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Hall AJ, Dillon B, Pryce H, Ambler M, Hanvey K. A qualitative exploration of the assessment process to cochlear implantation for children with hearing loss. Int J Audiol 2024:1-9. [PMID: 39373479 DOI: 10.1080/14992027.2024.2400328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Revised: 08/19/2024] [Accepted: 08/28/2024] [Indexed: 10/08/2024]
Abstract
OBJECTIVE To explore the process of paediatric cochlear implant assessment, from referral to implantation, from the perspective of parents, cochlear implant professionals, and through observations of clinics. DESIGN Qualitative approach, using grounded theory methodology. STUDY SAMPLE Twelve families with children under 5 years with permanent hearing loss referred for a cochlear implant or received an implant in the past year, and six professionals who refer or assess children for cochlear implants. Data collection involved interviews and ethnographic observations of assessment clinics. RESULTS The core theme derived from interview and observation data related to the work of the cochlear implant assessment for families. The relationship between the work generated by the assessment process and capacity of parents to do the work provides a model to examine access to early implantation, consistent with the Burden of Treatment theory. We identified variation in terms of workload, relating to factors such as a child's additional needs or number of appointments required, and in terms of capacity, relating to factors such as social circumstances or health literacy. Social, peer and professional support and information helped families manage the workload. CONCLUSIONS Findings have implications for delivery of paediatric cochlear implant services.
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Affiliation(s)
- Amanda J Hall
- Department of Audiology, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Briony Dillon
- Department of Audiology, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Helen Pryce
- Department of Audiology, College of Health and Life Sciences, Aston University, Birmingham, United Kingdom
| | - Marette Ambler
- The Midlands Hearing Implant Programme, Aston University Day Hospital, Aston University, Birmingham, United Kingdom
| | - Kate Hanvey
- The Midlands Hearing Implant Programme, Aston University Day Hospital, Aston University, Birmingham, United Kingdom
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2
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Osborn TG, Town R, Bawendi M, Stapley E, Saunders R, Fonagy P. University students' access to mental health services: A qualitative study of the experiences of health service professionals through the lens of candidacy in England. J Health Serv Res Policy 2024; 29:230-239. [PMID: 38414282 PMCID: PMC11346130 DOI: 10.1177/13558196241235877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/29/2024]
Abstract
OBJECTIVES In order to develop a better understanding of students' access to mental health services, we explored the experiences of health care professionals interacting with university students with mental health problems. METHODS We interviewed 23 professionals working across university advice and counselling services, NHS general practice, crisis, and psychological services in North and East London between June 2022 and January 2023. Our approach drew on reflexive thematic analysis and the principles of abductive analysis. The notion of candidacy - that is, how different needs are deemed deserving of health service attention - was particularly helpful to our understanding of the ongoing phenomenon of interest in the data. RESULTS Each student's access to mental health support was highly contingent on the student's dynamic social context and the pressures and organisation of the local health system. Professionals described how different students viewed different needs as deserving of health service attention. Which students reached the professional's service depended on the resources and relationships a student could draw upon, and the service's relative permeability. Once there, what action professionals took was strongly influenced by the professional's service expertise, resource constraints, the relationships the professional's service had with other organisations, the students' wishes, and whether students regarded treatment offers as acceptable. CONCLUSIONS Candidacy offers a useful lens to view university students' access to mental health support. Access appears to be an increasingly intricate task for students, given the fragmented service landscape, surging demand for mental health care and challenges of emerging adulthood. Our findings suggest that policy goals to increase use of mental health services are unlikely to improve outcomes for students without policy makers and health systems giving holistic consideration of inter-service relationships and available resources.
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Affiliation(s)
- Tom G Osborn
- ARC Research Assistant, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Rosa Town
- Digital Community Manager, The Tavistock and Portman NHS Foundation Trust, London, UK
| | - Majeed Bawendi
- MBBS Student, UCL Medical School, University College London, London, UK
| | - Emily Stapley
- Senior Research Fellow, Evidence Based Practice Unit, University College London, London, UK
| | - Rob Saunders
- Associate Professor, CORE Data Lab, Research Department of Clinical, Educational and Health Psychology, University College London, London, UK
| | - Peter Fonagy
- Professor, Division of Psychology and Language Sciences, University College London, London, UK
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3
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Cavers D, Cunningham‐Burley S, Watson E, Banks E, Campbell C. Living With and Beyond Cancer With Comorbid Conditions: Qualitative Insights to Understand Psychosocial Support Needs. Health Expect 2024; 27:e70039. [PMID: 39369340 PMCID: PMC11456226 DOI: 10.1111/hex.70039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Revised: 08/27/2024] [Accepted: 09/08/2024] [Indexed: 10/07/2024] Open
Abstract
INTRODUCTION There is a pressing need to understand and explore the complex experiences and psychosocial support needs of people LWBC-CM and their informal caregivers, to inform survivorship and supportive care interventions. METHODS In-depth qualitative interviews were conducted with people LWBC-CM and their informal caregivers in Scotland, invited via primary care. One-to-one, face-to-face interviews were conducted with informed consent exploring experiences of symptoms, psychosocial support needs and interactions with health services. Interviews were transcribed and analysed using a thematic approach. RESULTS Forty-one people LWBC-CM and twenty-three informal caregivers were interviewed. Four themes were identified: the Physical and Psychological Impact of Cancer and Comorbidity, Dominant Storie-Prioritising Conditions and Making Sense of Illness, Navigating Health Services and Treatments and Caring for People with Complex Health Conditions. Type and severity of conditions mediated people's experiences and daily living. Complex fatigue-fatigue arising from a number of health conditions-dominated symptomology. Participants navigated multiple appointments and complex medication regimes. Patients identified the need for acknowledgement of other chronic conditions and for streamlined care provision. Mutual caring and social isolation were also identified as part of the caring relationship. CONCLUSIONS There is a mandate to address the psychosocial support needs of people LWBC-CM, and their informal carers, given the burden of treatment for cancer survivors with moderate to severe complex conditions as they navigate health services. PATIENT OR PUBLIC CONTRIBUTION A patient representative has been involved in all stages of the study from development of the application through study design, commenting on documentation, analysis of transcripts and writing the manuscript. They are included as an author on the manuscript.
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Affiliation(s)
| | | | - Eila Watson
- Faculty of Health and Life SciencesOxford Brookes UniversityOxfordUK
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Papoutsi C, Abel G, Iglesias C, van Dael J, Reidy C, Faulkner SD, Raynsford H, Siciliano M, Beltran Galindo L, Gc V, Campbell J, Greenhalgh T, Shaw SE. Evaluating video and hybrid group consultations in general practice: mixed-methods, participatory study protocol (TOGETHER 2). NIHR OPEN RESEARCH 2024; 4:30. [PMID: 39310089 PMCID: PMC11415752 DOI: 10.3310/nihropenres.13584.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/17/2024] [Indexed: 09/25/2024]
Abstract
Background General practice is facing an unprecedented challenge in managing the consequences of the pandemic. In the midst of a policy drive to balance remote and in-person service provision, substantial workload pressures remain, together with increasing prevalence of long-term conditions, and declining staff numbers and morale. To address these challenges, some practices in the UK have been delivering video and hybrid group consultations (VHGCs) providing clinical care to multiple patients at the same time. Despite positive initial findings and enthusiasm, there are still gaps in our understanding of the influence VHGCs have on patient experience, healthcare utilisation, quality, safety, equity and affordability. Objectives To generate an in-depth understanding of VHGCs for chronic conditions in general practice, surface assumptions and sociotechnical dynamics, inform practice and extend theorisation. Methods Mixed-methods, multi-site research study using co-design and participatory methods, from qualitative, quantitative and cost-related perspectives. WP1 includes a national, cross-sectional survey on VHGC provision across the UK. In WP2 we will engage patients and general practice staff in co-design workshops to develop VHGC models with emphasis on digital inclusion and equity. In WP3 we will carry out a mixed-methods process evaluation in up to 10 GP practices across England (5 sites already running VHGCs and 5 comparison sites). Qualitative methods will include interviews, focus groups and ethnographic observation to examine the experiences of patients, carers, clinical and non-clinical NHS staff, commissioners and policy-makers. Quantitative methods will examine the impact of VHGCs on healthcare utilisation in primary and secondary care, patient satisfaction, engagement and activation. We will also assess value for money of group and individual care models from a health economics perspective. Conclusions We aim to develop transferable learning on sociotechnical change in healthcare delivery, using VHGCs as an exemplar of technology-supported innovation. Findings will also inform the design of a future study.
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Affiliation(s)
- Chrysanthi Papoutsi
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, OX26GG, UK
| | - Gary Abel
- Department of Health and Community Science, Smeall Building, St Luke’s Campus, University of Exeter, Exeter, England, EX1 2LU, UK
| | - Cynthia Iglesias
- Department of Health Sciences, Seebohm Rowntree Building, University of York, York, England, YO10 5SQ, UK
| | - Jackie van Dael
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, OX26GG, UK
| | - Claire Reidy
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, OX26GG, UK
| | - Stuart D Faulkner
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, OX26GG, UK
| | | | - Michele Siciliano
- Department of Health Sciences, Seebohm Rowntree Building, University of York, York, England, YO10 5SQ, UK
| | - Luis Beltran Galindo
- Department of Health Sciences, Seebohm Rowntree Building, University of York, York, England, YO10 5SQ, UK
| | - Vijay Gc
- School of Human & Health Sciences, University of Huddersfield, Huddersfield, England, UK
| | - John Campbell
- Department of Health and Community Science, Smeall Building, St Luke’s Campus, University of Exeter, Exeter, England, EX1 2LU, UK
| | - Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, OX26GG, UK
| | - Sara E Shaw
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England, OX26GG, UK
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Roberts K, Baysari M, Ho E, Beckenkamp P, Tian Y, Jennings M, Amorim A, Maka K, Morton R, Ceprnja D, Halliday M, Ferreira M, Ferreira P. A community health-coaching referral program following discharge from treatment for chronic low back pain - a qualitative study of the patient's perspective. BMC Health Serv Res 2024; 24:1072. [PMID: 39285417 PMCID: PMC11403819 DOI: 10.1186/s12913-024-11509-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Accepted: 08/28/2024] [Indexed: 09/22/2024] Open
Abstract
BACKGROUND Global policy and guidelines for low back pain (LBP) management promote physical activity and self-management yet adherence is poor and a decline in outcomes is common following discharge from treatment. Health coaching is effective at improving exercise adherence, self-efficacy, and social support in individuals with chronic conditions, and may be an acceptable, cost-effective way to support people in the community following discharge from treatment for LBP. AIM This qualitative study aimed to understand which aspects of a community over-the-phone health-coaching program, were liked and disliked by patients as well as their perceived outcomes of the service after being discharged from LBP treatment. METHODS A purposive sampling approach was used to recruit 12 participants with chronic LBP, from a large randomised controlled trial, who were randomly allocated to receive a health coaching program from the Get Healthy Service® in Australia. Semi-structured interviews were conducted, and a general inductive thematic analysis approach was taken. RESULTS The main themes uncovered regarding the intervention included the positive and negative aspects of the health coaching service and the relationship between the participant and health coach. Specifically, the participants spoke of the importance of the health coach, the value of goal setting, the quality of the advice received, the benefits of feeling supported, the format of the coaching service, and LBP-specific knowledge. They also reported the health coach and the coaching relationship to be the primary factors influencing the program outcomes and the qualities of the coaching relationship they valued most were connection, communication, care, and competence. The sub-themes uncovered regarding the outcomes of the intervention included positive impacts (a greater capacity to cope, increased confidence, increased motivation and increased satisfaction) and negative impacts (receiving no personal benefit). CLINICAL IMPLICATIONS In an environment where self-management and self-care are becoming increasingly important, understanding the patient's experience as part of a coaching program is likely to lead to improved quality of health coaching care, more tailored service delivery and potentially more effective and cost-effective community-based care for individuals with chronic LBP in the community after being discharged from treatment. TRIAL REGISTRATION The GBTH trial was prospectively registered with the Australian New Zealand Clinical Trials Registry (ACTRN12620000889954) on 10/9/2020. Ethical approval was prospectively granted by the Western Sydney Local Health District Human Research and Ethics Committee (2020/ETH00115). Written informed consent was obtained from all participants. The relevant sponsor has reviewed the study protocol and consent form.
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Affiliation(s)
- Katharine Roberts
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
| | - Melissa Baysari
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Emma Ho
- Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Paula Beckenkamp
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Ye Tian
- Faculty of Medicine and Health, School of Health Sciences, The University of Sydney, Sydney, Australia
| | - Matthew Jennings
- South Western Sydney Local Health District, Sydney, NSW, Australia
| | - Anita Amorim
- Physiotherapy Department, Westmead Hospital, Sydney, NSW, Australia
| | - Katherine Maka
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Rachael Morton
- Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Dragana Ceprnja
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
| | - Mark Halliday
- The George Institute for Global Health, The University of New South Wales, Sydney, Australia
| | - Manuela Ferreira
- Faculty of Medicine and Health, School of Health Sciences, Charles Perkins Centre, The University of Sydney, Sydney, Australia
| | - Paulo Ferreira
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Camperdown, NSW, Australia
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6
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Jin R, Liu C, Chen J, Cui M, Xu B, Yuan P, Chen L. Exploring medication self-management in polypharmacy: a qualitative systematic review of patients and healthcare providers perspectives. Front Pharmacol 2024; 15:1426777. [PMID: 39376612 PMCID: PMC11456697 DOI: 10.3389/fphar.2024.1426777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2024] [Accepted: 08/28/2024] [Indexed: 10/09/2024] Open
Abstract
Purpose: Polypharmacy presents many challenges to patient medication self-management. This study aims to explore the self-management processes of medication in polypharmacy from the perspectives of both patients and healthcare providers, which can help identify barriers and facilitators to effective management. Methods: A systematic review of qualitative studies was performed by searching seven databases: PubMed, Web of Science, Cochrane Library, Embase, CINAHL, PsycINFO, and MEDLINE, from their establishment until August 2024. The Critical Appraisal Skills Programme (CASP) tool was employed to evaluate the quality of the studies included. The extracted data were then analysed thematically and integrated into The Taxonomy of Everyday Self-management Strategies (TEDSS) framework. Results: A total of 16 studies were included, involving 403 patients and 119 healthcare providers. Patient management measures were mapped into TEDSS framework, including categories such as medical management, support-oriented domains, and emotional and role management. Conclusion: Enhancing patients' proactive health awareness, improving medication literacy, balancing lifestyle adjustments with medication therapy, dynamically reviewing and optimizing medications, strengthening patients' social support networks, and helping patients integrate medication management into their daily life are the key elements that can effectively assist patients in self-managing their medications. Future interventions to improve patient medication self-management ability should be designed for these issues. Systematic Review Registration: https://www.crd.york.ac.uk/PROSPERO/, identifier CRD42024524742.
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Affiliation(s)
- Ran Jin
- School of Nursing, Nanjing Medical University, Nanjing, China
| | - Caiyan Liu
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Jinghao Chen
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Mengjiao Cui
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Bo Xu
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Ping Yuan
- Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, China
| | - Lu Chen
- School of Nursing, Nanjing Medical University, Nanjing, China
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Cross SP, Alvarez-Jimenez M. The digital cumulative complexity model: a framework for improving engagement in digital mental health interventions. Front Psychiatry 2024; 15:1382726. [PMID: 39290300 PMCID: PMC11405244 DOI: 10.3389/fpsyt.2024.1382726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 08/14/2024] [Indexed: 09/19/2024] Open
Abstract
Mental health disorders affect a substantial portion of the global population. Despite preferences for psychotherapy, access remains limited due to various barriers. Digital mental health interventions (DMHIs) have emerged to increase accessibility, yet engagement and treatment completion rates are concerning. Evidence across healthcare where some degree of self-management is required show that treatment engagement is negatively influenced by contextual complexity. This article examines the non-random factors influencing patient engagement in digital and face-to-face psychological therapies. It reviews established models and introduces an adapted version of the Cumulative Complexity Model (CuCoM) as a framework for understanding engagement in the context of digital mental health. Theoretical models like the Fogg Behavior Model, Persuasive System Design, Self-Determination Theory, and Supportive Accountability aim to explain disengagement. However, none adequately consider these broader contextual factors and their complex interactions with personal characteristics, intervention requirements and technology features. We expand on these models by proposing an application of CuCoM's application in mental health and digital contexts (known as DiCuCoM), focusing on the interplay between patient burden, personal capacity, and treatment demands. Standardized DMHIs often fail to consider individual variations in burden and capacity, leading to engagement variation. DiCuCoM highlights the need for balancing patient workload with capacity to improve engagement. Factors such as life demands, burden of treatment, and personal capacity are examined for their influence on treatment adherence. The article proposes a person-centered approach to treatment, informed by models like CuCoM and Minimally Disruptive Medicine, emphasizing the need for mental healthcare systems to acknowledge and address the unique burdens and capacities of individuals. Strategies for enhancing engagement include assessing personal capacity, reducing treatment burden, and utilizing technology to predict and respond to disengagement. New interventions informed by such models could lead to better engagement and ultimately better outcomes.
