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Tong LK, Li YY, Liu YB, Zheng MR, Fu GL, Au ML. Social determinants of health and their relation to suboptimal health status in the context of 3PM: a latent profile analysis. EPMA J 2024; 15:221-232. [PMID: 38841621 PMCID: PMC11147970 DOI: 10.1007/s13167-024-00365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2024] [Accepted: 05/03/2024] [Indexed: 06/07/2024]
Abstract
Background Suboptimal health is identified as a reversible phase occurring before chronic diseases manifest, emphasizing the significance of early detection and intervention in predictive, preventive, and personalized medicine (PPPM/3PM). While the biological and genetic factors associated with suboptimal health have received considerable attention, the influence of social determinants of health (SDH) remains relatively understudied. By comprehensively understanding the SDH influencing suboptimal health, healthcare providers can tailor interventions to address individual needs, improving health outcomes and facilitating the transition to optimal well-being. This study aimed to identify distinct profiles within SDH indicators and examine their association with suboptimal health status. Method This cross-sectional study was conducted from June 16 to September 23, 2023, in five regions of China. Various SDH indicators, such as family health, economic status, eHealth literacy, mental disorder, social support, health behavior, and sleep quality, were examined in this study. Latent profile analysis was employed to identify distinct profiles based on these SDH indicators. Logistic regression analysis by profile was used to investigate the association between these profiles and suboptimal health status. Results The analysis included 4918 individuals. Latent profile analysis revealed three distinct profiles (prevalence): the Adversely Burdened Vulnerability Group (37.6%), the Adversity-Driven Struggle Group (11.7%), and the Advantaged Resilience Group (50.7%). These profiles exhibited significant differences in suboptimal health status (p < 0.001). The Adversely Burdened Vulnerability Group had the highest risk of suboptimal health, followed by the Adversity-Driven Struggle Group, while the Advantaged Resilience Group had the lowest risk. Conclusions and relevance Distinct profiles based on SDH indicators are associated with suboptimal health status. Healthcare providers should integrate SDH assessment into routine clinical practice to customize interventions and address specific needs. This study reveals that the group with the highest risk of suboptimal health stands out as the youngest among all the groups, underscoring the critical importance of early intervention and targeted prevention strategies within the framework of 3PM. Tailored interventions for the Adversely Burdened Vulnerability Group should focus on economic opportunities, healthcare access, healthy food options, and social support. Leveraging their higher eHealth literacy and resourcefulness, interventions empower the Adversity-Driven Struggle Group. By addressing healthcare utilization, substance use, and social support, targeted interventions effectively reduce suboptimal health risks and improve well-being in vulnerable populations. Supplementary Information The online version contains supplementary material available at 10.1007/s13167-024-00365-5.
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Affiliation(s)
- Lai Kun Tong
- Research Management and Development Department, Kiang Wu Nursing College of Macau, Macao, China
| | - Yue Yi Li
- Education Department, Kiang Wu Nursing College of Macau, Macao, China
| | - Yong Bing Liu
- School of Nursing, Yangzhou University, Yangzhou, China
| | - Mu Rui Zheng
- Faculty of Health Sciences, University of Macau, Macao, China
| | - Guang Lei Fu
- Infectious Disease Department, The First Affiliated Hospital of Jinan University, Guangzhou, China
| | - Mio Leng Au
- Education Department, Kiang Wu Nursing College of Macau, Macao, China
- Avenida Do Hospital, Complexo de Cuidados de Saúde das Ilhas – Edifício do Instituto de Enfermagem Kiang Wu de Macau, das Ilhas No.447, Coloane, RAEM, Macao, China
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2
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Ginman H, Sitch M. Older adult's experiences of navigating healthcare whilst living with multimorbidity. Psychol Health 2024:1-19. [PMID: 38693663 DOI: 10.1080/08870446.2024.2339327] [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: 07/27/2023] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE The way older adults navigate their healthcare is critical to supporting positive health outcomes. However, navigating healthcare with multimorbidity is typically disjointed due to complexities in treatment, management, and service provision. This study sought to examine how older patients navigate healthcare whilst living with multimorbidity. METHODS AND MEASURES Semi-structured interviews were undertaken with five older adults, aged 65 or older, living with multimorbidity in residential care in England. An Interpretive Phenomenological Analysis was undertaken. RESULTS Overall, participants experienced navigating healthcare whilst living with multimorbidity as challenging. Group Experiential Themes included 'Health knowledge and understanding', 'Relationships and expectations' and 'Navigating health care with a single lens'. Collectively these themes represented narratives involving how having limited understanding of health conditions, experiencing challenges in communication with health professionals, and receiving segmented care in a health care system driven by a single condition focus interfered with navigation. CONCLUSION These findings highlight experiences of older adults living with multimorbidity navigating healthcare and illustrate several ways older adults living with multimorbidity may be supported to navigate services with less challenges. The research also promotes the need for future research in this area.
