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Tandan M, Dunlea S, Cullen W, Bury G. Teamwork and its impact on chronic disease clinical outcomes in primary care: a systematic review and meta-analysis. Public Health 2024; 229:88-115. [PMID: 38412699 DOI: 10.1016/j.puhe.2024.01.019] [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: 07/14/2023] [Revised: 12/31/2023] [Accepted: 01/22/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE Teamwork positively affects staff performance and patient outcomes in chronic disease management. However, there is limited research on the impact of specific team components on clinical outcomes. This review aims to explore the impact of teamwork components on key clinical outcomes of chronic diseases in primary care. STUDY DESIGN Systematic review and meta-analysis. METHODS This systematic review and meta-analysis conducted searching EMBASE, PubMed, Cochrane Central Register of Controlled Trials. Studies included must have at least one teamwork component, conducted in primary care for selected chronic diseases, and report an impact of teamwork on clinical outcomes. Mean differences and 95% confidence intervals were used to determine pooled effects of intervention. RESULTS A total of 54 studies from 1988 to 2021 were reviewed. Shared decision-making, roles sharing, and leadership were missing in most studies. Team-based intervention showed a reduction in mean systolic blood pressure (MD = 5.88, 95% CI 3.29-8.46, P= <0.001, I2 = 95%), diastolic blood pressure (MD = 3.23, 95% CI 1.53 to 4.92, P = <0.001, I2 = 94%), and HbA1C (MD = 0.38, 95% CI 0.21 to 0.54, P = <0.001, I2 = 58%). More team components led to better SBP and DBP outcomes, while individual team components have no impact on HbA1C. Fewer studies limit analysis of cholesterol levels, hospitalizations, emergency visits and chronic obstructive pulmonary disease-related outcomes. CONCLUSION Team-based interventions improve outcomes for chronic diseases, but more research is needed on managing cholesterol, hospitalizations, and chronic obstructive pulmonary disease. Studies with 4-5 team components were more effective in reducing systolic blood pressure and diastolic blood pressure. Heterogeneity should be considered, and additional research is needed to optimize interventions for specific patient populations.
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Affiliation(s)
- Meera Tandan
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Shane Dunlea
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Walter Cullen
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
| | - Gerard Bury
- School of Medicine, University College Dublin (UCD), Dublin, Ireland.
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Cuesta-Briand B, Rock D, Tayba L, Hoimes J, Ngo H, Taran M, Coleman M. GP perspectives on a psychiatry phone line in Western Australia's Great Southern region: implications for addressing rural GP workload. Aust J Prim Health 2024; 30:NULL. [PMID: 37743540 DOI: 10.1071/py23039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Accepted: 09/01/2023] [Indexed: 09/26/2023]
Abstract
BACKGROUND Mental illness is a public health challenge disproportionately affecting rural Australians. GPs provide most of the mental health care, and they report increasing levels of burnout and unsustainable workload in the context of increased patient complexity. This may be more salient in rural settings characterised by resource constraints. In this paper, we use evaluation data from a GP psychiatry phone line established in Western Australia's Great Southern region in 2021 to describe GPs' perspectives on the service and reflect on how it may help alleviate rural GP workload. METHODS The sample was recruited among GPs practicing in the region. Data were collected through an online survey and semistructured interviews. Descriptive statistics were used to analyse the survey data. Interview data were subjected to thematic analysis; qualitative survey data were used for triangulation. RESULTS A total of 45GPs completed the survey and 14 were interviewed. Interview data yielded three themes: the criticality of timeliness; the building blocks of confidence; and trust. GPs were highly satisfied with the service, and timeliness and trust were the characteristics underpinning its effectiveness. The service built GPs' confidence in managing mental health and alcohol and other drug use issues through strengthening knowledge and providing reassurance. CONCLUSIONS Our results suggest that a telephone line operated by trusted, local psychiatrists with knowledge of the local mental health ecosystem of support can reduce rural GP workload through building confidence and strengthening personal agency, helping GPs navigate the ethical and clinical labyrinth of managing patient complexity in rural settings.