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Affiliation(s)
- Shane P Cross
- Orygen Digital, Orygen, Parkville, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Mario Alvarez-Jimenez
- Orygen Digital, Orygen, Parkville, Melbourne, VIC, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia
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Muir D, McLarty L, Drinkwater J, Bennett C, Birks Y, Broadway-Parkinson A, Cooksey V, Gleeson P, Holland C, Ledger L, Lowe DJ, McGoverin A, Nixon J, Perry T, Sandoz H, Rawson B, Rawson Y, Stubbs N, Walker K, Whitaker H, Coleman S. Pressure ulcer prevention for people with long-term neurological conditions (LTNCs) who self-manage care and live at home. J Tissue Viability 2024:S0965-206X(24)00131-1. [PMID: 39289092 DOI: 10.1016/j.jtv.2024.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2024] [Accepted: 08/23/2024] [Indexed: 09/19/2024]
Abstract
AIM To develop a Theory of Change (ToC) pathway to facilitate the development of a multi-component intervention package supporting pressure Ulcer (PU) risk identification and management, in partnership with people with Long Term Neurological Conditions (LTNC) who self-manage care and live at home, their informal carers and PAs. METHODS A participatory approach, with extensive input from those whose lives are the focus of the research, was used throughout the 4 interlinked work packages (WP): Iterative data analysis was undertaken with emerging findings from each WP informing subsequent stages of the study. FINDINGS Overall, 74 participants contributed across the 4 WPs, incorporating 31 Service Users (SU), 8 carers, 9 Personal Assistants (PAs) and 26 professional stakeholders. We identified 8 key themes related to PU prevention, incorporating, learning, safe routines, third sector and peer support, navigating complex systems, adapting and reacting to change, perceptions of risk, risk negotiation and supporting roles. The findings indicate systemic and professional barriers which hamper people's ability to self-care and seek help. CONCLUSIONS The study highlights the complexities and impact of managing PU prevention activities at home for people with LTNC and areas of learning for health professionals and systems. By understanding these complexities we developed a systems map, identified resource requirements and illustrated a Theory of Change (ToC) pathway, to underpin future work to develop and user test an interactive, multi-component intervention.
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Affiliation(s)
- Delia Muir
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK.
| | - Laura McLarty
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK
| | - Jessica Drinkwater
- Centre for Primary Care and Health Service Research, The University of Manchester, UK
| | | | - Yvonne Birks
- School for Business and Society, University of York, UK
| | | | | | - Phil Gleeson
- Pressure Ulcer at Home Co-operative Inquiry Group, UK
| | | | - Lisa Ledger
- NIHR Coordinating Centre, 21 Queen Street, Leeds, LS1 2TW, UK
| | | | | | - Jane Nixon
- Institute of Health Sciences, University, of Leeds, Leeds, LS2 9JT, UK
| | - Tanya Perry
- Pressure Ulcer at Home Co-operative Inquiry Group, UK
| | - Heidi Sandoz
- Pressure Ulcer at Home Co-operative Inquiry Group, UK
| | - Brian Rawson
- Pressure Ulcer at Home Co-operative Inquiry Group, UK
| | - Yvonne Rawson
- Tissue Viability CNS, Hertfordshire Community NHS Trust, UK
| | | | - Kay Walker
- Pressure Ulcer at Home Co-operative Inquiry Group, UK
| | | | - Susanne Coleman
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, LS2 9JT, UK.
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He Y, Huang Y, Li R, Zhang M, Zhu M, Wang F. Switching indoor fuels and the incidence of physical-psychological-cognitive multimorbidity: A prospective cohort study. ECOTOXICOLOGY AND ENVIRONMENTAL SAFETY 2024; 282:116719. [PMID: 39002375 DOI: 10.1016/j.ecoenv.2024.116719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/01/2024] [Revised: 07/07/2024] [Accepted: 07/09/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND In developing countries, including China, solid-fuel-based heating and cooking is common. For older people, the multimorbidity prevalence is exceptionally high. Nevertheless, studies on the associations of indoor solid fuels use, especially switching fuels types, on multimorbidity in middle-aged and older people is scarce. METHODS Data from five waves of the China Health and Retirement Longitudinal Study were used in this study. Indoor fuels were classified as solid or clean fuels. Physical-psychological-cognitive multimorbidity (PPC-multimorbidity) was defined as the simultaneous presence of three disease types (physical illness, psychological disorders, cognitive impairment). Using Cox proportional risk models, hazard ratios (HRs) and 95 % confidence intervals (95 % CI) were calculated to investigate the associations of heating- and cooking-related baseline indoor fuels and switching indoor fuels with PPC-multimorbidity incidence. RESULTS In the heating (n=3121, mean age=56.55 years, male proportion=54.25 %) and cooking (n=3574, mean age=56.67 years, male proportion=52.94 %) analyses, 75.07 % and 45.64 % of the participants used solid fuels at baseline, and 564 (18.07 %) and 613 (17.15 %) PPC-multimorbidity cases were diagnosed during follow-up, respectively. Participants with baseline heating- and cooking-based solid fuels use had greater PPC-multimorbidity incidences [HRs (95 % CIs): 1.23 (0.98, 1.55) and 1.44 (1.21, 1.73)], respectively. Additionally, combined baseline heating- and cooking-based solid fuels use was associated with even greater PPC-multimorbidity incidence [HR (95 % CI): 1.55 (1.18, 2.04)]. Persistent solid fuels use obviously increased the PPC-multimorbidity incidence [HRs (95 % CIs): 2.43 (1.67, 3.55) for heating and 2.63 (2.03, 3.40) for cooking]. Moreover, switching from solid to clean fuels was associated with a significantly decreased PPC-multimorbidity incidence [HRs (95 % CIs): 0.27 (0.20, 0.35) for heating and 0.36 (0.28, 0.46) for cooking]. CONCLUSIONS Long-term solid-fuels use is associated with an increased PPC-multimorbidity incidence, and switching to cleaner fuels is associated with a decreased PPC-multimorbidity incidence in adults aged ≥45 years.
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Affiliation(s)
- Yurou He
- Group of Chronic Disease and Environmental Genomics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China.
| | - Yuwei Huang
- Group of Chronic Disease and Environmental Genomics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China.
| | - Runze Li
- Group of Chronic Disease and Environmental Genomics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China
| | - Mingqi Zhang
- Group of Chronic Disease and Environmental Genomics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China
| | - Mingye Zhu
- Group of Chronic Disease and Environmental Genomics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China
| | - Fang Wang
- Group of Chronic Disease and Environmental Genomics, School of Public Health, China Medical University, Shenyang, Liaoning 110122, China; Key Laboratory of Environmental Stress and NCDs Control, Ministry of Education, China Medical University, Shenyang, Liaoning 110122, China; The Key Laboratory of Liaoning Province on Toxic and Biological Effects of Arsenic, China Medical University, Shenyang, Liaoning 110122, China.
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10
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Charles L, Jensen L, Añez Delfin JM, Norman E, Dobbs B, Tian PGJ, Parmar J. Characteristics of Patients Receiving Complex Case Management in an Acute Care Hospital. Prof Case Manag 2024; 29:198-205. [PMID: 39058563 DOI: 10.1097/ncm.0000000000000742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
BACKGROUND Improving transitions in care is a major focus of health care planning. In the research team's prior intervention study, the length of stay (LOS) was reduced when patients at high risk for readmission were identified early in their acute care stay and received complex management. OBJECTIVE This study will describe the characteristics of patients receiving complex case management in an urban acute care hospital. PRIMARY PRACTICE SETTING Acute care hospital. METHODOLOGY AND SAMPLE This was a retrospective chart review of patients in a previous quality assurance study. A random selection of patients who previously underwent high-risk screening using the LACE (Length of stay; Acuity of the admission; Comorbidity of the patient; Emergency department use) index and received complex case management (the intervention group) were reviewed. The charts of a random selection of patients from the previous comparison group were also reviewed. Patient characteristics were collected and compared using descriptive statistics. RESULTS In the intervention group, more patients had their family physicians (FPs) documented (93.1% [81/87] vs. 89.2% [66/74]). More patients in the intervention group (89.7% [77/87] vs. 85.1% [63/74]) lived at home prior to admission. More patients in the intervention group had a family caregiver involved (44.8% [39/87] vs. 41.9% [31/74]). At discharge, more patients in the intervention group (87.1% [74/85]) were discharged home compared with the comparison group (78.4% [58/74]). IMPLICATIONS FOR CASE MANAGEMENT PRACTICE (1) Having an identified FP, living at home, and having family caregiver(s) characterized those with lower LOS and discharged home. (2) Case management, risk screening, and discharge planning improve patient outcomes. (3) This study identified the importance of having a FP and engaged family caregivers in improving care outcomes.
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Affiliation(s)
- Lesley Charles
- Lesley Charles, MBChB, CCFP(COE), is a Professor and the Program Director in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Lisa Jensen, MBA, is the Corporate Director of the Provincial Patient Access (Integrated Access) in Covenant Health, Edmonton, Alberta
- Jorge Mario Añez Delfin, MD, CCFP, is a Care of the Elderly physician in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Erin Norman, MSc, is the Corporate Services Manager for Quality in Covenant Health, Edmonton, Alberta
- Bonnie Dobbs, PhD, is Professor Emerita and former Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Peter George Jaminal Tian, MD, MSc, is the Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Jasneet Parmar, MBBS, MSc, MCFP(COE), is a Professor in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
| | - Lisa Jensen
- Lesley Charles, MBChB, CCFP(COE), is a Professor and the Program Director in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Lisa Jensen, MBA, is the Corporate Director of the Provincial Patient Access (Integrated Access) in Covenant Health, Edmonton, Alberta
- Jorge Mario Añez Delfin, MD, CCFP, is a Care of the Elderly physician in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Erin Norman, MSc, is the Corporate Services Manager for Quality in Covenant Health, Edmonton, Alberta
- Bonnie Dobbs, PhD, is Professor Emerita and former Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Peter George Jaminal Tian, MD, MSc, is the Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Jasneet Parmar, MBBS, MSc, MCFP(COE), is a Professor in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
| | - Jorge Mario Añez Delfin
- Lesley Charles, MBChB, CCFP(COE), is a Professor and the Program Director in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Lisa Jensen, MBA, is the Corporate Director of the Provincial Patient Access (Integrated Access) in Covenant Health, Edmonton, Alberta
- Jorge Mario Añez Delfin, MD, CCFP, is a Care of the Elderly physician in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Erin Norman, MSc, is the Corporate Services Manager for Quality in Covenant Health, Edmonton, Alberta
- Bonnie Dobbs, PhD, is Professor Emerita and former Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Peter George Jaminal Tian, MD, MSc, is the Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Jasneet Parmar, MBBS, MSc, MCFP(COE), is a Professor in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
| | - Erin Norman
- Lesley Charles, MBChB, CCFP(COE), is a Professor and the Program Director in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Lisa Jensen, MBA, is the Corporate Director of the Provincial Patient Access (Integrated Access) in Covenant Health, Edmonton, Alberta
- Jorge Mario Añez Delfin, MD, CCFP, is a Care of the Elderly physician in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Erin Norman, MSc, is the Corporate Services Manager for Quality in Covenant Health, Edmonton, Alberta
- Bonnie Dobbs, PhD, is Professor Emerita and former Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Peter George Jaminal Tian, MD, MSc, is the Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Jasneet Parmar, MBBS, MSc, MCFP(COE), is a Professor in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
| | - Bonnie Dobbs
- Lesley Charles, MBChB, CCFP(COE), is a Professor and the Program Director in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Lisa Jensen, MBA, is the Corporate Director of the Provincial Patient Access (Integrated Access) in Covenant Health, Edmonton, Alberta
- Jorge Mario Añez Delfin, MD, CCFP, is a Care of the Elderly physician in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Erin Norman, MSc, is the Corporate Services Manager for Quality in Covenant Health, Edmonton, Alberta
- Bonnie Dobbs, PhD, is Professor Emerita and former Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Peter George Jaminal Tian, MD, MSc, is the Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Jasneet Parmar, MBBS, MSc, MCFP(COE), is a Professor in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
| | - Peter George Jaminal Tian
- Lesley Charles, MBChB, CCFP(COE), is a Professor and the Program Director in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Lisa Jensen, MBA, is the Corporate Director of the Provincial Patient Access (Integrated Access) in Covenant Health, Edmonton, Alberta
- Jorge Mario Añez Delfin, MD, CCFP, is a Care of the Elderly physician in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Erin Norman, MSc, is the Corporate Services Manager for Quality in Covenant Health, Edmonton, Alberta
- Bonnie Dobbs, PhD, is Professor Emerita and former Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Peter George Jaminal Tian, MD, MSc, is the Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Jasneet Parmar, MBBS, MSc, MCFP(COE), is a Professor in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
| | - Jasneet Parmar
- Lesley Charles, MBChB, CCFP(COE), is a Professor and the Program Director in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Lisa Jensen, MBA, is the Corporate Director of the Provincial Patient Access (Integrated Access) in Covenant Health, Edmonton, Alberta
- Jorge Mario Añez Delfin, MD, CCFP, is a Care of the Elderly physician in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Erin Norman, MSc, is the Corporate Services Manager for Quality in Covenant Health, Edmonton, Alberta
- Bonnie Dobbs, PhD, is Professor Emerita and former Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Peter George Jaminal Tian, MD, MSc, is the Research Director of the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
- Jasneet Parmar, MBBS, MSc, MCFP(COE), is a Professor in the Division of Care of the Elderly, Department of Family Medicine, University of Alberta
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Jia Z, Niu Z, Wang JJ, Hernandez J, Li YT, Wang HHX. Trajectories of Treatment Burden Among Primary Care Patients with Long-Term Conditions in Southern China: A Latent Class Growth Analysis. Risk Manag Healthc Policy 2024; 17:2009-2021. [PMID: 39188662 PMCID: PMC11346491 DOI: 10.2147/rmhp.s464434] [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: 02/17/2024] [Accepted: 07/21/2024] [Indexed: 08/28/2024] Open
Abstract
Background Treatment burden is a patient-centred, dynamic concept. However, longitudinal data on the changing pattern of treatment burden among patients with one or more long-term conditions (LTCs) are relatively scanty. We aimed to explore the longitudinal trajectories of treatment burden and associated risk factors in a large, patient population in primary care settings. Methods We analysed data from 5573 primary care patients with long-term conditions (LTCs) recruited using a multistage sampling method in Shenzhen, southern China. The treatment burden was assessed by the Mandarin Chinese version of the Treatment Burden Questionnaire (TBQ). We used latent class growth mixture modelling (LCGMM) to determine trajectories of treatment burden across four time points, ie, at baseline, and at 6, 12, and 18 months. Predictors of trajectory classes were explored using multivariable logistic regression analysis. Results The mean TBQ scores of patients with a single LTC (n = 2756), 2 LTCs (n = 1871), 3 LTCs (n = 699), and ≥4 LTCs (n = 247) were 18.17, 20.28, 21.32, and 26.10, respectively, at baseline. LCGMM identified three discrete classes of treatment burden trajectories over time, ie, a high-increasing class, a low-stable class, and a high-decreasing class. When controlling for individual-level factors including age, education, monthly household income per head, smoking, alcohol consumption, and attendance in health education, patients who had a clinical diagnosis of 3 LTCs (adjusted odds ratio [aOR] = 1.49, 95% CI = 1.21-1.86, P < 0.001) or ≥4 LTCs (aOR = 1.97, 95% CI = 1.44-2.72, P < 0.001) were more likely to belong to the high-increasing class. Sensitivity analysis using propensity score methods obtained similar results. Conclusion Our study revealed the presence of discrete patterns of treatment burden over time in Chinese primary care patients with LTCs, providing directions for tailored interventions to optimise disease management. Patients with 3 or more LTCs should receive close attention in healthcare delivery as they tend to experience a greater treatment burden.