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Bogerd MJ, Exmann CJ, Slottje P, Bont J, Van Hout HP. Predicting anticipated benefit from an extended consultation to personalise care in multimorbidity: a development and internal validation study of a prioritisation algorithm in general practice. Br J Gen Pract 2024; 74:e307-e314. [PMID: 38164549 PMCID: PMC11044021 DOI: 10.3399/bjgp.2023.0114] [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: 03/05/2023] [Accepted: 10/04/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Persons with multimorbidity may gain from person-centred care compared with the current protocolised chronic-disease management in Dutch general practice. Given time constraints and limited resources, it is essential to prioritise those most in need of an assessment of person-centred chronic-care needs. AIM To develop and validate a prioritisation algorithm based on routine electronic medical record (EMR) data that distinguishes between patients with multimorbidity who would, and those who would not, benefit from an extended person-centred consultation to assess person-centred chronic-care needs, as judged by GPs. DESIGN AND SETTING A mixed-methods study was conducted in five general practices in the north-west region of the Netherlands. Four out of the five practices were situated in rural areas. METHOD Multivariable logistic regression using EMR data to predict the GPs' judgement on patients' anticipated benefit from an extended consultation, as well as a thematic analysis of a focus group exploring GPs' clinical reasoning for this judgement were conducted. Internal validation was performed using 10-fold cross-validation. Multimorbidity was defined as the presence of ≥3 chronic conditions. RESULTS In total, EMRs from 1032 patients were included in the analysis; of these, 352 (34.1%) were judged to have anticipated benefit. The model's cross-validated C-statistic was 0.72 (95% confidence interval = 0.70 to 0.75). Calibration was good. Presence of home visit(s) and history of myocardial infarction were associated with anticipated benefit. Thematic analysis revealed three dimensions feeding anticipated benefit: GPs' cause for concern, patients' mindset regarding their conditions, and balance between received care/expected care needed. CONCLUSION This algorithm may facilitate automated prioritisation, potentially avoiding the need for GPs to personally triage the whole practice population that has multimorbidity. However, external validation of the algorithm and evaluation of actual benefit of consultation is recommended before implementation.
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Affiliation(s)
- Mieke Jl Bogerd
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Collin Jc Exmann
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Pauline Slottje
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Jettie Bont
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Hein Pj Van Hout
- Department of General Practice, Amsterdam UMC, Vrije Universiteit Amsterdam, and Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
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4
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Reilly CC, Higginson IJ, Chalder T. Illness perceptions, cognitive and behavioural responses to chronic breathlessness in individuals living with advanced respiratory disease: an observational study. ERJ Open Res 2024; 10:00874-2023. [PMID: 38686180 PMCID: PMC11057503 DOI: 10.1183/23120541.00874-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2023] [Accepted: 02/11/2024] [Indexed: 05/02/2024] Open
Abstract
Background Understanding the complexity and multidimensional nature of chronic breathlessness is key to its successful management. The aim of this study was to explore illness perceptions, cognitive and behavioural responses to chronic breathlessness in individuals living with advanced respiratory disease. Methods This was a cross-sectional secondary analysis of data from a feasibility randomised control trial (SELF-BREATHE) for individuals living with chronic breathlessness due to advanced disease. All participants completed the following questionnaires: numerical rating scale (NRS) breathlessness severity, NRS distress due to breathlessness, NRS self-efficacy for managing breathlessness, Dyspnea-12 (D-12), Chronic Respiratory Disease Questionnaire (CRQ), Brief Illness Perception Questionnaire (Brief IPQ) and the Cognitive and Behavioural Responses Questionnaire, short version (CBRQ-S). The associations between the Brief IPQ and CBRQ-S with NRS breathlessness severity, distress and self-efficacy, D-12 and CRQ were examined using Spearman's rho correlation coefficient rs. A Spearman's rs of ≥0.50 was predefined as the threshold to denote important associations between variables. A p-value of <0.008 was considered statistically significant, to account for the number of comparisons performed. Results The illness perception items consequences, identity, concern and emotional response were associated with increased breathlessness severity, increased distress, reduced breathlessness self-management ability and lower health-related quality of life. Symptom focusing and embarrassment avoidance were identified as important cognitive responses to chronic breathlessness. Conclusion Interventions that directly target illness perceptions, cognitive and behavioural responses to chronic breathlessness may improve symptom burden, self-efficacy and health-related quality of life.
