expand the use of health information technology; and (6) conduct cost evaluations. Fifteen recommendations related to mobilisation of primary care physicians, support for the transformation of professional roles, and strategies aimed at facilitating the implementation and evaluation of chronic disease management programs were formulated based on the discussions at this knowledge translation event. Conclusion The results from this knowledge translation day will help inform the sustainability of these seven chronic disease management programs in Quebec and the implementation and evaluation of similar programs elsewhere. Electronic supplementary material The online version of this article (doi:10.1186/s13104-015-1514-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Sara Ahmed
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada. .,Constance-Lethbridge Rehabilitation Center, Centre de recherche interdisciplinaire en réadaptation (CRIR), 7005 Boulevard De Maisonneuve O, Montréal, Quebec, H4B 1T3, Canada. .,Clinical Epidemiology, McGill University Health Center, 687 Pine Ave W, Montreal, QC, H3A 1A1, Canada.
| | - Patrick Ware
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
| | - Regina Visca
- Centre for Expertise in Chronic Pain of the Réseau universitaire intégré de santé McGill, 2155 Guy, Montreal, QC, H3H 2R9, Canada.
| | - Celine Bareil
- Department of Management, HEC Montreal, 3000, chemin de la Côte-Sainte-Catherine, Montreal, QC, H3T 2A7, Canada.
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, 555 boul. de l'Université, Chicoutimi, QC, G7H 2B1, Canada. .,Centre de santé et de services sociaux de Chicoutimi, 305 St-Vallier, Chicoutimi, QC, G7H 5H6, Canada.
| | - Johanne Desforges
- Groupe de médecine de famille de Verdun, 4000, boulevard Lasalle, Verdun, QC, H4G 2A3, Canada.
| | - Roderick Finlayson
- Centre for Expertise in Chronic Pain of the Réseau universitaire intégré de santé McGill, 2155 Guy, Montreal, QC, H3H 2R9, Canada.
| | - Martin Fortin
- Centre de santé et de services sociaux de Chicoutimi, 305 St-Vallier, Chicoutimi, QC, G7H 5H6, Canada. .,Département de médecine de famille et médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12ème avenue Nord, Fleurimont, QC, J1H 5N4, Canada.
| | - Josée Gauthier
- Institut national de santé publique du Quebec, Consortium InterEst Santé, Département des sciences infirmières, Université du Québec à Rimouski, 300 Allée des Ursulines, Bureau K-310, Rimouski, QC, G5L 3A1, Canada.
| | - Dominique Grimard
- Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, 1301 Sherbrooke Est, Montreal, QC, H2L 1M3, Canada.
| | - Maryse Guay
- Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5N4, Canada. .,Direction de santé publique de l'Agence de la santé et des services sociaux de la Montérégie, 1255 Beauregard, Longueuil, J4H 2M3, Canada.
| | - Catherine Hudon
- Département de médecine de famille et médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001 12ème avenue Nord, Fleurimont, QC, J1H 5N4, Canada.
| | - Lyne Lalonde
- Faculté de pharmacie, Université de Montréal, pavillion Jean-Coutu, Montreal, QC, H3C 3J7, Canada. .,Centre de santé et de services sociaux de Laval, 1755 boulevard René-Laennec, Laval, QC, H7M 3L9, Canada.
| | - Lise Lévesque
- Centre de santé et de services sociaux de Laval, 1755 boulevard René-Laennec, Laval, QC, H7M 3L9, Canada.
| | - Cecile Michaud
- Faculté de médecine et des sciences de la santé, École des sciences infirmières, Université de Sherbrooke, Campus de Longueil, 150, Place Charles LeMoyne, Bureau 200, Sherbrooke, QC, J4K 0A8, Canada.
| | - Sylvie Provost
- Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, 1301 Sherbrooke Est, Montreal, QC, H2L 1M3, Canada.
| | - Tim Sutton
- Centre de santé et de services sociaux du Roché-Percé, 451, rue MGR-Ross Est, C.P. 3300, Chandler, QC, G0C 1K0, Canada.
| | - Pierre Tousignant
- Direction de santé publique de l'Agence de la santé et des services sociaux de Montréal, 1301 Sherbrooke Est, Montreal, QC, H2L 1M3, Canada.
| | - Stella Travers
- Centre de santé et de services sociaux du Roché-Percé, 451, rue MGR-Ross Est, C.P. 3300, Chandler, QC, G0C 1K0, Canada.
| | - Mark Ware
- Alan Edwards Pain Management Unit of the McGill University Health Centre, 650 Cedar Avenue, Montreal, QC, H3G 1A4, Canada.
| | - Amede Gogovor
- Faculty of Medicine, School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada.