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Affiliation(s)
- Zhihui Jia
- School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Zimin Niu
- School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Jia Ji Wang
- School of Public Health, Guangzhou Medical University, Guangzhou, People’s Republic of China
- Centre for General Practice, The Seventh Affiliated Hospital, Southern Medical University, Foshan, People’s Republic of China
| | - Jose Hernandez
- Faculty of Medicine and Health, EDU, Digital Education Holdings Ltd., Kalkara, Malta
- Green Templeton College, University of Oxford, Oxford, UK
| | - Yu Ting Li
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Guangdong Provincial Key Laboratory of Ophthalmology and Visual Science, Zhongshan Ophthalmic Center, Sun Yat-Sen University, Guangzhou, People’s Republic of China
| | - Harry H X Wang
- School of Public Health, Sun Yat-Sen University, Guangzhou, People’s Republic of China
- Department of General Practice, The Second Hospital of Hebei Medical University, Shijiazhuang, People’s Republic of China
- JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, New Territories, Hong Kong SAR, People’s Republic of China
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Diallo BA, Hassan S, Kagwanja N, Oyando R, Badjie J, Mumba N, Prentice AM, Perel P, Etyang A, Nolte E, Tsofa B. Managing hypertension in rural Gambia and Kenya: Protocol for a qualitative study exploring the experiences of patients, health care workers, and decision-makers. NIHR OPEN RESEARCH 2024; 4:5. [PMID: 39238902 PMCID: PMC11375402 DOI: 10.3310/nihropenres.13523.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/16/2024] [Indexed: 09/07/2024]
Abstract
Background Hypertension is the single leading risk factor for premature death in Sub-Saharan Africa (SSA). Prevalence is high, but awareness, treatment, and control are low. Community-centred interventions show promise for effective hypertension management, but embedding such interventions sustainably requires a good understanding of the wider context within which they are being introduced. This study aims to conduct a systematic health system assessment exploring the micro (patients/carers), meso (health care workers and facilities), and macro (broader system) contexts in rural Gambia and Kenya. Methods This study will utilise various qualitative approaches. We will conduct (i) focus group discussions with people living with hypertensive to map a 'typical' patient journey through health systems, and (ii) in-depth interviews with patients and family carers, health care workers, decision-makers, and NCD partners to explore their experiences of managing hypertension and assess the capacity and readiness of the health systems to strengthen hypertension management. We will also review national guidelines and policy documents to map the organisation of services and guidance on hypertension management. We will use thematic analysis to analyse data, guided by the cumulative complexity model, and theories of organisational readiness and dissemination of innovations. Expected findings This study will describe the current context for the management of hypertension from the perspective of those involved in seeking (patients), delivering (health care workers) and overseeing (decision-makers) health services in rural Gambia and Kenya. It will juxtapose what should be happening according to health system guidance and what is happening in practice, drawing on the experiences of study participants. It will outline the various barriers to and facilitators of hypertension management, as perceived by patients, providers, and decision-makers, and the conditions that would need to be in place for effective and sustainable implementation of a community-centred intervention to improve the management of hypertension in rural settings.
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Affiliation(s)
- Brahima A Diallo
- Nutrition and Planetary Health, MRC Unit The Gambia at LSHTM, Banjul, Other / None, 273, The Gambia
| | - Syreen Hassan
- London School of Hygiene and Tropical Medicine, London, UK
| | | | | | - Jainaba Badjie
- Nutrition and Planetary Health, MRC Unit The Gambia at LSHTM, Banjul, Other / None, 273, The Gambia
| | - Noni Mumba
- KEMRI Wellcome Trust Research Programme, Kilifi, Kenya
| | - Andrew M Prentice
- Nutrition and Planetary Health, MRC Unit The Gambia at LSHTM, Banjul, Other / None, 273, The Gambia
| | - Pablo Perel
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Ellen Nolte
- London School of Hygiene and Tropical Medicine, London, UK
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13
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Booth G, Di Rosa A, Corcoran P, Hallisey C, Lucas A, Zarnegar R. Patient perspectives on the unwanted effects of multidisciplinary pain management programmes: A qualitative study. Clin Rehabil 2024; 38:1118-1129. [PMID: 38747978 DOI: 10.1177/02692155241254250] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/27/2024]
Abstract
OBJECTIVE This study aimed to understand the impact of pain management programmes, focusing on the unwanted effects and their influence on patients' long-term use of self-management strategies. DESIGN Qualitative study. SETTING Specialist musculoskeletal hospital in North London, England. PARTICIPANTS Patients with chronic musculoskeletal pain that have completed a pain management programme. INTERVENTION Multidisciplinary pain management programmes. MAIN MEASURES Data were collected regarding patients' experiences and unwanted effects from the pain management programme using semi-structured interviews. Data were analysed using thematic analysis. RESULTS Fourteen participant interviews were included in the analysis (median age 54 years, 12 females). Four themes were generated from the data: Benefits and burdens, Pain management programme and real life, Social support and Healthcare interventions. Unwanted effects included heightened anxiety related to negative interactions with peers, being in a new environment, worries about ability to cope with the programme, social anxiety from being in a group, the strain on families due to participants being away from home and a sense of abandonment at end of the programme. Burdens associated with implementing pain management strategies were identified, including the emotional burden of imposing their self-management on close family and competing demands with time and energy spent on self-management at the expense of work or home commitments. CONCLUSIONS Pain management programmes have an important role in helping patients to learn how to self-manage chronic pain. Their unwanted effects and the treatment burdens associated with long-term self-management may be an important consideration in improving the longevity of their beneficial effects.
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Affiliation(s)
- Gregory Booth
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
- Population Health Research Institute, St George's, University of London, London, UK
| | - Amanda Di Rosa
- Institute for Global Health and Development, Queen Margaret University, Musselburgh, UK
| | - Paula Corcoran
- Department of Psychology, City, University of London, London, UK
| | - Charlotte Hallisey
- Therapies Department, Royal National Orthopaedic Hospital NHS Trust, Middlesex, UK
| | - Andrew Lucas
- Department of Clinical Health Psychology, Royal National Orthopaedic Hospital NHS Trust, London, UK
| | - Roxaneh Zarnegar
- Pain Clinic, Royal National Orthopaedic Hospital NHS Trust, London, UK
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14
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Macgregor C, Blane DN, Tulle E, Campbell CL, Barber RJ, Hill O-Connor C, Seenan C. An ecosystem of accepting life with chronic pain: A meta-ethnography. Br J Pain 2024; 18:365-381. [PMID: 39092212 PMCID: PMC11289906 DOI: 10.1177/20494637241250271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024] Open
Abstract
Background Chronic pain is a highly prevalent long-term condition, experienced unequally, impacting both the individual living with pain, and wider society. 'Acceptance' of chronic pain is relevant to improved consultations in pain care, and navigating an approach towards evidence-based, long-term management and associated improvements in health. However, the concept proves difficult to measure, and primary qualitative studies of lived experiences show complexity related to our socio-cultural-political worlds, healthcare experiences, and difficulties with language and meaning. We framed acceptance of chronic pain as socially constructed and aimed to conceptualise the lived experiences of acceptance of chronic pain in adults. Methods We conducted a systematic search and screening process, followed by qualitative, interpretive, literature synthesis using Meta-ethnography. We included qualitative studies using chronic pain as the primary condition, where the study included an aim to research the acceptance concept. We conducted each stage of the synthesis with co-researchers of differing disciplinary backgrounds, and with lived experiences of chronic pain. Findings We included 10 qualitative studies from Canada, Sweden, The Netherlands, Ireland, UK, Australia and New Zealand. Our 'lines of argument' include a fluid and continuous journey with fluctuating states of acceptance; language and meaning of acceptance and chronic pain, a challenge to identity in a capitalist, ableist society and the limits to individualism; a caring, supportive and coherent system. The conceptual framework of the meta-ethnography is represented by a rosebush with interconnected branches, holding both roses and thorns, such is the nature of accepting life with chronic pain. Conclusion Our findings broaden conceptualisation of 'acceptance of chronic pain' beyond an individual factor, to a fluid and continuous journey, interconnected with our socio-cultural-political worlds; an ecosystem.
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Affiliation(s)
- Cassandra Macgregor
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Lanarkshire, Chronic Pain Service, Coatbridge, UK
| | - David N Blane
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emmanuelle Tulle
- Department of Social Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Claire L Campbell
- NHS Fife, Pain Management Service, Queen Margaret Hospital, Dunfermline, UK
| | - Ruth J Barber
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Lanarkshire, Chronic Pain Service, Coatbridge, UK
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
- Department of Social Sciences, Glasgow Caledonian University, Glasgow, UK
- NHS Fife, Pain Management Service, Queen Margaret Hospital, Dunfermline, UK
- School of Social and Political Sciences, University of Glasgow, Glasgow, UK
| | | | - Christopher Seenan
- School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, UK
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15
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Alonso JP, Ini N, Villarejo A, Belizán M, Roberti J. Amyotrophic lateral sclerosis in Argentina: unveiling the burden of treatment through patient and caregiver perspectives. Disabil Rehabil 2024:1-8. [PMID: 39072497 DOI: 10.1080/09638288.2024.2385732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Revised: 07/21/2024] [Accepted: 07/24/2024] [Indexed: 07/30/2024]
Abstract
PURPOSE To examine the burden of treatment (BoT) experienced by people with Amyotrophic Lateral Sclerosis (ALS) in Argentina. METHODS Qualitative methodological design based on semi-structured interviews. Nineteen semi-structured interviews were conducted (PwALS = 7, informal caregivers= 12). The interview guides were designed based on the literature and BoT theory. Data were analysed following a framework analysis approach. RESULTS The research highlighted the arduous journey toward obtaining a diagnosis, marked by delays influenced by healthcare system inefficiencies, lack of disease awareness and pandemic-related anxiety. Receiving the diagnosis was a destabilising experience, triggering the need to reframe self-identity, a new reality. As the disease progressed, patients encountered significant challenges in their daily activities and basic tasks, affecting their ability to work, communicate, and manage personal care. The burden extended beyond the patients to their primary caregivers. Access to specialised care, bureaucratic complexities in securing treatment, and the financial impact of managing the disease posed substantial challenges. CONCLUSION The findings offer valuable insights into the experiences of PwALS and their caregivers in Argentina. They underscore the need for increased disease awareness, improved access to specialised care, and enhanced support networks to alleviate the burdens PwALS and their families face.
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Affiliation(s)
- Juan Pedro Alonso
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- Gino Germani Institute, CONICET, Buenos Aires, Argentina
| | - Natalí Ini
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CIESP - CONICET, Buenos Aires, Argentina
| | - Agustina Villarejo
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - María Belizán
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
| | - Javier Roberti
- Institute for Clinical Effectiveness and Health Policy (IECS), Buenos Aires, Argentina
- CIESP - CONICET, Buenos Aires, Argentina
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Hargraves IG, Boehmer KR, Amer H, Kennedy CC, Griffin JM, Finnie DM, Montori VM, Smither FC, Mardini S, Moran S, Jowsey-Gregoire S. The role of the purposeful shared decision making model in vascularized composite allotransplantation. FRONTIERS IN TRANSPLANTATION 2024; 3:1421154. [PMID: 38993756 PMCID: PMC11235292 DOI: 10.3389/frtra.2024.1421154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2024] [Accepted: 06/17/2024] [Indexed: 07/13/2024]
Abstract
For some patients who have lost the lower part of an arm, hand transplant offers the possibility of receiving a new limb with varying degrees of sensation and function. This procedure, Vascularized Composite Allotransplantation (VCA), is demanding for patients and their care community and comes with significant risks. As a high-stakes decision, patients interested in VCA are subject to extensive clinical evaluation and eligibility decision making. Patients and their care community must also decide if hand transplant (versus other approaches including rehabilitative therapies with or without prosthesis) is right for them. This decision making is often confusing and practically and emotionally fraught. It is complicated in four ways: by the numerous beneficial and harmful potential effects of hand transplant or other options, the number of people affected by VCA and the diverse or conflicting positions that they may hold, the practical demands and limitations of the patient's life situation, and the existential significance of limb loss and transplant for the patient's being. Patients need support in working through these treatment determining issues. Evaluation does not provide this support. Shared decision making (SDM) is a method of care that helps patients think, talk, and feel their way through to the right course of action for them. However, traditional models of SDM that focus on weighing possible beneficial and harmful effects of treatments are ill-equipped to tackle the heterogeneous issues of VCA. A recent model, Purposeful SDM extends the range of troubling issues that SDM can help support beyond opposing effects, to include conflicting positions, life situations, and existential being. In this paper we explore the pertinence of these issues in VCA, methods of SDM that each require of clinicians, the benefits of supporting patients with the breadth of issues in their unique problematic situations, implications for outcomes and practice, and extend the theory of the Purposeful SDM model itself based on the issues present in hand transplant decision making.
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Affiliation(s)
- Ian G. Hargraves
- Knowledge and Encounter Research (KER) Unit, Mayo Clinic, Rochester, MN, United States
| | - Kasey R. Boehmer
- Knowledge and Encounter Research (KER) Unit, Mayo Clinic, Rochester, MN, United States
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States
| | - Hatem Amer
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, United States
| | - Cassie C. Kennedy
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, United States
| | - Joan M. Griffin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Dawn M. Finnie
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
| | - Victor M. Montori
- Knowledge and Encounter Research (KER) Unit, Mayo Clinic, Rochester, MN, United States
| | - Fantley Clay Smither
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States
| | - Samir Mardini
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States
| | - Steven Moran
- Division of Plastic and Reconstructive Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, United States
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17
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Broden EG, Boyden JY, Keller S, James R, Mooney-Doyle K. Who, What, Where, and How? The State of Family Science in Pediatric Palliative Care. J Pain Symptom Manage 2024:S0885-3924(24)00844-3. [PMID: 38992396 DOI: 10.1016/j.jpainsymman.2024.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 06/04/2024] [Accepted: 06/26/2024] [Indexed: 07/13/2024]
Abstract
CONTEXT Families are vital providers and recipients of pediatric palliative care (PPC) services. Understanding the scope and nature of evidence at the intersection of family science and PPC research is necessary to develop family-focused interventions that enhance child and family health. OBJECTIVES Explore and describe the family-level impact of pediatric serious illness. METHODS We conducted a librarian-assisted scoping review using Arskey and O'Malley's approach. We searched PubMed, Scopus, CINAHL, and EMBASE databases for empirical publications from 2016 to 2021 that focused on families navigating serious pediatric illness published in English. Two reviewers assessed eligibility, with discrepancies resolved by a third. We used Covidence and REDCap for data management and extraction. RESULTS We screened 10,983 abstracts; 309 abstracts were included in full text screening. The final group of 52 citations was analyzed by the entire team. Most research was conducted in Western Europe and North America. The perspectives of parents of children with cancer were most frequently described; voices of seriously ill youth and their siblings were less often presented. Most of the research was descriptive qualitative, followed by descriptive quantitative. Few studies were mixed methods, inferential, or interpretive. Studies most often described parent, youth, and family experience with illness and less often explored family processes and relationships. Irrespective of the approach (i.e., qualitative, quantitative), few studies focused on families as the analytic unit or used family-level analysis techniques. Study participants were usually from local dominant populations and less often from historically marginalized communities. CONCLUSION The robust, descriptive, and individual-level evidence describing family impact of serious pediatric illness provides a solid foundation for future research priorities. Stronger integration of family techniques and diverse family voices in pediatric palliative care research can clarify family processes, illuminate structural barriers, and inform interventions that are responsive to family needs. These steps will enhance the education, policy, and clinical provision of PPC to all who would benefit, thereby advancing health equity for children living with serious illness and their families.
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Affiliation(s)
- Elizabeth G Broden
- Yale National Clinician Scholars Program (E.G.B.), Yale University, New Haven, CT; School of Public Health (E.G.B.), Yale University, New Haven, CT.
| | - Jackelyn Y Boyden
- Department of Family and Community Health (J.Y.B.), School of Nursing, University of Pennsylvania, Philadelphia, PA; Division of General Pediatrics (J.Y.B.), Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Susan Keller
- Research Library (S.K.M.), Children's National Hospital, Washington, DC
| | - Richard James
- Nemours Children's Health (R.J.M.), Wilmington, DE; Fontan Outcomes Network
| | - Kim Mooney-Doyle
- Department of Family and Community Health (K.M-D.), School of Nursing, University of Maryland, Baltimore, MD
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Wood K, Sardar A, Eton DT, Mair FS, Kidd L, Quinn TJ, Gallacher KI. Adaptation and content validation of a patient-reported measure of treatment burden for use in stroke survivors: the patient experience with treatment and self-management in stroke (PETS-stroke) measure. Disabil Rehabil 2024; 46:3141-3150. [PMID: 37545161 DOI: 10.1080/09638288.2023.2241360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 07/23/2023] [Indexed: 08/08/2023]
Abstract
PURPOSE Stroke survivors often live with significant treatment burden yet our ability to examine this is limited by a lack of validated measurement instruments. We aimed to adapt the 60-item, 12-domain Patient Experience with Treatment and Self-Management (PETS) (version 2.0, English) patient-reported measure to create a stroke-specific measure (PETS-stroke) and to conduct content validity testing with stroke survivors. MATERIALS AND METHODS Step 1 - Adaptation of PETS to create PETS-stroke: a conceptual model of treatment burden in stroke was utilised to amend, remove or add items. Step 2 - Content validation: Fifteen stroke survivors in Scotland were recruited through stroke groups and primary care. Three rounds of five cognitive interviews were audio recorded and transcribed. Framework analysis was used to explore importance/relevance/clarity of PETS-stroke content. COSMIN reporting guidelines were followed. RESULTS The adapted PETS-stroke had 34 items, spanning 13 domains; 10 items unchanged from PETS, 6 new and 18 amended. Interviews (n = 15) resulted in further changes to 19 items, including: instructions; wording; item location; answer options; and recall period. CONCLUSIONS PETS-stroke has content that is relevant, meaningful and comprehensible to stroke survivors. Content validity and reliability testing are now required. The validated tool will aid testing of tailored interventions to lessen treatment burden.