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Affiliation(s)
- Charles C. Reilly
- Department of Physiotherapy, King's College Hospital, London, UK
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Irene J. Higginson
- Cicely Saunders Institute of Palliative Care, Policy and Rehabilitation, King's College London, London, UK
| | - Trudie Chalder
- Department of Psychological Medicine, Institute of Psychiatry, King's College London, London, UK
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5
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Horn AB, Zimmerli L, Maercker A, Holzer BM. The worse we feel, the more intensively we need to stick together: a qualitative study of couples' emotional co-regulation of the challenge of multimorbidity. Front Psychol 2023; 14:1213927. [PMID: 37637914 PMCID: PMC10450955 DOI: 10.3389/fpsyg.2023.1213927] [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: 04/28/2023] [Accepted: 07/28/2023] [Indexed: 08/29/2023] Open
Abstract
Introduction Being faced with multimorbidity (i.e., being diagnosed with at least two chronic conditions), is not only demanding in terms of following complicated medical regimes and changing health behaviors. The changes and threats involved also provoke emotional responses in the patients but also in their romantic partners. This study aims at exploring the ways of emotional co-regulation that couples facing multimorbidity express when interviewed together. Method N = 15 opposite sex couples with one multimorbid patient after an acute health crisis that led to hospitalization were asked in a semi-structured interview about how they found ways to deal with the health situation, what they would recommend to other couples in a similar situation, and how they regulated their emotional responses. Interviews were analyzed qualitatively following open, axial, and selective coding, as in the grounded theory framework. Results Emerging categories from the romantic partners' and the patients' utterances revealed three main categories: First, overlapping cognitive appraisals about the situation (from fighting spirit to fatalism) and we-ness (construing the couple self as a unit) emerged as higher order factor from the utterances. Second, relationship-related strategies including strategies aimed at maintaining high relationship quality in spite of the asymmetric situation like strengthening the common ground and balancing autonomy and equity in the couple were often mentioned. Third, some couples mentioned how they benefit from individual strategies that involve fostering individual resources of the partners outside the couple relationship (such as cultivating relationships with grandchildren or going outdoors to nature). Discussion Results underline the importance of a dyadic perspective not only on coping with disease but also on regulating the emotional responses to this shared challenging situation. The utterances of the couples were in line with earlier conceptualizations of interpersonal emotion regulation and dyadic perspectives on we-disease. They broaden the view by integrating the interplay between individual and interpersonal regulation strategies and underline the importance of balancing individual and relational resources when supporting couples faced with chronic diseases.