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Affiliation(s)
- Beatriz Cuesta-Briand
- Rural Clinical School of WA, The University of Western Australia, Crawley, WA 6009, Australia
| | - Daniel Rock
- WA Primary Health Alliance, Subiaco, WA 6008, Australia; and Discipline of Psychiatry, UWA Medical School, The University of Western Australia, Crawley, WA 6009, Australia; and Health Research Institute, Faculty of Health, University of Canberra, Bruce, ACT 2617, Australia
| | - Layale Tayba
- Great Southern Mental Health Service, WA Country Health Service, Albany, WA 6330, Australia
| | - James Hoimes
- Midwest Mental Health Service, WA Country Health Service, Geraldton, WA 6530, Australia
| | - Hanh Ngo
- Rural Clinical School of WA, The University of Western Australia, Crawley, WA 6009, Australia
| | - Michael Taran
- Great Southern Mental Health Service, WA Country Health Service, Albany, WA 6330, Australia
| | - Mathew Coleman
- Rural Clinical School of WA, The University of Western Australia, Crawley, WA 6009, Australia; and Great Southern Mental Health Service, WA Country Health Service, Albany, WA 6330, Australia; and Midwest Mental Health Service, WA Country Health Service, Geraldton, WA 6530, Australia; and Telethon Kids Institute, Nedlands, WA 6009, Australia
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Luo L, Li C. Application of digital health technology in autoimmune diseases: Opportunity and challenge. Int J Rheum Dis 2024; 27:e15092. [PMID: 38375676 DOI: 10.1111/1756-185x.15092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Liang Luo
- Department of Chinese Medicine, The People's Hospital of Yubei District of Chongqing City, Chongqing, China
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
| | - Chun Li
- Department of Rheumatology and Immunology, Peking University People's Hospital, Beijing, China
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Saleh S, Muhieddine D, Hamadeh R, Dimassi H, Diaconu K, Arakelyan S, Ager A, Alameddine M. The determinants of the quality of clinical management among diabetic and hypertensive patients in a context of fragility: A cross-sectional survey from Lebanon. Front Public Health 2022; 10:844864. [PMID: 35958868 PMCID: PMC9357988 DOI: 10.3389/fpubh.2022.844864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 07/04/2022] [Indexed: 11/13/2022] Open
Abstract
IntroductionThe management of NCDs is a growing challenge in low- and middle-income settings with the increasing prevalence and the associated demands that such conditions make on health systems. Fragile settings both exacerbate the risk of NCDs and undermine systems capacity. Lebanon is a setting where strategies to address rising NCDs burden have faced particularly acute contextual challenges.MethodsWe conducted a cross-sectional survey with patients accessing non-communicable disease across 11 primary care centers within the Greater Beirut and Beqaa areas. Response were received from 1,700 patients. We generated a Clinical Management Index Score as a measure of quality of care, and scores related to a range of socio-demographic characteristics and other context specific variables.ResultsSignificantly higher clinical management index scores (better quality of care) were associated with patients living in the semi-urban/rural context of Beqaa (compared to Greater Beirut), having health insurance coverage, aged above 60, having high levels of educational attainment, and making partial or full payment for their treatment. Relatively lower index scores (poorer quality of care) were associated with Syrian nationality (compared to Lebanese) and with patients suffering from diabetes or hypertension (compared to comorbid patients).ConclusionThe study identified a wide margin for improving quality of NCDs care in fragile contexts with particular gaps identified in referral to ophthalmology, accessing all prescribed medication and receiving counseling for smoking cessation. Additionally, findings indicate a number of predictors of comparatively poor quality of care that warrant attention, notably with regard to Syrian nationality/legal status, lack of health coverage, seeking free health provision and lower educational attachment. Although these are all relevant risk factors, the findings call on donor agencies, NGOs and provider institutions to design targeted programs and activities that especially ensure equitable delivery of services to diabetic and hypertensive patients with compounded vulnerability as a result of a number of these factors.
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Affiliation(s)
- Shadi Saleh
- Global Health Institute, American University of Beirut, Beirut, Lebanon
- Department of Health Management and Policy, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Dina Muhieddine
- Global Health Institute, American University of Beirut, Beirut, Lebanon
| | | | - Hani Dimassi
- Department of Pharmaceutical Sciences, School of Pharmacy, Lebanese American University, Byblos, Lebanon
| | - Karin Diaconu
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Stella Arakelyan
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Alastair Ager
- Institute for Global Health and Development, Queen Margaret University, Edinburgh, United Kingdom
| | - Mohamad Alameddine
- College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
- *Correspondence: Mohamad Alameddine
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Lu X, Tang H, Xu T, Song X, Jiang F, Zheng X, Li Y. The Significance of Three-Dimensional Team Management in the Medical Community Model for Patients with Hypertension and Diabetes. JOURNAL OF HEALTHCARE ENGINEERING 2022; 2022:1960030. [PMID: 35444777 PMCID: PMC9015871 DOI: 10.1155/2022/1960030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 02/16/2022] [Accepted: 02/26/2022] [Indexed: 11/17/2022]
Abstract
Diabetes and hypertension are the most common diseases and often coexist. Currently, hypertension is the most widespread chronic disease in China. To explore the value of three-dimensional team management in improving the effect of the management of primary diabetes and hypertension in patients in the medical community model, the expert team at the Department of Cardiology and Endocrinology of Anji County People's Hospital is selected to train 59 community general practitioners in the medical community model (the study group adopts the three-dimensional team management model in the medical community model), and another 59 community medical general practitioners adopts the conventional training method (the control group). The two groups of doctors managed patients with diabetes and hypertension who are registered in the jurisdiction (200 patients per group) as per the respective training methods. The three-dimensional management of the team under the medical community model significantly improves the diagnostic and treatment capabilities of grassroot general practitioners to better control patients' diabetes and hypertension levels.