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Affiliation(s)
- Karen Wood
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Aleema Sardar
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Frances S Mair
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Lisa Kidd
- School of Health & Life Sciences, Glasgow Caledonian University, Glasgow, UK
| | - Terence J Quinn
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, UK
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Joyce DD, Boehmer KR, Kamath CC, LaVecchia CM, Sharma V, Schulte PJ, Tilburt JC, Penson DF, Boorjian SA. Financial Toxicity Among Patients With Metastatic Prostate Cancer: A Mixed Methods Approach to Identify Effective Interventions. UROLOGY PRACTICE 2024; 11:640-652. [PMID: 38899638 PMCID: PMC11192241 DOI: 10.1097/upj.0000000000000589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/05/2024] [Indexed: 06/21/2024]
Abstract
INTRODUCTION Financial toxicity associated with treatments for metastatic prostate cancer remains poorly defined. We sought to understand aspects of financial toxicity not captured in a commonly employed financial toxicity questionnaire and identify potential interventions to help alleviate financial toxicity through a convergent mixed methods approach. METHODS Patients seen at our institution's advanced prostate cancer clinic were approached for completion of the Comprehensive Score for Financial Toxicity (COST-FACIT) questionnaire (quantitative analysis). A maximal variation purposive sample was chosen to participate in focus group discussions (qualitative analysis). Conventional content analysis was performed using an inductive approach. COST-FACIT scores were compared between patients experiencing high and low financial toxicity using Wilcoxon rank sum test. RESULTS Three themes were identified through qualitative analysis: (1) workload, (2) coping strategies, and (3) communication. We found alignment with the existing theory of financial capacity across our findings. Two unique aspects of financial toxicity emerged that were not assessed quantitatively and deemed to be significant. Specifically, cost transparency (including health care teams knowledgeable about and willing to discuss costs) and inclusion of informal caregivers in financial toxicity screening and decision-making may guide future interventions aimed at limiting financial toxicity in this population. CONCLUSIONS Prolonged treatment courses involving multiple lines of treatment with varying costs result in distinct financial toxicity components for patients with metastatic prostate cancer that are not assessed with COST-FACIT. Improving cost transparency, health care team knowledge and engagement, and providing resources to support informal caregivers may have a significant impact on the financial toxicity experienced by these patients.
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Affiliation(s)
| | - Kasey R. Boehmer
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
| | - Celia C. Kamath
- Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Christina M. LaVecchia
- Knowledge and Evaluation Research (KER) Unit, Mayo Clinic, Rochester, Minnesota, United States of America
- Department of English, University of Cincinnati, Cincinnati, OH
| | - Vidit Sharma
- Department of Urology, Mayo Clinic, Rochester, MN
| | | | - Jon C. Tilburt
- Department of General Internal Medicine, Mayo Clinic, Scottsdale, AZ
| | - David F. Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN
- Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN
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Lin K, Yao M, Ji X, Li R, Andrew L, Oosthuizen J, Sim M, Chen Y. Measuring treatment burden in people with Type 2 Diabetes Mellitus (T2DM): a mixed-methods systematic review. BMC PRIMARY CARE 2024; 25:206. [PMID: 38858619 PMCID: PMC11165743 DOI: 10.1186/s12875-024-02461-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 06/03/2024] [Indexed: 06/12/2024]
Abstract
BACKGROUND Measuring treatment burden is important for the effective management of Type 2 Diabetes Mellitus (T2DM) care. The purpose of this systematic review was to identify the most robust approach for measuring treatment burden in people with T2DM based on existing evidence. METHODS Articles from seven databases were retrieved. Qualitative, quantitative, and mixed-methods studies examining treatment burden in adults with T2DM and/or reporting relevant experiences were included. A convergent segregated approach with a mixed-methods design of systematic review was employed, creating a measurement framework in a narrative review for consistent critical appraisal. The quality of included studies was assessed using the Joanna Briggs Institute tool. The measurement properties of the instruments were evaluated using the Consensus based Standards for selection of Health Measurement Instruments (COSMIN) checklist. RESULTS A total of 21,584 records were screened, and 26 articles were included, comprising 11 quantitative, 11 qualitative, and 4 mixed-methods studies. A thematic analysis of qualitative data extracted from the included articles summarised a measurement framework encompassing seven core and six associated measurements. The core measurements, including financial, medication, administrative, lifestyle, healthcare, time/travel, and medical information burdens, directly reflect the constructs pertinent to the treatment burden of T2DM. In contrast, the associated measurement themes do not directly reflect the burdens or are less substantiated by current evidence. The results of the COSMIN checklist evaluation demonstrated that the Patient Experience with Treatment and Self-management (PETS), Treatment Burden Questionnaire (TBQ), and Multimorbidity Treatment Burden Questionnaire (MTBQ) have robust instrument development processes. These three instruments, with the highest total counts combining the number of themes covered and "positive" ratings in COSMIN evaluation, were in the top tertile stratification, demonstrating superior applicability for measuring T2DM treatment burden. CONCLUSIONS This systematic review provides evidence for the currently superior option of measuring treatment burden in people with T2DM. It also revealed that most current research was conducted in well-resourced institutions, potentially overlooking variability in under-resourced settings.
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Affiliation(s)
- Kai Lin
- Family Medicine Centre, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, 6027, Australia
| | - Mi Yao
- General Practice, Peking University First Hospital, Beijing, 100034, China
| | - Xinxin Ji
- Family Medicine Centre, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, China
| | - Rouyan Li
- Family Medicine Centre, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, China
| | - Lesley Andrew
- School of Nursing and Midwifery, Edith Cowan University, Perth, 6027, Australia
| | - Jacques Oosthuizen
- School of Medical and Health Sciences, Edith Cowan University, Perth, 6027, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Perth, 6027, Australia.
| | - Yongsong Chen
- Endocrinology Department, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, China.
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21
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Smith SK, Pryce H, O'Connell GB, Hussain S, Shaw R, Straus J. 'The burden is very much on yourself': A qualitative study to understand the illness and treatment burden of hearing loss across the life course. Health Expect 2024; 27:e14067. [PMID: 38715316 PMCID: PMC11076985 DOI: 10.1111/hex.14067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/12/2024] Open
Abstract
INTRODUCTION Hearing loss is a chronic health condition that rises sharply with age. The way people respond to and cope with health conditions is influenced by their capacity to perform illness and treatment-related work. The aim was to explore the cumulative burdens of living with hearing loss and the resources mobilised to ease the burdens. METHODS A qualitative design was used with semi-structured interviews (online or in-person) with participants recruited through audiology services and nonclinical services, such as lip-reading classes. Forty-six participants with hearing loss aged between 16 and 96 years were interviewed. An abductive approach, informed by May et al.'s burden of treatment theory, was used to analyse the data. RESULTS The illness burden involved participants working to make sense of their hearing loss, engaging in emotional work in response to changes in sound, social interactions and identity and coping with the daily frustrations required to communicate with others. Abandonment and uncertainty characterised the treatment burden; participants engaged in emotional work to adjust to hearing technology and deal with the uncertainty of how their hearing might progress. To ameliorate the burdens, participants drew on internal resources (psychological, health literacy, cognitive) and external resources (social support, financial, information, technology). CONCLUSIONS The workload of hearing loss appears largely devolved to the patient and is not always visible. Our work indicates the need to widen approaches in audiological care through the implementation of lifeworld-led care, family-centred care and peer support to build support for those with hearing loss. PATIENT OR PUBLIC CONTRIBUTION We developed the project in consultation with members of the public who have lived experience of hearing loss recruited through Aston University and volunteer links to audiology services. We also consulted people more likely to be affected by hearing loss adults including adults with learning disabilities, older adults in residential care and people from South Asia (Bangladeshi, Indian and Pakistani communities). These individuals commented on the study aims, interview schedule and participant recruitment practices. One of our co-authors (expert by experience) contributed to the development and interpretation of themes and preparation of the final manuscript.
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Affiliation(s)
- Sian K. Smith
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
| | - Helen Pryce
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
| | | | - Saira Hussain
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
| | - Rachel Shaw
- Aston Institute of Health and Neurodevelopment and School of Psychology, College of Health and Life SciencesAston UniversityBirminghamUK
| | - Jean Straus
- Department of Audiology, College of Health and Life SciencesAston UniversityBirminghamUK
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22
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Hollick RJ, James WRG, Nicoll A, Locock L, Black C, Dhaun N, Egan AC, Fluck N, Laidlaw L, Lanyon PC, Little MA, Luqmani RA, Moir L, McBain M, Basu N. Identifying key health system components associated with improved outcomes to inform the re-configuration of services for adults with rare autoimmune rheumatic diseases: a mixed-methods study. THE LANCET. RHEUMATOLOGY 2024; 6:e361-e373. [PMID: 38782514 DOI: 10.1016/s2665-9913(24)00082-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2024] [Revised: 03/12/2024] [Accepted: 03/13/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND Adults with rare autoimmune rheumatic diseases face unique challenges and struggles to navigate health-care systems designed to manage common conditions. Evidence to inform an optimal service framework for their care is scarce. Using systemic vasculitis as an exemplar, we aimed to identify and explain the key service components underpinning effective care for rare diseases. METHODS In this mixed-methods study, data were collected as part of a survey of vasculitis service providers across the UK and Ireland, interviews with patients, and from organisational case studies to identify key service components that enable good care. The association between these components and patient outcomes (eg, serious infections, mortality) and provider outcomes (eg, emergency hospital admissions) were examined in a population-based data linkage study using routine health-care data obtained from patients with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis from national health datasets in Scotland. We did univariable and multivariable analyses using Bayesian poisson and negative binomial regression to estimate incident rate ratios (IRRs), and Cox proportional hazards models to estimate hazard ratios (HRs). People with lived experiences were involved in the research and writing process. FINDINGS Good care was characterised by service components that supported timely access to services, integrated care, and expertise. In 1420 patients with ANCA-associated vasculitis identified from national health datasets, service-reported average waiting times for new patients of less than 1 week were associated with fewer serious infections (IRR 0·70 [95% credibility interval 0·55-0·88]) and fewer emergency hospital admissions (0·78 [0·68-0·92]). Nurse-led advice lines were associated with fewer serious infections (0·76 [0·58-0·93]) and fewer emergency hospital admissions (0·85 [0·74-0·96]). Average waiting times for new patients of less than 1 week were also associated with reduced mortality (HR 0·59 [95% credibility interval 0·37-0·93]). Cohorted clinics, nurse-led clinics, and specialist vasculitis multi-disciplinary team meetings were associated with fewer serious infections (IRR 0·75 [0·59-0·96] for cohorted clinics; 0·65 [0·39-0·84] for nurse-led clinics; 0·72 [0·57-0·90] for specialist vasculitis multi-disciplinary team meetings) and emergency hospital admissions (0·81 [0·71-0·91]; 0·75 [0·65-0·94]; 0·86 [0·75-0·96]). Key components were characterised by their ability to overcome professional tensions between specialties. INTERPRETATION Key service components associated with important health outcomes and underpinning factors were identified to inform initiatives to improve the design, delivery, and effectiveness of health-care models for rare autoimmune rheumatic diseases. FUNDING Versus Arthritis.
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Affiliation(s)
- Rosemary J Hollick
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK.
| | - Warren R G James
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Avril Nicoll
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Louise Locock
- Health Services Research Unit, University of Aberdeen, Aberdeen, UK
| | - Corri Black
- Aberdeen Centre for Health Data Science, University of Aberdeen, Aberdeen, UK; NHS Grampian, Foresterhill, Aberdeen, UK
| | - Neeraj Dhaun
- British Heart Foundation/University Centre for Cardiovascular Science, University of Edinburgh, Edinburgh, UK
| | - Allyson C Egan
- Trinity Health Kidney Centre, Tallaght University Hospital, Dublin, Ireland
| | | | - Lynn Laidlaw
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Peter C Lanyon
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK; Lifespan and Population Health, School of Medicine, University of Nottingham, Nottingham, UK
| | - Mark A Little
- Trinity Kidney Centre, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Oxford, UK
| | - Laura Moir
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Maureen McBain
- Epidemiology Group, Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
| | - Neil Basu
- School of Infection and Immunity, University of Glasgow, Glasgow, UK
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Hanley SJ, McCann S, Lee SI, Vowles Z, Plachcinski R, Nirantharakumar K, Black M, Locock L, Taylor B. Lost in the System: Responsibilisation and Burden for Women With Multiple Long-Term Health Conditions During Pregnancy. Health Expect 2024; 27:e14104. [PMID: 38872453 PMCID: PMC11176589 DOI: 10.1111/hex.14104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 05/23/2024] [Accepted: 05/26/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Over a fifth of pregnant women are living with multiple long-term health conditions, which is associated with increased risks of adverse outcomes for mothers and infants. While there are many examples of research exploring individuals' experiences and care pathways for pregnancy with a single health condition, evidence relating to multiple health conditions is limited. This study aimed to explore experiences and care of women with multiple long-term health conditions around the time of pregnancy. METHODS Semistructured interviews were conducted between March 2022 and May 2023 with women with multiple long-term health conditions who were at least 28 weeks pregnant or had had a baby in the last 2 years, and healthcare professionals with experience of caring for these women. Participants were recruited from across the United Kingdom. Data were analysed using thematic analysis. RESULTS Fifty-seven women and 51 healthcare professionals participated. Five themes were identified. Women with long-term health conditions and professionals recognised that it takes a team to avoid inconsistent care and communication, for example, medication management. Often, women were required to take a care navigation role to link up their healthcare providers. Women described mixed experiences regarding care for their multiple identities and the whole person. Postnatally, women and professionals recognised a downgrade in care, particularly for women's long-term health conditions. Some professionals detailed the importance of engaging with women's knowledge, and recognising their own professional boundaries of expertise. Many participants described difficulties in providing informational continuity and subsequent impacts on care. Specifically, the setup of care systems made it difficult for everyone to access necessary information, especially when care involved multiple sites. CONCLUSION Pregnant women with long-term health conditions can experience a substantial burden of responsibility to maintain communication with their care team, often feeling vulnerable, patronised, and let down by a lack of acknowledgement of their expertise. These results will be used to inform the content of coproduction workshops aimed at developing a list of care recommendations for affected women. It will also inform future interventional studies aimed at improving outcomes for these women and their babies. PATIENT OR PUBLIC CONTRIBUTION Our Patient and Public Involvement group were involved in the design of the study and the analysis and interpretation of the data, and a public study investigator was part of the author group.
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Affiliation(s)
- Stephanie J. Hanley
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamWest MidlandsUK
| | - Sharon McCann
- Health Services Research UnitUniversity of AberdeenAberdeenAberdeenshireUK
| | - Siang Ing Lee
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamWest MidlandsUK
| | - Zoe Vowles
- Department of Women and Children's HealthGuy's and St. Thomas' NHS Foundation TrustLondonUK
| | - Rachel Plachcinski
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamWest MidlandsUK
| | - Krish Nirantharakumar
- Institute of Applied Health ResearchUniversity of BirminghamBirminghamWest MidlandsUK
| | - Mairead Black
- Aberdeen Centre for Women's Health ResearchUniversity of AberdeenAberdeenAberdeenshireUK
| | - Louise Locock
- Health Services Research UnitUniversity of AberdeenAberdeenAberdeenshireUK
| | - Beck Taylor
- Department of Health SciencesUniversity of WarwickWarwickWest MidlandsUK
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Christiansen J, Lasgaard M, Pedersen SS, Pedersen MH, Friis K. Social Disconnectedness in Individuals with Cardiovascular Disease: Associations with Health Literacy and Treatment Burden. Int J Behav Med 2024; 31:363-371. [PMID: 38480621 PMCID: PMC11106123 DOI: 10.1007/s12529-024-10263-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Knowledge is limited on associations between social disconnectedness (i.e. loneliness and social isolation), health literacy and perceived treatment burden in individuals with cardiovascular disease (CVD). However, understanding these associations may be important for clinical practice. METHODS This study used cross-sectional self-reported data from the 2017 Danish health and morbidity survey entitled 'How are you?', investigating the associations of loneliness and social isolation with low health literacy and high treatment burden in individuals with CVD (n = 2521; mean age = 65.7 years). RESULTS Logistic regression analysis showed that loneliness and social isolation were associated with low health literacy in terms of difficulties in 'understanding health information' (loneliness: adjusted odds ratio (AOR) = 1.32, 95% confidence intervals (CI) [1.16, 1.50]; social isolation: AOR = 1.47, 95% CI [1.24, 1.73]) and 'engaging with healthcare providers' (loneliness: AOR = 1.53, 95% CI [1.37, 1.70]; social isolation: AOR = 1.21, 95% CI [1.06, 1.40]) and associated with high treatment burden (loneliness: AOR = 1.49, 95% CI [1.35, 1.65]; social isolation: AOR = 1.20, 95% CI [1.06, 1.37]). CONCLUSIONS Our findings show that loneliness and social isolation coexisted with low health literacy and high treatment burden in individuals with CVD. These findings are critical as socially disconnected individuals experience more health issues. Low health literacy and a high treatment burden may potentially exacerbate these issues.