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Affiliation(s)
- Andrea B. Horn
- CoupleSense: Health and Interpersonal Emotion Regulation Lab, University Research Priority Program “Dynamics of Healthy Aging,” University of Zurich, Zurich, Switzerland
- Center of Gerontology, Healthy Longevity Center, University of Zurich, Zurich, Switzerland
- Gerontopsychology and Gerontology, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Lukas Zimmerli
- Department of Internal Medicine, Cantonal Hospital Olten (KSO), Olten, Switzerland
| | - Andreas Maercker
- Psychopathology and Clinical Intervention, Department of Psychology, University of Zurich, Zurich, Switzerland
| | - Barbara M. Holzer
- Department of Internal Medicine, University Hospital Zurich, Zurich, Switzerland
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6
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Thong MSY, Boakye D, Jansen L, Martens UM, Chang-Claude J, Hoffmeister M, Brenner H, Arndt V. Comorbidities, Rather Than Older Age, Are Strongly Associated With Higher Utilization of Healthcare in Colorectal Cancer Survivors. J Natl Compr Canc Netw 2021; 20:468-478.e7. [PMID: 34875626 DOI: 10.6004/jnccn.2021.7030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 02/17/2021] [Indexed: 01/21/2023]
Abstract
BACKGROUND Colorectal cancer (CRC) survivors generally have a higher healthcare utilization (HCU) than the general population due to cancer burden. However, it is unclear which factors are associated with this increased uptake. Our study aimed to (1) compare CRC-related and non-CRC visits to general practitioners (GPs) and medical specialists (MSs) by comorbidities, and (2) assess whether HCU differs by demographic, clinical, and psychological factors. METHODS We used data from a German population-based cohort of 1,718 survivors of stage I-III CRC diagnosed in 2003 through 2010 who provided information on HCU at 5-year follow-up. Multivariable linear regression was used to calculate least-square means of CRC-related and non-CRC HCU according to the Charlson comorbidity index and comorbidity cluster, adjusting for relevant demographic, clinical, and psychological characteristics. RESULTS A higher comorbidity level was associated with more CRC-related MS visits and non-CRC GP visits. In addition to being strongly associated with non-CRC GP visits, comorbidity clusters were associated with CRC-related GP and MS visits, but their association varied by specific cardiometabolic comorbidities. HCU was less dependent on prognostic factors for CRC, such as age and tumor stage, but was strongly associated with disease recurrence, depression, and emotional functioning. CONCLUSIONS Comorbidities, rather than age or tumor stage, were related to HCU, suggesting that CRC survivors use healthcare mainly for reasons other than cancer 5 years postdiagnosis. Improved communication between primary and tertiary healthcare providers could enhance the medical care of cancer survivors with complex health needs and thereby also reduce healthcare costs.
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Affiliation(s)
- Melissa S Y Thong
- 1Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg
| | - Daniel Boakye
- 2Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg
| | - Lina Jansen
- 2Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg
| | - Uwe M Martens
- 3SLK-Clinics, Cancer Center Heilbronn-Franken, Heilbronn
| | - Jenny Chang-Claude
- 4Unit of Genetic Epidemiology, Division of Cancer Epidemiology, German Cancer Research Center (DKFZ), Heidelberg.,5Genetic Tumour Epidemiology Group, University Medical Center Hamburg-Eppendorf, University Cancer Center Hamburg, Hamburg
| | - Michael Hoffmeister
- 2Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg
| | - Hermann Brenner
- 2Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg.,6Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Heidelberg; and.,7German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Heidelberg, Germany
| | - Volker Arndt
- 1Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Heidelberg
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7
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Garratt AM, Coste J, Rouquette A, Valderas JM. The Norwegian PROMIS-29: psychometric validation in the general population for Norway. J Patient Rep Outcomes 2021; 5:86. [PMID: 34499288 PMCID: PMC8427163 DOI: 10.1186/s41687-021-00357-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/25/2021] [Indexed: 12/17/2022] Open
Abstract
Background The Patient Reported Outcome Measurement Information System profile instruments include “high information” items drawn from large item banks following the application of modern psychometric criteria. The shortest adult profile, PROMIS-29, looks set to replace existing short-form instruments in research and clinical practice. The objective of this study was to undertake the first psychometric evaluation of the Norwegian PROMIS-29, following a postal survey of a random sample of 12,790 Norwegians identified through the National Registry of the Norwegian Tax Administration. Confirmatory factor analysis was used to assess structural validity. Fit to the Rasch partial credit model and differential item functioning (DIF) were assessed in relation to age, gender, and education. PROMIS-29 scores were compared to those for the EQ-5D-5L and the Self-assessed Comorbidity Questionnaire (SCQ), for purposes of assessing validity based on a priori hypotheses. Results There were 3200 (25.9%) respondents with a mean age (SD) of 51 (20.7, range 18 to 97 years) and 55% were female. The PROMIS-29 showed satisfactory structural validity and acceptable fit to Rasch model including unidimensionality, and measurement invariance across age and education levels. One pain interference item had uniform DIF for gender but splitting gave satisfactory fit. Domain reliability estimates ranged from 0.85 to 0.95. Correlations between PROMIS-29 domain, SCQ and EQ-5D scores were largely as expected, the largest being for scores assessing very similar aspects of health. Conclusions The Norwegian version of the PROMIS-29 is a reliable and valid generic self-reported measure of health in the Norwegian general population. The instrument is recommended for further application, but the analysis should be replicated and responsiveness to change assessed in future studies before it can be recommended for clinical and health services evaluation in Norway. Supplementary Information The online version contains supplementary material available at 10.1186/s41687-021-00357-3.