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Affiliation(s)
- Xiaoli Lu
- Department of Cardiology, Anji People's Hospital, Anji 313300, China
| | - Hualiang Tang
- Department of Cardiology, the First Affiliated Hospital of Baotou Medical College, I, nner Mongolia University of Science and Technology, Baotou 014010, China
| | - Tan Xu
- Department of Cardiology, Anji People's Hospital, Anji 313300, China
| | - Xuehui Song
- Child Health Section, Anji Changshuo Street Health Center, Anji 313300, China
| | - Fei Jiang
- Department of Endocrinology,People's Hospital, Anji 313300, China
| | - Xie Zheng
- Department of Endocrinology,People's Hospital, Anji 313300, China
| | - Yang Li
- Department of Cardiology, the First Affiliated Hospital of Baotou Medical College, I, nner Mongolia University of Science and Technology, Baotou 014010, China
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Campbell C, Braund R, Morris C. A mixed methods study on medicines information needs and challenges in New Zealand general practice. BMC FAMILY PRACTICE 2021; 22:150. [PMID: 34246231 PMCID: PMC8272906 DOI: 10.1186/s12875-021-01451-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 05/05/2021] [Indexed: 11/13/2022]
Abstract
BACKGROUND Medicines are central to healthcare in aging populations with chronic multi-morbidity. Their safe and effective use relies on a large and constantly increasing knowledge base. Despite the current era of unprecedented access to information, there is evidence that unmet information needs remain an issue in clinical practice. Unmet medicines information needs may contribute to sub-optimal use of medicines and patient harm. Little is known about medicines information needs in the primary care setting. The aim of this study was to investigate the nature of medicines information needs in routine general practice and understand the challenges and influences on the information-seeking behaviour of general practitioners. METHODS A mixed methods study involving 18 New Zealand general practitioner participants was undertaken. Quantitative data were collected to characterize the medicines information needs arising during 642 consultations conducted by the participants. Qualitative data regarding participant views on their medicines information needs, resources used, challenges to meeting the needs and potential solutions were collected by semi-structured interview. Integration occurred by comparison of results from each method. RESULTS Of 642 consultations, 11% (n = 73/642) featured at least one medicines information need. The needs spanned 14 different categories with dosing the most frequent (26%) followed by side effects (15%) and drug interactions (14%). Two main themes describing the nature of general practitioners' medicines information needs were identified from the qualitative data: a 'common core' related to medicine dose, side effects and interactions and a 'perplexing periphery'. Challenges in the perplexing periphery were the variation in information needs, complexity, 'known unknowns' and 'unknown unknowns'. Key factors affecting general practitioners' strategies for meeting medicines information needs were trust in a resource, presence of the patient, how the information was presented, scarcity of time, awareness of the existence of a resource, and its accessibility. CONCLUSIONS General practitioners face challenges in meeting wide-ranging medicines information needs in patients with increasingly complex care needs. Recognising the challenges and factors that influence resource use in practice can inform optimisation of medicines information support resources. Resources for general practitioners must take into account the complexity and time constraints of real-world practice. An individually responsive approach involving greater collaboration with pharmacists and specialist medicines information support services may provide a potential solution.
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Affiliation(s)
- Chloë Campbell
- School of Pharmacy, University of Otago, Dunedin, New Zealand.
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand.
- Pharmaceutical Society of New Zealand, Wellington, New Zealand.