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Affiliation(s)
- Julie Christiansen
- Department of Psychology, University of Southern Denmark, Odense, Denmark.
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark.
| | - Mathias Lasgaard
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
| | - Susanne S Pedersen
- Department of Psychology, University of Southern Denmark, Odense, Denmark
- Department of Cardiology, Odense University Hospital, Odense, Denmark
| | - Marie Hauge Pedersen
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Karina Friis
- DEFACTUM - Public Health Research, Central Denmark Region, Aarhus, Denmark
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Pearce A, Henery P, Katikireddi SV, Dundas R, Leyland AH, Nicholls D, Viner RM, Fenton L, Hope S. Childhood attention-deficit hyperactivity disorder: socioeconomic inequalities in symptoms, impact, diagnosis and medication. Child Adolesc Ment Health 2024; 29:126-135. [PMID: 38497431 DOI: 10.1111/camh.12707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/06/2024] [Indexed: 03/19/2024]
Abstract
BACKGROUND Children from disadvantaged backgrounds are at greater risk of attention-deficit hyperactivity disorder (ADHD)-related symptoms, being diagnosed with ADHD, and being prescribed ADHD medications. We aimed to examine how inequalities manifest across the 'patient journey', from perceptions of impacts of ADHD symptoms on daily life, to the propensity to seek and receive a diagnosis and treatment. METHODS We investigated four 'stages': (1) symptoms, (2) caregiver perception of impact, (3) diagnosis and (4) medication, in two data sets: UK Millennium Cohort Study (MCS, analytic n ~ 9,000), with relevant (parent-reported) information on all four stages (until 14 years); and a population-wide 'administrative cohort', which includes symptoms (child health checks) and prescriptions (dispensing records), born in Scotland, 2010-2012 (analytic n ~ 100,000), until ~6 years. We described inequalities according to maternal occupational status, with percentages and relative indices of inequality (RII). RESULTS The prevalence of ADHD symptoms and medication receipt was considerably higher in the least compared to the most advantaged children in the administrative cohort (RIIs of 5.9 [5.5-6.4] and 8.1 [4.2-15.6]) and the MCS (3.08 [2.68-3.55], 3.75 [2.21-6.36]). MCS analyses highlighted complexities between these two stages, however, those from least advantaged backgrounds, with ADHD symptoms, were the least likely to perceive impacts on daily life (15.7% vs. average 19.5%) and to progress from diagnosis to medication (44.1% vs. average 72.5%). CONCLUSIONS Despite large inequalities in ADHD symptoms and medication, parents from the least advantaged backgrounds were less likely to report impacts of ADHD symptoms on daily life, and their children were less likely to have received medication postdiagnosis, highlighting how patient journeys differed according to socioeconomic circumstances.
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Affiliation(s)
| | - Paul Henery
- Public Health Scotland, Edinburgh and Glasgow, UK
| | | | | | | | | | | | - Lynda Fenton
- Public Health Scotland, Edinburgh and Glasgow, UK
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26
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Polus M, Keikhosrokiani P, Korhonen O, Behutiye W, Isomursu M. Impact of Digital Interventions on the Treatment Burden of Patients With Chronic Conditions: Protocol for a Systematic Review. JMIR Res Protoc 2024; 13:e54833. [PMID: 38652531 PMCID: PMC11077406 DOI: 10.2196/54833] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 02/20/2024] [Accepted: 03/13/2024] [Indexed: 04/25/2024] Open
Abstract
BACKGROUND There is great potential for delivering cost-effective, quality health care for patients with chronic conditions through digital interventions. Managing chronic conditions often includes a substantial workload required for adhering to the treatment regimen and negative consequences on the patient's function and well-being. This treatment burden affects adherence to treatment and disease outcomes. Digital interventions can potentially exacerbate the burden but also alleviate it. OBJECTIVE The objective of this review is to identify, summarize, and synthesize the evidence of how digital interventions impact the treatment burden of people with chronic conditions. METHODS The search, selection, and data synthesis processes were designed according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015. A systematic search was conducted on October 16, 2023, from databases PubMed, Scopus, Web of Science, ACM, PubMed Central, and CINAHL. RESULTS Preliminary searches have been conducted, and screening has been started. The review is expected to be completed in October 2024. CONCLUSIONS As the number of patients with chronic conditions is increasing, it is essential to design new digital interventions for managing chronic conditions in a way that supports patients with their treatment burden. To the best of our knowledge, the proposed systematic review will be the first review that investigates the impact of digital interventions on the treatment burden of patients. The results of this review will contribute to the field of health informatics regarding knowledge of the treatment burden associated with digital interventions and practical implications for developing better digital health care for patients with chronic conditions. TRIAL REGISTRATION PROSPERO CRD42023477605; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=477605. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/54833.
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Affiliation(s)
- Manria Polus
- Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Pantea Keikhosrokiani
- Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
- Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Olli Korhonen
- Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Woubshet Behutiye
- Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
| | - Minna Isomursu
- Faculty of Information Technology and Electrical Engineering, University of Oulu, Oulu, Finland
- Faculty of Medicine, University of Oulu, Oulu, Finland
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Bűhler M, Atmore C, Perry M, Crengle S, Norris P, Baxter GD. Patient experiences and perspectives of health service access for carpal tunnel syndrome in Aotearoa New Zealand: a normalisation process theory-informed qualitative study. BMC Health Serv Res 2024; 24:465. [PMID: 38614968 PMCID: PMC11015558 DOI: 10.1186/s12913-024-10871-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 03/14/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Early access to care for carpal tunnel syndrome (CTS) can avoid higher rates of surgery and permanent harm yet is often delayed, particularly for populations more likely to underutilise care. OBJECTIVE We sought to explore patient experiences and perspectives of health service access for CTS to inform an equity-focussed co-design of a health service for improving early care access. METHODS In this Normalisation Process Theory (NPT)-informed qualitative study we conducted semistructured in-depth interviews with 19 adults with experience of CTS. Recruitment prioritised New Zealand Māori, Pasifika, low-income, and rural populations. Data were analysed using deductive then inductive thematic analysis. RESULTS We identified five major themes: (1) the 'Significant Impact of CTS' of the sense-making and relational work to understand the condition, deciding when to get care, compelling clinicians to provide care, and garnering help from others; (2) 'Waiting and Paying for Care'- the enacting, relational, and appraising work to avoid long wait times unless paying privately, particularly where quality of care was low, employment relations poor, or injury compensation processes faltered; (3) circumstances of 'Occupation and CTS Onset' whereby the burden of proof to relate onset of CT symptoms to occupation created excessive relational and enacting work; (4) the 'Information Scarcity' of good information about CTS and the high relational and appraising work associated with using online resources; (5) 'Negotiating Telehealth Perspectives' where telehealth was valued if it meant earlier access for all despite the challenges it held for many. CONCLUSION Quality, culturally and linguistically responsive information and communication from clinicians and health services will improve equitable early access to CTS care including realising the potential of telehealth modes of care. Policy changes that reduce individual burden of proof in injury compensation claims processes, enable time off work to attend health appointments, and increase public funding for surgical resources would improve early access to CTS care particularly for Māori and Pacific populations and those in small and rural workplaces. NPT is valuable for understanding where opportunities lie to reduce inequitable delays to accessing care including the impact of racism, particularly for populations more likely to underutilise care.
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Affiliation(s)
- Miranda Bűhler
- Department of General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin, 9010, New Zealand.
| | - Carol Atmore
- Department of General Practice & Rural Health, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Meredith Perry
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, Wellington, New Zealand
| | - Sue Crengle
- Ngāi Tahu Māori Health Research Unit, University of Otago, Dunedin, New Zealand
- Department of Preventive and Social Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Pauline Norris
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - G David Baxter
- Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago, PO Box 56, Dunedin, 9010, New Zealand
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Dona AC, Jewett PI, Hwee S, Brown K, Solomon M, Gupta A, Teoh D, Yang G, Wolfson J, Fan Y, Blaes AH, Vogel RI. Logistic burdens of cancer care: A qualitative study. PLoS One 2024; 19:e0300852. [PMID: 38573993 PMCID: PMC10994350 DOI: 10.1371/journal.pone.0300852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024] Open
Abstract
Cancer treatment often creates logistic conflicts with everyday life priorities; however, these challenges and how they are subjectively experienced have been largely unaddressed in cancer care. Our goal was to describe time and logistic requirements of cancer care and whether and how they interfered with daily life and well-being. We conducted interviews with 20 adults receiving cancer-directed treatment at a single academic cancer center. We focused on participants' perception of the time, effort, and energy-intensiveness of cancer care activities, organization of care requirements, and preferences in how to manage the logistic burdens of their cancer care. Participant interview transcripts were analyzed using an inductive thematic analysis approach. Burdens related to travel, appointment schedules, healthcare system navigation, and consequences for relationships had roots both at the system-level (e.g. labs that were chronically delayed, protocol-centered rather than patient-centered bureaucratic requirements) and in individual circumstances (e.g. greater stressors among those working and/or have young children versus those who are retired) that determined subjective burdensomeness, which was highest among patients who experienced multiple sources of burdens simultaneously. Our study illustrates how objective burdens of cancer care translate into subjective burden depending on patient circumstances, emphasizing that to study burdens of care, an exclusive focus on objective measures does not capture the complexity of these issues. The complex interplay between healthcare system factors and individual circumstances points to clinical opportunities, for example helping patients to find ways to meet work and childcare requirements while receiving care.
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Affiliation(s)
- Allison C. Dona
- School of Medicine, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Epidemiology and Community Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Patricia I. Jewett
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Sharon Hwee
- Division of Pediatric Hematology and Oncology, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Katherine Brown
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Matia Solomon
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Arjun Gupta
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Deanna Teoh
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Guang Yang
- Daynamica, Inc., Chanhassen, Minnesota, United States of America
| | - Julian Wolfson
- Daynamica, Inc., Chanhassen, Minnesota, United States of America
- Division of Biostatistics and Health Data Science, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Yingling Fan
- Daynamica, Inc., Chanhassen, Minnesota, United States of America
- Humphrey School of Public Affairs, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Anne H. Blaes
- Division of Hematology, Oncology and Transplantation, University of Minnesota, Minneapolis, Minnesota, United States of America
| | - Rachel I. Vogel
- Department of Obstetrics, Gynecology, and Women’s Health, University of Minnesota, Minneapolis, Minnesota, United States of America
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Woodward A, Nimmons D, Davies N, Walters K, Stevenson FA, Protheroe J, Chew‐Graham CA, Armstrong M. A qualitative exploration of the barriers and facilitators to self-managing multiple long-term conditions amongst people experiencing socioeconomic deprivation. Health Expect 2024; 27:e14046. [PMID: 38623837 PMCID: PMC11019445 DOI: 10.1111/hex.14046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 03/25/2024] [Accepted: 03/29/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND Globally, it is estimated that one in three adults live with two or more long-term conditions (multiple long-term conditions, MLTCs), that require self-management. People who experience socioeconomic deprivation face significant health inequalities due to a range of interrelated characteristics that lead to a lack of resources and opportunities. Previous research with underserved populations indicate low levels of trust towards primary care providers and potential barriers for developing patient-healthcare professional relationships. The purpose of this paper is to explore the barriers and facilitators to self-managing MLTCs, amongst people who experience socioeconomic deprivation. METHODS Semistructured one-to-one interviews with adults (n = 28) living in London and Sheffield, United Kingdom with MLTCs who are experiencing socioeconomic deprivation. Participants were recruited through general practices, community channels and social media. Data were analysed in NVivo using reflexive thematic analysis methods. FINDINGS Four analytical themes were developed: (1) challenges in accessing healthcare services, financial assistance, and cultural awareness; (2) empowerment and disempowerment through technology, including digital exclusion, and use of technology; (3) impact and causes of exclusion on self-management, including social isolation, area-based and economic exclusion, and health-related stigma and (4) adapting self-management strategies, including cost-effective, and culturally/lifestyle appropriate strategies. CONCLUSIONS Future health interventions and services need to be developed with consideration of the combined complexities of managing MLTCs while experiencing socioeconomic deprivation. Increased awareness in practitioners and commissioners of the complexities surrounding the lives of people experiencing socioeconomic deprivation, and the need for targeted strategies to promote self-management of MLTCs are of great importa. PATIENT OR PUBLIC CONTRIBUTION A patient advisory group contributed to all stages of the study, including providing important feedback on study documents (topic guides and recruitment materials), as well as providing critical insights surrounding the interpretation of interview data.
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Affiliation(s)
- Abi Woodward
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Danielle Nimmons
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Nathan Davies
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Kate Walters
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | - Fiona A. Stevenson
- Research Department of Primary Care and Population HealthUniversity College LondonLondonUK
| | | | | | - Megan Armstrong
- Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
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Lin K, Yao M, Andrew L, Li R, Chen Y, Oosthuizen J, Sim M, Chen Y. Exploring treatment burden in people with type 2 diabetes mellitus: a thematic analysis in china's primary care settings. BMC PRIMARY CARE 2024; 25:88. [PMID: 38491369 PMCID: PMC10941610 DOI: 10.1186/s12875-024-02301-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 02/08/2024] [Indexed: 03/18/2024]
Abstract
BACKGROUND Understanding treatment burden is a critical element to the effective management of Type 2 Diabetes Mellitus (T2DM). The current study aims to address the knowledge gap surrounding treatment burden of T2DM from the patient's perspective in China's primary care settings. METHODS A narrative review informed the creation of an a priori coding structure to identify aspects of T2DM treatment burden. Focus groups were conducted, employing a maximum variation sampling strategy to select participants from diverse sociodemographic backgrounds across urban, suburban, rural, and remote areas in China. Participants included adults with T2DM care in primary care settings for over a year and a Treatment Burden Questionnaire score of 25 or higher. Deductive thematic analysis, guided by the coding structure, facilitated a comprehensive exploration and further development of the conceptual framework of T2DM treatment burden. RESULTS Four focus groups, each comprising five participants from diverse areas, were conducted. Utilising the Cumulative Complexity Model and Normalisation Process Theory as theoretical underpinnings, the thematic analysis refined the conceptual framework based on the coding structure from the narrative review. Five key themes were refined, encompassing medical information, medication, administration, healthcare system, and lifestyle. Additionally, the financial and time/travel themes merged into a new theme termed "personal resources", illustrating their overlapping within the framework. Participants in these focus groups highlighted challenges in managing medical information, an aspect often underrepresented in prior treatment burden research. The thematic analysis culminated in a finalised conceptual framework, offering a comprehensive understanding of the treatment burden experiences of people with T2DM in China's primary care settings. This framework includes six key constructs, delineating T2DM treatment burden and associated factors, such as antecedents and consequences. CONCLUSIONS This study provides insights into the treatment burden of T2DM. A conceptual framework was finalised to deepen the understanding of the multifaceted constructs and the nature of treatment burden in people with T2DM. Furthermore, it emphasises the need to tailor T2DM treatment to individual capacities, considering their personal resource allocation and treatment utilisation.
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Affiliation(s)
- Kai Lin
- Family Medicine Centre, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, China
- School of Medical and Health Sciences, Edith Cowan University, Perth, 6027, Australia
| | - Mi Yao
- General Practice, Peking University First Hospital, Beijing, 100034, China
| | - Lesley Andrew
- School of Nursing and Midwifery, Edith Cowan University, Perth, 6027, Australia
| | - Rouyan Li
- Clinical Medicine, Shantou University Medical College, Shantou, 515000, China
| | - Yilin Chen
- Clinical Medicine, Shantou University Medical College, Shantou, 515000, China
| | - Jacques Oosthuizen
- School of Medical and Health Sciences, Edith Cowan University, Perth, 6027, Australia
| | - Moira Sim
- School of Medical and Health Sciences, Edith Cowan University, Perth, 6027, Australia.
| | - Yongsong Chen
- Endocrinology Department, The First Affiliated Hospital of Shantou University Medical College, Shantou, 515000, China.