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Benzer JK, Cramer IE, Burgess JF, Mohr DC, Sullivan JL, Charns MP. How personal and standardized coordination impact implementation of integrated care. BMC Health Serv Res 2015; 15:448. [PMID: 26432790 PMCID: PMC4592548 DOI: 10.1186/s12913-015-1079-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 09/18/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Integrating health care across specialized work units has the potential to lower costs and increase quality and access to mental health care. However, a key challenge for healthcare managers is how to develop policies, procedures, and practices that coordinate care across specialized units. The purpose of this study was to identify how organizational factors impacted coordination, and how to facilitate implementation of integrated care. METHODS Semi-structured interviews were conducted in August 2009 with 30 clinic leaders and 35 frontline staff who were recruited from a convenience sample of 16 primary care and mental health clinics across eight medical centers. Data were drawn from a management evaluation of primary care-mental health integration in the US Department of Veterans Affairs. To protect informant confidentiality, the institutional review board did not allow quotations. RESULTS Interviews identified antecedents of organizational coordination processes, and highlighted how these antecedents can impact the implementation of integrated care. Overall, implementing new workflow practices were reported to create conflicts with pre-existing standardized coordination processes. Personal coordination (i.e., interpersonal communication processes) between primary care leaders and staff was reported to be effective in overcoming these barriers both by working around standardized coordination barriers and modifying standardized procedures. DISCUSSION This study identifies challenges to integrated care that might be solved with attention to personal and standardized coordination. A key finding was that personal coordination both between primary care and mental health leaders and between frontline staff is important for resolving barriers related to integrated care implementation. CONCLUSION Integrated care interventions can involve both new standardized procedures and adjustments to existing procedures. Aligning and integrating procedures between primary care and specialty care requires personal coordination amongst leaders. Interpersonal relationships should be strengthened between staff when personal connections are important for coordinating patient care across clinical settings.
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Affiliation(s)
- Justin K Benzer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
- VISN 17 Center of Excellence for Research on Returning War Veterans, Waco, TX, USA.
| | - Irene E Cramer
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - James F Burgess
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - David C Mohr
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - Jennifer L Sullivan
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
| | - Martin P Charns
- Center for Healthcare Organization and Implementation Research, VA Boston Healthcare System, 150 S. Huntington Ave (152-M), Boston, MA, 02130, USA.
- Department of Health Policy and Management, Boston University School of Public Health, 715 Albany Street Talbot Building, T2W, Boston, MA, 02118, USA.
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Bélanger A, Hudon C, Fortin M, Amirall J, Bouhali T, Chouinard MC. Validation of a French-language version of the health education impact Questionnaire (heiQ) among chronic disease patients seen in primary care: a cross-sectional study. Health Qual Life Outcomes 2015; 13:64. [PMID: 26306793 PMCID: PMC4549914 DOI: 10.1186/s12955-015-0254-0] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 04/30/2015] [Indexed: 01/05/2023] Open
Abstract
Background The Health Education Impact Questionnaire (heiQ) allows for the evaluation of the effects of education interventions provided to patients with chronic diseases. This study describes the process for the cross-cultural adaptation and validation of the heiQ into French (heiQ-Fv). Methods We undertook a systematic translation process followed by a validation study based on the secondary analysis of cross-sectional data from a longitudinal study. Participants in the validation study were adult patients from primary care clinics in Quebec, Canada, with one or more of the following diseases: diabetes, asthma, chronic obstructive pulmonary disease, cardiovascular disease; or one or more risk factors for these diseases. Main outcomes of the study were the French version of the heiQ-Fv and the validation analyses that included internal consistency, test-retest reliability, confirmatory factor analysis (CFA) and concomitant validity. Results The validation analysis was conducted on results from 332 participants. Cronbach’s alphas (internal consistency) for seven domains of the heiQ-Fv varied from 0.80 to 0.89; one domain scored 0.69. The test-retest analysis (n = 50) yielded intra-class correlation coefficients from 0.66 to 0.86. The CFA of the eight heiQ domains with the hypothesis of no correlation between the domains yielded a model that did not exhibit acceptable fit values. A model with the hypothesis of all domains correlated exhibited acceptable fit values (scaled chi-square = 1210.15, degrees of freedom = 712, p < 0.001; CFI = 0.98; RMSEA = 0.06; SRMR = 0.065). Results show a moderate correlation (concomitant validity) between five domains of the heiQ-Fv and the Self-Efficacy for Managing Chronic Diseases. We also found a moderate to strong correlation between the Emotional Wellbeing domain of the heiQ and the Kessler Psychological Distress Scale (K6) (r = 0.61; 95 % CI: 0.52 –0.69, p < 0.01). Conclusions The heiQ was translated into French using a rigorous translation process; the French-language version showed good psychometric properties. Health professionals and researchers in primary care settings may use the heiQ-FV to evaluate the impact of educational programs on patients with chronic diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12955-015-0254-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Bélanger
- Registered nurse and graduate student, Department of health sciences, Université du Québec à Chicoutimi (UQAC), Quebec, Canada.