| | - Rhiannon Braund
- School of Pharmacy, University of Otago, Dunedin, New Zealand
- New Zealand Pharmacovigilance Centre, University of Otago, Dunedin, New Zealand
| | - Caroline Morris
- Department of Primary Health Care and General Practice, University of Otago, Wellington, New Zealand
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Abdullah Z, Abdul Aziz SH, Sodri NA, Mohd Hanafiah AN, Ibrahim NI, Johari MZ. Issues and Challenges in Implementing Care Coordinator in Primary Healthcare in Malaysia: A Qualitative Study. J Prim Care Community Health 2020; 11:2150132720956478. [PMID: 33089737 PMCID: PMC7585891 DOI: 10.1177/2150132720956478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Primary healthcare is the earliest gateway for patient care, and improvisations are often needed to accommodate the ever-increasing demand in public health. The Enhanced Primary Healthcare (EnPHC) initiative is aimed at improving such needs, and one core intervention is the introduction of a care coordinator (CC). The purpose of this study was to identify barriers and facilitators in implementing a new intervention in primary healthcare clinics. METHODS This qualitative exploration study. All healthcare providers who were involved in EnPHC at the intervention clinics were selected as participants. In-depth interviews and focus group discussions were carried out among healthcare providers working in the intervention clinic. Thematic analysis was used to categorize data, based on the consolidated framework for implementation research (CFIR) theoretical framework domains. RESULTS A total of 61 healthcare providers participated. All 5 domains with 19 CFIR constructs emerged from the analysis. Inner setting played a significant role in facilitating CC intervention, in which culture, networking, and collaboration and leadership engagement played an essential role in supporting CC activities. Although CC tasks are complex, concerns of losing clinical skill and resource constraints were identified as potential barriers in CC implementations. Criteria for appointing new CCs emerged from the characteristics of individual constructs, in which the individual must be familiar and interested in community health, have good communication skills, and at least 3 years' experience in the primary healthcare setting. CONCLUSION The implementation of the CC intervention faces varying challenges in different settings. This is partially resolved through teamwork, guidance from mentors, and support from superiors. The complexity of the responsibility of the CC intervention is perceived as both a validation and a burden. Above all, it is seen as paramount in EnPHC intervention.
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Affiliation(s)
- Zalilah Abdullah
- Institute for Health System's Research, National Institute of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Siti Hajar Abdul Aziz
- Institute for Health System's Research, National Institute of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Nur Aliyah Sodri
- Institute for Health System's Research, National Institute of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Ainul Nadziha Mohd Hanafiah
- Institute for Health System's Research, National Institute of Health, Ministry of Health Malaysia, Selangor, Malaysia
| | - Nor Idawaty Ibrahim
- Family Health Development Division, Ministry of Health Malaysia, Putrajaya, Malaysia
| | - Mohammad Zabri Johari
- Institute for Health Behavioural Research, National Institute of Health, Ministry of Health Malaysia, Selangor, Malaysia
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Feller DJ, Lor M, Zucker J, Yin MT, Olender S, Ferris DC, Elhadad N, Mamykina L. An investigation of the information technology needs associated with delivering chronic disease care to large clinical populations. Int J Med Inform 2020; 137:104099. [PMID: 32088558 DOI: 10.1016/j.ijmedinf.2020.104099] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 02/08/2020] [Accepted: 02/12/2020] [Indexed: 10/25/2022]
Abstract
BACKGROUND The growing number of individuals with complex medical and social needs has motivated the adoption of care management (CM) - programs wherein multidisciplinary teams coordinate and monitor the clinical and non-clinical aspects of care for patients with chronic disease. Despite claims that health information technology (IT) is essential to CM, there has been limited research focused on the IT needs of clinicians providing care management to large groups of patients with chronic disease. OBJECTIVE To assess clinicians' needs pertaining to CM and to identify inefficiencies and bottlenecks associated with the delivery of CM to large groups of patients with chronic disease. METHODS A qualitative study of two HIV care programs. Methods included observations of multidisciplinary care team meetings and semi-structured interviews with physicians, care managers, and social workers. Thematic analysis was conducted to analyze the data. RESULTS CM was perceived by staff as requiring the development of novel strategies including patient prioritization and patient monitoring, which was supported by patient registries but also required the creation of additional homegrown tools. Common challenges included: limited ability to identify pertinent patient information, specifically in regards to social and behavioral determinants of health, limited assistance in matching patients to appropriate interventions, and limited support for communication within multidisciplinary care teams. CONCLUSION Clinicians delivering care management to chronic disease patients are not adequately supported by electronic health records and patient registries. Tools that better enable population monitoring, facilitate communication between providers, and help address psychosocial barriers to treatment could enable more effective care.
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Affiliation(s)
- Daniel J Feller
- Department of Biomedical Informatics, Columbia University, New York, NY, United States.
| | - Maichou Lor
- School of Nursing, Columbia University, New York, NY, United States
| | - Jason Zucker
- Division of Infectious Disease, Department of Medicine, Columbia University, New York, NY, United States
| | - Michael T Yin
- Division of Infectious Disease, Department of Medicine, Columbia University, New York, NY, United States
| | - Susan Olender
- Division of Infectious Disease, Department of Medicine, Columbia University, New York, NY, United States
| | - David C Ferris
- Department of Population Health, BronxCare Health System, Bronx, NY, United States
| | - Noémie Elhadad
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
| | - Lena Mamykina
- Department of Biomedical Informatics, Columbia University, New York, NY, United States
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