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Davies J, Remington A, Buckley C, Crane L, Smalley K. 'It seems like a luxury to be able to offer that': Factors influencing the implementation of annual health checks for autistic people in England. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:656-673. [PMID: 37431819 PMCID: PMC10913342 DOI: 10.1177/13623613231182011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/12/2023]
Abstract
LAY ABSTRACT Autistic people are more likely to have mental and physical health problems than non-autistic people. Annual health checks could reduce these problems by finding and treating them early. Annual health checks are yearly medical appointments where a primary healthcare provider (such as a doctor or nurse) can check things like a patient's weight and heart rate and ask if they have any worries about their health. In this study, we wanted to understand what might encourage primary healthcare providers to use annual health checks with their autistic patients. First, we spoke to 10 autistic people and 11 primary healthcare providers. Using the findings from these conversations, we created an online survey for primary healthcare providers in England. We used the findings from the interviews and survey to help us understand what would encourage primary healthcare providers to offer annual health checks for autistic people. Our participants said that a lack of time and staff would make it hard to provide health checks. To help, they said other members of staff (such as nurses and healthcare assistants) could do the health checks, rather than doctors. They also said parts of the process could be made automatic to save time (e.g. sending automatic reminders). Knowledge about autism was important too (e.g. knowing about the common conditions autistic people have, and how to best support autistic patients). Participants said training on these topics, produced and delivered with autistic people, could encourage them to use annual health checks with their autistic patients.
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Affiliation(s)
| | | | | | | | - Katelyn Smalley
- University College London, UK
- University of Plymouth, UK
- Imperial College London
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Evans C, Clancy G, Evans K, Booth A, Nazmeen B, Timmons S, Sunney C, Clowes M, Jones NW, Spiby H. Developing initial programme theories for a realist synthesis on digital clinical consultations in maternity care: contributions from stakeholder involvement. J Res Nurs 2024; 29:127-140. [PMID: 39070565 PMCID: PMC11271666 DOI: 10.1177/17449871241226911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/30/2024] Open
Abstract
Background The COVID pandemic prompted an increase in the use of digital clinical consultations (telephone or video calls) within midwifery and nursing care. This paper reports on a realist review project related to maternity care that seeks to illuminate for whom such consultations can safely and acceptably be used, how, for what purposes and in what contexts. Aims This paper addresses the first phase of a realist enquiry - initial programme theory development - focusing particularly on the role of stakeholder involvement (including digital transformation leaders, midwives, obstetricians, service users and community organisations). Methods Three sub-stages of initial programme theory development are described highlighting the contribution of stakeholder groups to each stage: (i) consultation to focus the review question, (ii) focused searching and (iii) further consultation. Results Realist literature searching strategies yielded limited theory-rich evidence on digital consultations. Stakeholders provided essential additional contributions resulting in the development of 13 initial programme theories and a conceptual framework. Conclusions More research on the implementation of virtual midwifery/nursing consultations is needed. Nursing/midwifery digital researchers should involve stakeholders to help shape research priorities, deepen contextual understanding and sense-check emerging findings.
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Affiliation(s)
- Catrin Evans
- Professor in Evidence Based Healthcare, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Georgia Clancy
- Research Fellow, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Kerry Evans
- Senior Clinical Academic Midwife and Associate Professor, School of Health Sciences, University of Nottingham, Nottingham, UK
| | - Andrew Booth
- Professor in Evidence Synthesis, ScHARR, University of Sheffield, Sheffield, UK
| | - Benash Nazmeen
- Assistant Professor, School of Allied Health Professionals and Midwifery, University of Bradford, Bradford, UK
| | - Stephen Timmons
- Professor of Health Services Management, Nottingham University Business School, University of Nottingham, Nottingham, UK
| | - Candice Sunney
- Lay Researcher, Nottingham Maternity Research Network, Nottingham, UK
| | - Mark Clowes
- Information Scientist, ScHARR, University of Sheffield, Sheffield, UK
| | - Nia Wyn Jones
- Clinical Associate Professor, School of Medicine, University of Nottingham, Sheffield, UK
| | - Helen Spiby
- Professor of Midwifery, School of Health Sciences, University of Nottingham, Nottingham, UK
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Austin RC. Rewriting the heart failure pillars toward less burdensome heart failure care pathways. THE BRITISH JOURNAL OF CARDIOLOGY 2024; 31:005. [PMID: 39323945 PMCID: PMC11421064 DOI: 10.5837/bjc.2024.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/27/2024]
Affiliation(s)
- Rosalynn C Austin
- Post-doctoral Researcher, Department of Public Health, Faculty of Health Sciences, University of Stavanger, Norway; Cardiology Clinical Academic Nurse Researcher, Portsmouth Hospitals University NHS Trust; Visiting Researcher, Long-term Conditions Theme, National Institute for Health and Care Research Applied Research Collaboration Wessex Department of Cardiology, Portsmouth Hospitals University NHS Trust, Cosham, Portsmouth, PO6 3LY
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Coe A, Gunn J, Allnutt Z, Kaylor-Hughes C. Understanding Australian general practice patients' decisions to deprescribe antidepressants in the WiserAD trial: a realist informed approach. BMJ Open 2024; 14:e078179. [PMID: 38355180 PMCID: PMC10868251 DOI: 10.1136/bmjopen-2023-078179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 01/31/2024] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVES To evaluate how an approach to antidepressant deprescribing works, for whom, and in what contexts by (1) examining the experiences and perceptions of the approach for antidepressant users, (2) identifying the mechanisms of the approach and (3) describing what contexts are associated with antidepressant tapering. DESIGN This mixed methods study was informed by the principles of realist evaluation and was conducted in the first 3 months of participation in the WiserAD randomised control trial. SETTING General practice, Victoria, Australia. PARTICIPANTS 13 antidepressant users from general practice participating in the WiserAD trial for antidepressant deprescribing. INTERVENTION A patient-facing, web-based structured support tool that consists of a personalised tapering schedule, an action plan for managing withdrawal symptoms, a daily mood, sleep and activity tracker and mental health nurse support. PRIMARY/SECONDARY OUTCOME MEASURES The outcomes of the study were revealed on data analysis as per a realist evaluation approach which tests and refines an initial programme theory. RESULTS The contexts of learnt coping skills, knowledge and perceptions of antidepressants and feeling well were evident. Outcomes were intention to commence, initiation of deprescribing and successful completion of deprescribing. Key mechanisms for antidepressant deprescribing were (1) initiation of the deprescribing discussion; (2) patient self-efficacy; (3) provision of structured guidance; (4) coaching; (5) mood, sleep and activity tracking and (6) feelings of safety during the tapering period. CONCLUSIONS The WiserAD approach to antidepressant deprescribing supported participants to commence and/or complete tapering. The refined programme theory presents the WiserAD pragmatic framework for the application of antidepressant deprescribing in clinical practice. TRIAL REGISTRATION NUMBER ClinicalTrials.gov NCT05355025; ACTRN12622000567729; ISRCTN11562922; Pre-results.
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Affiliation(s)
- Amy Coe
- Department of General Practice and Primary Care, The University of Melbourne, Carlton, Victoria, Australia
| | - Jane Gunn
- Department of General Practice and Primary Care, The University of Melbourne, Carlton, Victoria, Australia
| | - Zoe Allnutt
- Department of General Practice and Primary Care, The University of Melbourne, Carlton, Victoria, Australia
| | - Catherine Kaylor-Hughes
- Department of General Practice and Primary Care, The University of Melbourne, Carlton, Victoria, Australia
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Pindi Sala T, Matondo Masisa D, Crave JC, Belmokhtar C, LeNy G, Situakibanza H, Duracinsky M, Cherin P, Chassany O. Contribution of Flexig mobile application to assess adherence of patients treated with immunoglobulins in chronic diseases. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100173. [PMID: 37915723 PMCID: PMC10616388 DOI: 10.1016/j.jacig.2023.100173] [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] [Received: 02/22/2023] [Revised: 06/09/2023] [Accepted: 07/12/2023] [Indexed: 11/03/2023]
Abstract
Background Long-term therapeutic adherence remains an essential challenge for better management of chronic diseases. It is estimated at 50% in developed countries. Objective The study aimed to evaluate, under real conditions, the influence of satisfaction with Flexig use on adherence to subcutaneous immunoglobulin home-treatment therapy in a sample of French patients with chronic dysimmune diseases. Methods This is a 2-year prospective cohort involving 241 patients from several hospitals in France whose data were extracted from the Flexig 2.0 mHealth application. Satisfaction was assessed by System Usability Scale (SUS) and user experience by User Experience Questionnaire (UEQ). Adherence to Ig therapy was assessed by medication possession rate. We analyzed the relationship between Flexig user satisfaction and adherence to treatment, as well as determinants of adherence. Results Most patients (82.7%) were being treated for an immunodeficiency, versus 17.3% for a chronic autoimmune and inflammatory disease. Almost all patients (97.9%) received subcutaneous immunoglobulin therapy. The patients' ages (means ± SDs) were 36.5 ± 18.3 years, disease duration was about 6 years, and 58.5% were men. Flexig user satisfaction was 76.2 ± 8 (System Usability Scale), associated with good user experience reported on UEQ. Adherence rate was 99.7%. Time on app, disease duration, and Flexig user satisfaction were statistically predictive of adherence to IgG therapy. High adherence to Ig therapy was associated with good satisfaction with using Flexig (P < .0001). Conclusion Adherence to Ig therapy in chronic dysimmune disease was strong and was associated with good satisfaction among Flexig users, suggesting that electronic support may be a valuable compliance aid.
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Affiliation(s)
- Taylor Pindi Sala
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, F-75004, Paris, France
| | | | | | | | | | - Hippolyte Situakibanza
- Département de Médecine Interne, Département de Médecine Tropical, Faculté de Médecine, Université de Kinshasa, Kinshasa, Democratic Republic of the Congo
| | - Martin Duracinsky
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, F-75004, Paris, France
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
| | - Patrick Cherin
- Département de Médecine Interne et Immunologie Clinique, Groupement Hospitalier Pitié-Salpêtrière, AP-HP, Sorbonne Université, Paris, France
| | - Olivier Chassany
- ECEVE, UMR-S 1123, Université Paris Cité, Inserm, F-75004, Paris, France
- Patient-Reported Outcomes Research (PROQOL), Unité de Recherche Clinique en Economie de la Santé (URC-ECO), Hôpital Hôtel-Dieu, AP-HP, Paris, France
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Jackson K, Kaner E, Hanratty B, Gilvarry E, Yardley L, O'Donnell A. Understanding people's experiences of the formal health and social care system for co-occurring heavy alcohol use and depression through the lens of relational autonomy: A qualitative study. Addiction 2024; 119:268-280. [PMID: 37778755 DOI: 10.1111/add.16350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 08/23/2023] [Indexed: 10/03/2023]
Abstract
BACKGROUND AND AIMS Heavy alcohol use and depression commonly co-occur. However, health and social care services rarely provide coordinated support for these conditions. Using relational autonomy, which recognizes how social and economic contexts and relational support alter people's capacity for agency, this study aimed to (1) explore how people experience formal care provision for co-occurring alcohol use and depression, (2) consider how this context could lead to adverse outcomes for individuals and (3) understand the implications of these experiences for future policy and practice. DESIGN Semi-structured qualitative interviews underpinned by the methodology of interpretive description. SETTING North East and North Cumbria, UK. PARTICIPANTS Thirty-nine people (21 men and 18 women) with current or recent experience of co-occurring heavy alcohol use ([Alcohol Use Disorders Identification Test [AUDIT] score ≥ 8]) and depression ([Patient Health Questionnaire test ≥ 5] screening tools to give an indication of their current levels of alcohol use and mental score). MEASUREMENTS Semi-structured interview guide supported in-depth exploration of the treatment and care people had sought and received for heavy alcohol use and depression. FINDINGS Most participants perceived depression as a key factor contributing to their heavy alcohol use. Three key themes were identified: (1) 'lack of recognition' of a relationship between alcohol use and depression and/or contexts that limit people's capacity to access help, (2) having 'nowhere to go' to access relevant treatment and care and (3) 'supporting relational autonomy' as opposed to assuming that individuals can organize their own care and recovery. Lack of access to appropriate treatment and provision that disregards individuals' differential capacity for agency may contribute to delays in help-seeking, increased distress and suicidal ideation. CONCLUSIONS Among people with co-occurring heavy alcohol use and depression, lack of recognition of a relationship between alcohol use and depression and formal care provision that does not acknowledge people's social and economic context, including their intrinsic need for relational support, may contribute to distress and limit their capacity to get well.
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Affiliation(s)
- Katherine Jackson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eileen Kaner
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Barbara Hanratty
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Eilish Gilvarry
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Lucy Yardley
- School of Psychological Science, University of Bristol, Bristol, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - Amy O'Donnell
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Haider S, Gonzalez-Lopez C, Clark J, Gravholt DL, Breslin M, Boehmer KR, Hartasanchez SA, Sanchez B, Montori VM, Lipska KJ. Feasibility and Acceptability of an Agenda-Setting Kit in the Care of People With Type 2 Diabetes: The QBSAFE ASK Feasibility Study. Clin Diabetes 2024; 42:358-363. [PMID: 39015172 PMCID: PMC11247036 DOI: 10.2337/cd23-0062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/18/2024]
Abstract
This article reports on a study to assess the feasibility of research procedures and acceptability of QBSAFE, a set of conversation cards focused on quality of life, treatment burden, safety, and avoidance of future events in people with type 2 diabetes. The study enrolled 84 patients and 7 clinicians. Of the 58 patients who completed questionnaires, 64% agreed that the QBSAFE agenda-setting kit (ASK) helped them discuss their situation, 78% agreed that others could benefit from it, and 38% said they would use it again. Most clinicians felt confident responding to issues (in 89% of encounters) and said they would use the kit again (78%) and recommend it to colleagues (82%). The QBSAFE ASK can be feasibly implemented and holds promise in facilitating discussion and collaborative problem-solving.
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Affiliation(s)
- Shanzay Haider
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT
| | | | - Jennifer Clark
- Division of Endocrinology, Diabetes and Nutrition, Mayo Clinic, Rochester, MN
| | | | | | - Kasey R. Boehmer
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | | | - Brianna Sanchez
- Knowledge and Evaluation Research Unit, Mayo Clinic, Rochester, MN
| | | | - Kasia J. Lipska
- Section of Endocrinology, Yale University School of Medicine, New Haven, CT
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Goulding R, Birtwell K, Hann M, Peters S, van Marwijk H, Bower P. Safer Patients Empowered to Engage and Communicate about Health (SPEECH) in primary care: a feasibility study and process evaluation of an intervention for older people with multiple long-term conditions (multimorbidity). BMC PRIMARY CARE 2024; 25:12. [PMID: 38178010 PMCID: PMC10768368 DOI: 10.1186/s12875-023-02221-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/22/2023] [Indexed: 01/06/2024]
Abstract
BACKGROUND Older people with multiple long-term conditions (multimorbidity) (MLTC-M) experience difficulties accessing and interacting with health and care services. Breakdowns in communication between patients and staff can threaten patient safety. To improve communication and reduce risks to patient safety in primary care, we developed an intervention: Safer Patients Empowered to Engage and Communicate about Health (SPEECH). SPEECH comprises a booklet for patients and an associated guide for staff. The booklet is designed to provide patients with information about staff and services, skills to prepare and explain, and confidence to speak up and ask. METHODS A single-arm mixed methods feasibility study with embedded process evaluation. General practices in the North West of England were recruited. Participating practices invited patients aged 65+ with MLTC-M who had an appointment scheduled during the study period. Patients were asked to complete questionnaires at baseline and follow-up (four to eight weeks after being sent the patient booklet), including the Consultation and Relational Empathy measure, Empowerment Scale, Multimorbidity Treatment Burden Questionnaire, and Primary Care Patient Measure of Safety. Staff completed questionnaires at the end of the study period. A sub-sample of patients and staff were interviewed about the study processes and intervention. Patients and the public were involved in all aspects of the study, from generation of the initial idea to interpretation of findings. RESULTS Our target of four general practices were recruited within 50 days of the study information being sent out. A fifth practice was recruited later to boost patient recruitment. We received expressions of interest from 55 patients (approx. 12% of those invited). Our target of 40 patient participants completed baseline questionnaires and were sent the SPEECH booklet. Of these, 38 (95%) completed follow-up. Patients found the intervention and study processes acceptable, and staff found the intervention acceptable and feasible to deliver. CONCLUSIONS Our findings suggest the intervention is acceptable, and it would be feasible to deliver a trial to assess effectiveness. Prior to further evaluation, study processes and the intervention will be updated to incorporate suggestions from participants. TRIAL REGISTRATION The study was registered on the ISRCTN registry (ISRCTN13196605: https://doi.org/10.1186/ISRCTN13196605 ).