| | - Catherine Hudon
- Family physician and professor, Department of family medicine and emergency medicine, Université de Sherbrooke, Quebec, Canada.
| | - Martin Fortin
- Family physician and professor, Department of family medicine and emergency medicine, Université de Sherbrooke, Quebec, Canada.
| | - José Amirall
- Adjunct professor, Department of family medicine and emergency medicine, Université de Sherbrooke, Quebec, Canada.
| | - Tarek Bouhali
- Adjunct professor, Department of family medicine and emergency medicine, Université de Sherbrooke, Quebec, Canada.
| | - Maud-Christine Chouinard
- Registered nurse and professor, Department of health sciences, Université du Québec à Chicoutimi (UQAC), Québec, Canada.
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Hujala A, Rijken M, Laulainen S, Taskinen H, Rissanen S. People with multimorbidity: forgotten outsiders or dynamic self-managers? J Health Organ Manag 2015; 28:696-712. [PMID: 25735425 DOI: 10.1108/jhom-10-2013-0221] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE The purpose of this paper is to draw attention to the discursive construction of multimorbidity. The study illustrates how the social reality of multimorbidity and the agency of patients are discursively constructed in scientific articles addressing care for people with multiple chronic conditions. DESIGN/METHODOLOGY/APPROACH The study is based on the postmodern assumptions about the power of talk and language in the construction of reality. Totally 20, scientific articles were analysed by critically oriented discourse analysis. The interpretations of the findings draw on the agency theories and principals of critical management studies. FINDINGS Four discourses were identified: medical, technical, collaborative and individual. The individual discourse challenges patients to become self-managers of their health. It may, however, go too far in the pursuit of patients' active agency. The potential restrictions and consequences of a "business-like" orientation must be paid careful attention when dealing with patients with multimorbidity. RESEARCH LIMITATIONS/IMPLICATIONS The data consisted solely of scientific texts and findings therefore serve as limited illustrations of the discursive construction of multimorbidity. In future, research focusing for example on political documents and practice talk of professionals and patients is needed. Social implications - The findings highlight the power of talk and importance of ethical considerations in the development of care for challenging patient groups. ORIGINALITY/VALUE By identifying the prevailing discourses the study attempts to cast doubt on the taken-for-granted understandings about the agency of patients with multimorbidity.
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Raivio R, Jääskeläinen J, Holmberg-Marttila D, Mattila KJ. Decreasing trends in patient satisfaction, accessibility and continuity of care in Finnish primary health care - a 14-year follow-up questionnaire study. BMC FAMILY PRACTICE 2014; 15:98. [PMID: 24885700 PMCID: PMC4030039 DOI: 10.1186/1471-2296-15-98] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Accepted: 05/07/2014] [Indexed: 11/10/2022]
Abstract
BACKGROUND The aim here was to explore trends in patient satisfaction with primary health care and its accessibility and continuity, and to explore whether through reforms and improvements some of the essential goals had been achieved over a 14-year period of time in Finland. METHODS Nine questionnaire surveys were conducted over a period of 14 years among patients attending within one week in the 65 health centres in the Tampere University Hospital catchment area. A total of 147,394 responded out of a sample of 333,648 patients. The response rate varied yearly from 53% to 37%. RESULTS Patient satisfaction with care in Finnish health centres decreased by nearly 9 percentage units from 1998 to 2011. The fall-off was most marked in the age-group over 64 years. There was a 20 percentage unit's reduction in ease of access as reported by patients. Respondents also reported that the continuity of care had deteriorated. CONCLUSIONS Despite major reforms in Finnish health care policy, patients seem to be less satisfied. Our findings challenge both Finnish authorities and GPs to improve the accessibility and continuity of care in primary health services.
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Affiliation(s)
- Risto Raivio
- Primary Care Unit, Joint Authority for Päijät-Häme Social and Health Care Group, Keskussairaalankatu 7, FI-15850 Lahti, Finland
- School of Medicine, Department of General Practice, FI-33014 University of Tampere, Tampere, Finland
| | - Juhani Jääskeläinen
- School of Medicine, Department of General Practice, FI-33014 University of Tampere, Tampere, Finland
| | - Doris Holmberg-Marttila
- Centre of General Practice, Pirkanmaa Hospital District, P.O. Box 2000, FI-33521 Tampere, Finland
| | - Kari J Mattila
- School of Medicine, Department of General Practice, FI-33014 University of Tampere, Tampere, Finland
- Centre of General Practice, Pirkanmaa Hospital District, P.O. Box 2000, FI-33521 Tampere, Finland
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