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Affiliation(s)
- Rebecca Goulding
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England.
| | - Kelly Birtwell
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England.
| | - Mark Hann
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Sarah Peters
- Manchester Centre for Health Psychology, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England
| | - Harm van Marwijk
- Department of Primary Care and Public Health, Brighton and Sussex Medical School, University of Brighton, Watson Building, Brighton, England
| | - Peter Bower
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, School of Health Sciences, The University of Manchester, Manchester Academic Health Science Centre, Manchester, England
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Storm M, Morken IM, Austin RC, Nordfonn O, Wathne HB, Urstad KH, Karlsen B, Dalen I, Gjeilo KH, Richardson A, Elwyn G, Bru E, Søreide JA, Kørner H, Mo R, Strömberg A, Lurås H, Husebø AML. Evaluation of the nurse-assisted eHealth intervention 'eHealth@Hospital-2-Home' on self-care by patients with heart failure and colorectal cancer post-hospital discharge: protocol for a randomised controlled trial. BMC Health Serv Res 2024; 24:18. [PMID: 38178097 PMCID: PMC10768157 DOI: 10.1186/s12913-023-10508-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 12/20/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Patients with heart failure (HF) and colorectal cancer (CRC) are prone to comorbidity, a high rate of readmission, and complex healthcare needs. Self-care for people with HF and CRC after hospitalisation can be challenging, and patients may leave the hospital unprepared to self-manage their disease at home. eHealth solutions may be a beneficial tool to engage patients in self-care. METHODS A randomised controlled trial with an embedded evaluation of intervention engagement and cost-effectiveness will be conducted to investigate the effect of eHealth intervention after hospital discharge on the self-efficacy of self-care. Eligible patients with HF or CRC will be recruited before discharge from two Norwegian university hospitals. The intervention group will use a nurse-assisted intervention-eHealth@Hospital-2-Home-for six weeks. The intervention includes remote monitoring of vital signs; patients' self-reports of symptoms, health and well-being; secure messaging between patients and hospital-based nurse navigators; and access to specific HF and CRC health-related information. The control group will receive routine care. Data collection will take place before the intervention (baseline), at the end of the intervention (Post-1), and at six months (Post-2). The primary outcome will be self-efficacy in self-care. The secondary outcomes will include measures of burden of treatment, health-related quality of life and 30- and 90-day readmissions. Sub-study analyses are planned in the HF patient population with primary outcomes of self-care behaviour and secondary outcomes of medication adherence, and readmission at 30 days, 90 days and 6 months. Patients' and nurse navigators' engagement and experiences with the eHealth intervention and cost-effectiveness will be investigated. Data will be analysed according to intention-to-treat principles. Qualitative data will be analysed using thematic analysis. DISCUSSION This protocol will examine the effects of the eHealth@ Hospital-2-Home intervention on self-care in two prevalent patient groups, HF and CRC. It will allow the exploration of a generic framework for an eHealth intervention after hospital discharge, which could be adapted to other patient groups, upscaled, and implemented into clinical practice. TRIAL REGISTRATION Clinical trials.gov (ID 301472).
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Affiliation(s)
- Marianne Storm
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway.
- Faculty of Health Sciences and Social Care, Molde University College, Molde, Norway.
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway.
| | - Ingvild Margreta Morken
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
- Department of Quality and Health Technologies, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| | - Rosalynn C Austin
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Department of Cardiology, Portsmouth Hospitals University NHS Trust, Portsmouth, UK
- National Institute of Health and Care Research (NIHR) Applied Research Collaborative (ARC) Wessex, Southampton, SO17 1BJ, UK
| | - Oda Nordfonn
- Department of Health and Caring Science, Western Norway University of Applied Science, Stord, Norway
| | - Hege Bjøkne Wathne
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Kristin Hjorthaug Urstad
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Faculty of Health Studies, VID Specialized University, Oslo, Norway
| | - Bjørg Karlsen
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
| | - Ingvild Dalen
- Department of Quality and Health Technologies, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
- Section of Biostatistics, Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Kari Hanne Gjeilo
- Department of Public Health and Nursing, Faculty of Medicine, and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
- Department of Cardiology, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Alison Richardson
- National Institute of Health and Care Research (NIHR) Applied Research Collaborative (ARC) Wessex, Southampton, SO17 1BJ, UK
- University Hospital Southampton NHS Foundation Trust, Southampton General Hospital, Mailpoint 11, Clinical Academic Facility (Room AA102), South Academic Block, Tremona Road, Southampton, SO16 6YD, UK
| | - Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine at Dartmouth College, Hanover, NH, USA
| | - Edvin Bru
- Centre for Learning Environment, University of Stavanger, Stavanger, Norway
| | - Jon Arne Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hartwig Kørner
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rune Mo
- Department of Cardiology, St. Olav's Hospital, and Trondheim University Hospital, Trondheim, Norway
- Department of Circulation and Medical Imaging, Faculty of Medicine, and Health Sciences, NTNU - Norwegian University of Science and Technology, Trondheim, Norway
| | - Anna Strömberg
- Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Department of Cardiology, Linköping University, Linköping, Sweden
| | - Hilde Lurås
- Avdeling for Helsetjenesteforskning (HØKH), Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Anne Marie Lunde Husebø
- Department of Public Health, Faculty of Health Sciences, University of Stavanger, 4036, Stavanger, Norway
- Research Group of Nursing and Health Sciences, Research Department, Stavanger University Hospital, Stavanger, Norway
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Dalgarno E, McDermott I, Goff M, Spooner S, McBride A, Hodgson D, Donnelly A, Hogg J, Checkland K. The patient experience of skill mix changes in primary care: an in-depth study of patient 'work' when accessing primary care. J Public Health (Oxf) 2023; 45:i54-i62. [PMID: 38127564 PMCID: PMC10734673 DOI: 10.1093/pubmed/fdad203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 07/19/2023] [Accepted: 09/28/2023] [Indexed: 12/23/2023] Open
Abstract
BACKGROUND This paper presents insights into patient experiences of changes in workforce composition due to increasing deployment in general practice of practitioners from a number of different professional disciplines (skill mix). We explore these experiences via the concept of 'patient illness work'; how a patient's capacity for action is linked to the work arising from healthcare. METHODS We conducted four focus group interviews with Patient Participation Group members across participating English general practitioner practices. Thematic analysis and a theoretical lens of illness work were used to explore patients' attempts to understand and navigate new structures, roles and ways to access healthcare. RESULTS Participants' lack of knowledge about incoming practitioners constrained their agency in accessing primary care. They reported both increased and burdensome illness work as they were given responsibility for navigating and understanding new systems of access while simultaneously understanding new practitioner roles. CONCLUSIONS While skill mix changes were not resisted by patients, they were keen to improve their agency in capacity to access, by being better informed about newer practitioners to accept and trust them. Some patients require support to navigate change, especially where new systems demand specific capacities such as technological skills and adaptation to unfamiliar practitioners.
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Affiliation(s)
- Elizabeth Dalgarno
- Department of Public Health, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PT, UK
| | - Imelda McDermott
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Mhorag Goff
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Sharon Spooner
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
| | - Anne McBride
- Institute of Health Policy and Management, Alliance Manchester Business School, University of Manchester, Manchester M13 9PT, UK
| | - Damian Hodgson
- The University of Sheffield, Management School, Sheffield, South Yorkshire, S10 2JA, UK
| | - Ailsa Donnelly
- The patient and public involvement and engagement group at The Centre for Primary Care and Health Services Research (Primer), The University of Manchester, Manchester, M13 9PL, UK
| | - Judith Hogg
- The patient and public involvement and engagement group at The Centre for Primary Care and Health Services Research (Primer), The University of Manchester, Manchester, M13 9PL, UK
| | - Kath Checkland
- Health Organisation, Policy and Economics (HOPE), Centre for Primary Care Research, School of Health Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester M13 9PL, UK
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Hunter R, Beattie M, O'Malley C, Gorely T. Mobile apps to self-manage chronic low back pain: A realist synthesis exploring what works, for whom and in what circumstances. PEC INNOVATION 2023; 3:100175. [PMID: 38213759 PMCID: PMC10782115 DOI: 10.1016/j.pecinn.2023.100175] [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] [Received: 09/13/2022] [Revised: 06/01/2023] [Accepted: 06/02/2023] [Indexed: 01/13/2024]
Abstract
Objective Chronic low back pain places a significant burden on healthcare services and sufferers. Clinical guidelines state that it is a condition that requires self-management. This realist synthesis explores how a mobile app could help people to self-manage chronic low back pain. Method Six databases and several non-academic sources were searched. In addition, nineteen realist interviews were conducted with stakeholders. Sources were selected and appraised for relevancy, richness, and rigour. Data was coded with analytical memos making retroductive inferences. Causal explanations were presented in context-mechanism-outcome configurations to form three programme theories. Results Data from 57 sources was synthesised to create 16 context-mechanism-outcome configurations and presented as three refined programme theories. The findings suggest people need to feel believed before they will engage with a self-management app. For those who feel abandoned by the healthcare service, a self-management app for chronic low back pain can be a valuable source of ongoing support and reduce feelings of social isolation. Conclusion A self-management app, if introduced appropriately and as adjunct to care, can be an empowering tool to self-manage chronic low back pain. Innovation Using input from key stakeholders enhances our understanding of the hidden generative mechanisms underpinning a programme's success or failure.
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Affiliation(s)
- Rebecca Hunter
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Michelle Beattie
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Chris O'Malley
- Specialist Librarian (Learning and Information Services), University of Highlands and Islands, Inverness, Scotland, United Kingdom
| | - Trish Gorely
- Department Nursing and Midwifery, University of Highlands and Islands, Inverness, Scotland, United Kingdom
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Stewart J, Bradley J, Smith S, McPeake J, Walsh T, Haines K, Leggett N, Hart N, McAuley D. Do critical illness survivors with multimorbidity need a different model of care? Crit Care 2023; 27:485. [PMID: 38066562 PMCID: PMC10709866 DOI: 10.1186/s13054-023-04770-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 11/30/2023] [Indexed: 12/18/2023] Open
Abstract
There is currently a lack of evidence on the optimal strategy to support patient recovery after critical illness. Previous research has largely focussed on rehabilitation interventions which aimed to address physical, psychological, and cognitive functional sequelae, the majority of which have failed to demonstrate benefit for the selected outcomes in clinical trials. It is increasingly recognised that a person's existing health status, and in particular multimorbidity (usually defined as two or more medical conditions) and frailty, are strongly associated with their long-term outcomes after critical illness. Recent evidence indicates the existence of a distinct subgroup of critical illness survivors with multimorbidity and high healthcare utilisation, whose prior health trajectory is a better predictor of long-term outcomes than the severity of their acute illness. This review examines the complex relationships between multimorbidity and patient outcomes after critical illness, which are likely mediated by a range of factors including the number, severity, and modifiability of a person's medical conditions, as well as related factors including treatment burden, functional status, healthcare delivery, and social support. We explore potential strategies to optimise patient recovery after critical illness in the presence of multimorbidity. A comprehensive and individualized approach is likely necessary including close coordination among healthcare providers, medication reconciliation and management, and addressing the physical, psychological, and social aspects of recovery. Providing patient-centred care that proactively identifies critical illness survivors with multimorbidity and accounts for their unique challenges and needs is likely crucial to facilitate recovery and improve outcomes.
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Affiliation(s)
- Jonathan Stewart
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland.
| | - Judy Bradley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
| | - Susan Smith
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin 2, Ireland
| | - Joanne McPeake
- The Healthcare Improvement Studies Institute, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Timothy Walsh
- Usher Institute, University of Edinburgh, Edinburgh, Scotland, UK
| | - Kimberley Haines
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nina Leggett
- Department of Critical Care, Melbourne Medical School, University of Melbourne, Melbourne, Australia
| | - Nigel Hart
- Centre for Medical Education, Queen's University Belfast, Belfast, Northern Ireland
| | - Danny McAuley
- Centre for Experimental Medicine, Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland
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Solberg M, Berg GV, Andreassen HK. Lost in the loop - a qualitative study on patient experiences of care in standardized cancer patient pathways. BMC Health Serv Res 2023; 23:1371. [PMID: 38062413 PMCID: PMC10702039 DOI: 10.1186/s12913-023-10364-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 11/22/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND The Norwegian health authorities introduced standardized cancer patient pathways (CPPs) in 2015, aiming to reduce practice variations across hospitals and regions, and improve the continuity, coordination and overall quality of the health care service provided to cancer patients. There has been few studies investigating this change, and that have looked into the organisational and economic benefits of standardized pathways, however the element of care and the patient perspective has been especially neglected. This study explored the care element in cancer patient pathways through an in-depth study of patient experiences. METHODS The patients were enrolled approximately three years after the introduction of standardized CPPs in Norway. Through a qualitative design with in-depth interviews, a total of 21 interviews were conducted with seven patients between 2018 and 2020. The first interview took place after the diagnosis was established and before treatment, the second interview during treatment, and the final interview approximately one year after the completion of active treatment. The empirical catchment area was eastern Norway. Data were analysed using a theoretical thematic analysis. RESULTS This study sheds light on the complex challenges patients' faces, while navigating CPPs, including the need for better transition support, improved coordination and continuity in care, and a more holistic approach that encompasses emotional well-being and family support. Three overarching themes were identified: [1] Navigating CPPs: patient care and transition challenges, [2] Fragmented cancer care: challenges in coordination and continuity [3] Unmet needs and overlooked opportunities in CPPs. CONCLUSIONS Patients experience that cancer patient pathways offer good medical treatment, but that the care element deserves more attention. Current CPPs are trapped in a logic of choice, preventing room for the element of care to receive the attention it requires for the patient to truly experience holistic person-centred care and continuous, well-coordinated services. Based in our study we argue there is a need to look into the missed opportunities for using the CPPs as points of departure for more holistic collaborative models for cancer care.
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Affiliation(s)
- Monica Solberg
- Innlandet Hospital Trust, Norway, Brumunddal and Norwegian University of Science and Technology, Gjøvik, Norway.
| | | | - Hege Kristin Andreassen
- UiT The Artic University of Norway, Tromsø, Norway
- Norwegian University of Science and Technology, Gjøvik, Norway
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Willis R, Akik C, El-Dirani Z, Truppa C, Zmeter C, Fleri F, Perone SA, Paci R, Frederiksen S, Haidar CA, Hamadeh RS, Fouad FM, Perel P, Roberts B, Ansbro É. Patient experiences of diabetes and hypertension care during an evolving humanitarian crisis in Lebanon: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0001383. [PMID: 38055706 DOI: 10.1371/journal.pgph.0001383] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 10/19/2023] [Indexed: 12/08/2023]
Abstract
Humanitarian health care models increasingly incorporate care for non-communicable diseases (NCDs). Current research evidence focuses on burden of disease, service provision and access to care, and less is known about patient's experience of the continuum of care in humanitarian settings. To address this gap, this study explored experiences of displaced Syrian and vulnerable Lebanese patients receiving care for hypertension and/or diabetes at four health facilities supported by humanitarian organisations in Lebanon. We conducted in-depth, semi-structured qualitative interviews with a purposive sample of patients (n = 18) and their informal caregivers (n = 10). Data were analysed thematically using both deductive and inductive approaches. Both Syrian and Lebanese patients reported interrupted pathways of care. We identified three typologies of patient experience at the time of interview; (1) managing adequately from the patient's perspective; (2) fragile management and (3) unable to manage their condition(s) adequately, with the majority falling into typologies 2 and 3. Patients and their families recognised the importance of maintaining continuity of care and self-management, but experienced substantial challenges due to changing availability and cost of medications and services, and decreasing economic resources during a period of national crises. Family support underpinned patient's response to challenges. Navigating the changing care landscape was a significant burden for patients and their families. Interactions were identified between mental health and NCD management. This study suggests that patients experienced disrupted, non-linear pathways in maintaining care for hypertension and diabetes in a humanitarian setting, and family support networks were key in absorbing treatment burden and sustaining NCD management. Recommendations are made to reduce treatment burden for patients and their families and to support sustainable condition management.
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Affiliation(s)
- Ruth Willis
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Chaza Akik
- Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Zeinab El-Dirani
- Faculty of Health Sciences, Center for Research on Population and Health, American University of Beirut, Beirut, Lebanon
| | - Claudia Truppa
- International Committee of the Red Cross, Beirut, Lebanon
| | - Carla Zmeter
- International Committee of the Red Cross, Beirut, Lebanon
| | - Fabrizio Fleri
- International Committee of the Red Cross, Beirut, Lebanon
| | - Sigiriya Aebischer Perone
- International Committee of the Red Cross, Geneva, Switzerland
- Division of Tropical and Humanitarian Medicine, Hôpitaux Universitaires de Genève, Geneva, Switzerland
| | | | | | | | - Randa S Hamadeh
- Primary Healthcare and Social Health Department, Ministry of Public Health, Lebanon
| | - Fouad M Fouad
- Faculty of Health Sciences, Department of Epidemiology and Population Health, American University of Beirut, Lebanon
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Bayard Roberts
- Faculty of Public Health and Policy, Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Éimhín Ansbro
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Department of Non-communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Mikkonen U, Voutilainen A, Mikola T, Roponen J, Rajapolvi S, Lehto SM, Ruusunen A, Mäntyselkä P. The effects of motivational self-care promotion on depressive symptoms among adults with type 2 diabetes: A systematic review and meta-analysis. Prev Med Rep 2023; 36:102431. [PMID: 37771374 PMCID: PMC10523005 DOI: 10.1016/j.pmedr.2023.102431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 09/16/2023] [Accepted: 09/19/2023] [Indexed: 09/30/2023] Open
Abstract
In individuals with type 2 diabetes (T2D), comorbid depression leads to increased health care costs and unsatisfactory treatment outcomes. Supporting healthy behaviors and self-efficacy might provide means to prevent depressive symptoms. We assessed the effects of motivational interviewing (MI) - based self-care promotion that specifically targets health behaviors, on depressive symptoms in adults with T2D. We followed PRISMA guidelines and searched Pubmed, Scopus, PsycINFO, Cinahl, and Cochrane Library to find randomized controlled trials (RCTs) published up to February 2023. Eligible RCTs had to target the T2D adult population, examine MI-based interventions that focus on multiple health behaviors, and measure depressive symptoms on a validated scale. Standardized mean differences (SMD) with 95% confidence intervals were calculated using a random-effects model. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of the evidence. After the screening, eleven studies with 2,682 individuals were eligible for the narrative synthesis. A meta-analysis of nine studies favored interventions with a pooled SMD of -0.19 (95% Cl = -0.34 to -0.05, p = 0.008, I2 = 52%). Due to the indirectness and imprecision of the evidence, we assessed the certainty of evidence based on GRADE as low. MI-based self-care promotion with a focus on health behaviors and implemented by a well MI-trained person had a preventive effect on depressive symptoms among adults with T2D. However, the certainty of evidence remained low. In future trials, the effect of MI-based self-care promotion on depression should be studied in clinically depressed populations.
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Affiliation(s)
- Ulla Mikkonen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Primary Health Care Center, Wellbeing Services County of North Savo, P.O. Box 1711, FI-70211 Kuopio, Finland
| | - Ari Voutilainen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Tuomas Mikola
- Institute Of Clinical Medicine, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Johanna Roponen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Sanna Rajapolvi
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
| | - Soili M. Lehto
- Institute Of Clinical Medicine, University Of Oslo, P.O. Box 1171 - Blindern, 0318 Oslo, Norway
- R&D Department, Division Of Mental Health Services, Akershus University Hospital, 1478 Lørenskog, Norway
- Department Of Psychiatry, University Of Helsinki, P.O. Box 22, FI-00014 University Of Helsinki, Finland
| | - Anu Ruusunen
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Department Of Psychiatry, Kuopio University Hospital, Wellbeing Services County of North Savo, P.O. Box 1711, FI-70211 Kuopio, Finland
- Deakin University, Institute For Mental And Physical Health And Clinical Translation (IMPACT), Food & Mood Centre, School Of Medicine, Barwon Health, P.O. Box 281 Geelong, Victoria 3220, Australia
| | - Pekka Mäntyselkä
- Institute Of Public Health and Clinical Nutrition, University Of Eastern Finland, P.O. Box 1627, FI-70211 Kuopio, Finland
- Clinical Research And Trials Centre, Kuopio University Hospital, Wellbeing Services County Of North Savo, P.O. Box 1711, FI-70211 Kuopio, Finland
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Johnson R, Kovalenko AG, Blakeman T, Panagioti M, Lawton M, Dawson S, Duncan P, Fraser SD, Valderas JM, Chilcott S, Goulding R, Salisbury C. Treatment burden in multiple long-term conditions: a mixed-methods study protocol. BJGP Open 2023; 7:BJGPO.2023.0097. [PMID: 37295796 PMCID: PMC11176699 DOI: 10.3399/bjgpo.2023.0097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 06/02/2023] [Accepted: 06/05/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Treatment burden represents the work patients undertake because of their health care, and the impact of that effort on the patient. Most research has focused on older adults (aged >65 years) with multiple long-term conditions (multimorbidity) (MLTC-M), but there are now more younger adults (aged 18-65 years) living with MLTC-M and they may experience treatment burden differently. Understanding experiences of treatment burden, and identifying those most at risk of high treatment burden, are important for designing primary care services to meet their needs. AIM To understand the treatment burden associated with MLTC-M, for people aged 18-65 years, and how primary care services affect this burden. DESIGN & SETTING Mixed-methods study in up to 33 primary care practices in two UK regions. METHOD The following two approaches will be used: (i) in-depth qualitative interviews with adults living with MLTC-M (approximately 40 participants) to understand their experiences of treatment burden and the impact of primary care, with a think-aloud aspect to explore face validity of a novel short treatment burden questionnaire (STBQ) for routine clinical use in the initial 15 interviews; (ii) cross-sectional patient survey (approximately 1000 participants), with linked routine medical record data to examine the factors associated with treatment burden for people living with MLTC-M, and to test the validity of STBQ. CONCLUSION This study will generate in-depth understanding of the treatment burden experienced by people aged 18-65 years living with MLTC-M, and how primary care services affect this burden. This will inform further development and testing of interventions to reduce treatment burden, and potentially influence MLTC-M trajectories and improve health outcomes.
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Affiliation(s)
- Rachel Johnson
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Anastasiia G Kovalenko
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Thomas Blakeman
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Maria Panagioti
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Michael Lawton
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Shoba Dawson
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Polly Duncan
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
| | - Simon Ds Fraser
- School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton, UK
| | - Jose M Valderas
- Centre for Research in Health Systems Performance (CRiHSP) and Division of Family Medicine, Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Queenstown, Singapore
| | | | - Rebecca Goulding
- Division of Population Health, Health Services Research and Primary Care, The University of Manchester, Manchester, UK
| | - Chris Salisbury
- Centre for Academic Primary Care, Bristol Medical School, University of Bristol, Bristol, UK
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Roberti JE, Alonso JP, May CR. Negotiating treatment and managing expectations in chronic kidney disease: A qualitative study in Argentina. Chronic Illn 2023; 19:730-742. [PMID: 36062573 DOI: 10.1177/17423953221124312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe how patients with CKD negotiated assigned responsibilities in the management of their disease, resulting in potential relational nonadherence. METHODS Qualitative study performed in two healthcare facilities in Buenos Aires, Argentina, including 50 patients and 14 healthcare providers. We conducted semistructured interviews which were analysed using a frame of reference with concepts of Burden of Treatment and Cognitive Authority theories. FINDINGS Adherence to treatment defined "good patients". Patients needed to negotiate starting treatment, its modality and dialysis schedule, although most patients felt they did not participate in the decision process and that providers did not acknowledge implications of these decisions on their routine. Some patients skipped dialysis if concerns were not attended. Regularly, patients negotiated frequency of visits, doses, dietary restrictions and redefined relationships with their support networks, sometimes with devasting effects. As a result of overwhelming uncertainty some patients refused enrolling into a transplant program. When the frequency of complications increased, patients considered abandoning dialysis. CONCLUSION When patients perceived demands were excessive or conflicting, they entered into negotiations. Relationally induced nonadherence may arise when professionals do not or cannot enter into negotiations over patients' beliefs or knowledge about what is possible for them to do.
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Affiliation(s)
- Javier E Roberti
- CIESP/CONICET, Buenos Aires, Argentina
- IECS, Buenos Aires, Argentina
| | - Juan P Alonso
- CIESP/CONICET, Buenos Aires, Argentina
- IECS, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, London, UK
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Layton N, Lalor A, Slatyer S, Lee DA, Bryant C, Watson M, Khushu A, Burton E, Oliveira D, Brusco NL, Jacinto A, Tiller E, Hill KD. Who cares for the carer? Codesigning a carer health and wellbeing clinic for older care partners of older people in Australia. Health Expect 2023; 26:2644-2654. [PMID: 37680165 PMCID: PMC10632619 DOI: 10.1111/hex.13863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/18/2023] [Accepted: 08/25/2023] [Indexed: 09/09/2023] Open
Abstract
INTRODUCTION Older carers or 'care partners' of older people experiencing care needs often provide essential support, at times while neglecting their own health and well-being. This is an increasingly frequent scenario due to both demographic changes and policy shifts towards ageing in place. Multiple community stakeholders within the care and support ecosystem hold valuable expertise about the needs of older care partners, and the programme and policy responses that may better support their health and well-being. The aim of this study was to identify the perspectives of stakeholders obtained through the codesign phase of a multicomponent research project investigating new models of care and support for older care partners suitable for the Australian context. METHODS Principles of codesign were used to engage a purposeful sample of older care partners, health professionals, researchers, policy makers and health service administrators. Participants took part in a series of three codesign workshops conducted remotely via video conferencing. The workshops were supported with briefing material and generated consensus-based summaries, arriving at a preferred service model. FINDINGS This paper reports the research design and structure of the codesign panels, the range of findings identified as important to support the health and well-being of older carers of older people, and the resulting service model principles. The codesigned and preferred model of care is currently being prepared for implementation and evaluation in Australia. PUBLIC CONTRIBUTION This study was conducted using codesign methodology, whereby stakeholders including older care partners and others involved in supporting older carers, were integrally involved with design, development, results and conclusions.
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Affiliation(s)
- Natasha Layton
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingMonash University and Peninsula HealthFrankstonVictoriaAustralia
| | - Aislinn Lalor
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingMonash University and Peninsula HealthFrankstonVictoriaAustralia
- Department of Occupational Therapy, School of Primary and Allied Health CareMonash UniversityMelbourneVictoriaAustralia
| | - Susan Slatyer
- Centre for Healthy AgeingMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Den‐Ching A Lee
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingMonash University and Peninsula HealthFrankstonVictoriaAustralia
| | - Christina Bryant
- Melbourne School of Psychological SciencesUniversity of MelbourneMelbourneVictoriaAustralia
| | - Moira Watson
- Centre for Healthy AgeingMurdoch UniversityMurdochWestern AustraliaAustralia
| | - Anjali Khushu
- Department of Geriatric MedicinePeninsula HealthFrankstonVictoriaAustralia
| | - Elissa Burton
- Curtin School of Allied HealthCurtin UniversityBentleyWestern AustraliaAustralia
- enAble Institute, Faculty of Health SciencesCurtin UniversityBentleyWestern AustraliaAustralia
| | - Déborah Oliveira
- Faculty of Nursing, Universidad Andrés BelloCampus Viña del MarViña del MarChile
- Millennium Institute for Care Research (MICARE)SantiagoChile
| | - Natasha L. Brusco
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingMonash University and Peninsula HealthFrankstonVictoriaAustralia
| | - Alessandro Jacinto
- Programa de Pós‐Graduação em Medicina Translacional, Faculty of Geriatric MedicineFederal University of São Paulo (UNIFESP)São PauloBrazil
| | - Elizabeth Tiller
- Department of Geriatrics (Falls Prevention Service)Peninsula HealthFrankstonVictoriaAustralia
| | - Keith D. Hill
- Rehabilitation, Ageing and Independent Living (RAIL) Research CentreMonash UniversityFrankstonVictoriaAustralia
- National Centre for Healthy AgeingMonash University and Peninsula HealthFrankstonVictoriaAustralia
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Vasiliauskienė O, Vasiliauskas D, Duncan P, Kontrimiene A, Jaruseviciene L, Cesnuleviciene A, Urbonas G, Liseckiene I. Validation of the Lithuanian multimorbidity treatment burden questionnaire (MTBQ) and its association with primary care patient characteristics. Eur J Gen Pract 2023; 29:2284257. [PMID: 38010870 PMCID: PMC10990257 DOI: 10.1080/13814788.2023.2284257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 11/02/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND The increasing prevalence of multimorbidity among older people in Lithuania and other Central-Eastern European countries leads to a greater patient treatment burden and puts additional pressure on healthcare services. OBJECTIVES This study aimed to validate the Lithuanian version of the Multimorbidity Treatment Burden Questionnaire (MTBQ). METHODS The Lithuanian version of the MTBQ was tested (2021-2022) with 789 patients from seven Lithuanian primary care centres who had two or more long-term conditions. The questionnaire translation's reliability, validity and dimensionality of the were assessed with Spearman's rank correlation, Cronbach's alpha, and factor reduction analysis. Treatment burden and its associations with sociodemographic and other indicators were analysed. RESULTS Lithuanian version of MTBQ had good internal reliability (Cronbach's alpha 0.711), validity, factor reduction applicability, and interpretability. The MTBQ scores of the questionnaire had a negative association with the quality-of-life scale (r=-0.327, 95% CI [-0.389, -0.264]) and positive associations with the self-rated health scores (r = 0.230, 95% CI [0.163, 0.297]) and with the number of comorbidities (r = 0.164, 95% CI [0.097, 0.233]). Distribution of treatment burden was identified (none (19,4%), low (46,6%), medium (25%), high (9%)). High treatment burden was found to be associated with having five or more long-term diseases, taking five or more medications, having anxiety or depression and living in a rural area. CONCLUSION The study's findings show that the MTBQ is applicable in assessing the treatment burden of multimorbid patients in Lithuania. Furthermore, the study demonstrates that Lithuanian patients with multimorbidity have average treatment burden scores similar to or higher than participants in previous MTBQ validation studies.
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Affiliation(s)
- Olga Vasiliauskienė
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | | | - Polly Duncan
- Centre for Academic Primary Care, NIHR School for Primary Care Research, University of Bristol, Bristol, UK
| | - Ausrine Kontrimiene
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Lina Jaruseviciene
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Aiste Cesnuleviciene
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Gediminas Urbonas
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
| | - Ida Liseckiene
- Department of Family Medicine, Lithuanian University of Health Sciences (LUHS), Kaunas, Lithuania
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50
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Pryce H, Smith SK, Burns-O'Connell G, Knibb R, Greenwood R, Shaw R, Hussain S, Banks J, Hall A, Straus J, Noble S. Protocol for the development and validation of a patient-reported experience measure (PREM) for people with hearing loss: the PREM-HeLP. BMJ Open 2023; 13:e075229. [PMID: 38030247 PMCID: PMC10689349 DOI: 10.1136/bmjopen-2023-075229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Accepted: 11/14/2023] [Indexed: 12/01/2023] Open
Abstract
INTRODUCTION Hearing loss is a common chronic health condition and adversely affects communication and social function resulting in loneliness, social isolation and depression. We know little about the patient experience of living with hearing loss and their views on the quality of the audiology service. In this study, we will develop and validate the first patient-reported experience measure (PREM) to understand patients' experiences of living with hearing loss and their healthcare interactions with audiology services. METHODS AND ANALYSIS We will develop the PREM in three phases: (1) development of PREM prototype (items/statements) derived from previous qualitative work and narrative review, (2) cognitive interview testing of the PREM prototype using a 'think aloud' technique to examine the acceptability and comprehensibility of the tool and refine accordingly and (3) psychometric testing of the modified PREM with 300 participants to assess the reliability and validity of the tool using Rasch analyses with sequential item reduction. Eligible participants will be young people and adults aged 16 years and over who have hearing loss. Participants will be recruited from three clinical sites located in England (Bath, Bristol) and Scotland (Tayside) and non-clinical settings (eg, lip-reading classes, residential care settings, national charity links, social media). ETHICS AND DISSEMINATION The study was approved by the West of Scotland Research Ethics Service (approval date: 6 May 2022; ref: 22/WS/0057) and the Health Research Authority and Health and Care Research Wales (HCRW) Approval (approval date: 14 June 2022; IRAS project ID: 308816). Findings will be shared with our patient and public involvement groups, academics, audiology communities and services and local commissioners via publications and presentations. The PREM will be made available to clinicians and researchers without charge.
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Affiliation(s)
- Helen Pryce
- Audiology, School of Optometry, Aston University College of Health and Life Sciences, Birmingham, West Midlands, UK
| | - Sian Karen Smith
- Audiology, School of Optometry, Aston University College of Health and Life Sciences, Birmingham, West Midlands, UK
| | - Georgina Burns-O'Connell
- Audiology, School of Optometry, Aston University College of Health and Life Sciences, Birmingham, West Midlands, UK
| | - Rebecca Knibb
- School of Psychology, Aston University, Birmingham, UK
| | - Rosemary Greenwood
- University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, UK
| | - Rachel Shaw
- School of Psychology, Aston University, Birmingham, UK
| | - Saira Hussain
- Audiology, School of Optometry, Aston University College of Health and Life Sciences, Birmingham, West Midlands, UK
| | - Jonathan Banks
- Social & Community Medicine, University of Bristol, Bristol, UK
| | - Amanda Hall
- Audiology, School of Optometry, Aston University College of Health and Life Sciences, Birmingham, West Midlands, UK
- Children's Hearing Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, UK
| | | | - Sian Noble
- School of Social and Community Medicine, University of Bristol, Bristol, UK
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