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Affiliation(s)
- Andrew M Garratt
- Division for Health Services, Norwegian Institute of Public Health, Post Box 4404, 0403, Nydalen, Oslo, Norway.
| | - Joël Coste
- Biostatistics and Epidemiology Unit, Cochin Hospital, AP-HP, 27 rue du faubourg Saint-Jacques, 75014, Paris, France.,Paris University, 75014, Paris, France
| | - Alexandra Rouquette
- Université Paris-Saclay, UVSQ, Inserm, CESP, 75014, Paris, France.,Public Health and Epidemiology Department, AP-HP Paris-Saclay, 94276, Le Kremlin-Bicêtre Cedex, France
| | - José M Valderas
- Health Services and Policy Research Group (HSPRG), Exeter Collaboration for Academic Primary Care (APEx), and NIHR ARC South West Peninsula (PenARC), University of Exeter, Exeter, UK.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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8
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Gu J, Yang C, Zhang K, Zhang Q. Mediating role of psychological capital in the relationship between social support and treatment burden among older patients with chronic obstructive pulmonary disease. Geriatr Nurs 2021; 42:1172-1177. [PMID: 34419869 DOI: 10.1016/j.gerinurse.2021.07.006] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 07/20/2021] [Accepted: 07/21/2021] [Indexed: 11/19/2022]
Abstract
This study was conducted to investigate the connection between social support and the treatment burden among older patients with chronic obstructive pulmonary disease (COPD), and to examine the mediating role of psychological capital within that connection. Although treatment burden is common, the current data on social support associated with it is limited, and the theoretical mechanisms underlying the relationship between the two variables have not yet been clarified. A total of 245 older outpatients with COPD were recruited. Descriptive and Structural Equation Modelling was employed to test the hypothesised model using SPSS 26 and IBM SPSS AMOS 26. The modified model yielded an adequate fit to the data. The variation in the treatment burden explained by the hypothetical model was 57.2%. The study provides a new perspective for medical professionals to manage the treatment burden by developing efficient social support and psychological capital measures.
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Affiliation(s)
- Jiaxin Gu
- School of Nursing, Peking University, Beijing, China.
| | - Chaojuan Yang
- Department of Respiratory and Critical Care Medicine, the Fourth Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang Province, China.
| | - Ke Zhang
- Department of Psychology, Shanxi Datong University, Datong, Shanxi Province, China.
| | - Qi Zhang
- School of Nursing, Peking University, Beijing, China.
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9
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Rijken M, Stüssgen R, Leemrijse C, Bogerd MJL, Korevaar JC. Priorities and preferences for care of people with multiple chronic conditions. Health Expect 2021; 24:1300-1311. [PMID: 33938597 PMCID: PMC8369115 DOI: 10.1111/hex.13262] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 03/15/2021] [Accepted: 04/01/2021] [Indexed: 11/29/2022] Open
Abstract
Background To guide the development of high‐quality care for people with multiple chronic conditions, partners of the European Joint Action CHRODIS developed the Integrated Multimorbidity Care Model. To assess its suitability for improving care for people with multimorbidity in the Netherlands, the model was piloted in a primary care setting with both patients and care providers. Aim This paper reports on the patient perspective, and aims to explore the priorities, underlying values and preferences for care of people with multimorbidity. Participants and methods Twenty persons with multimorbidity (selected from general practice registries) participated in a focus group or telephone interview. Subsequently, a questionnaire was completed by 863 persons with multimorbidity registered with 14 general practices. Qualitative data were thematically analysed and quantitative data by means of descriptive statistics. Results Frequently prioritized elements of care were the use of shared electronic health records, regular comprehensive assessments, self‐management support and shared decision making, and care coordination. Preferences for how these elements should be specifically addressed differed according to individual values (eg weighing safety against privacy) and needs (eg ways of coping with multimorbidity). Conclusion The JA‐CHRODIS Integrated Multimorbidity Care Model reflects the priorities and preferences for care of people with multimorbidity in the Netherlands, which supports its relevance to guide the development of person‐centred integrated care for people with multiple chronic conditions in the Netherlands. Patient contribution European patient experts contributed to the development and applicability assessment of the JA‐CHRODIS Integrated Multimorbidity Care Model; Dutch patients participated in focus groups, interviews and a survey.
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Affiliation(s)
- Mieke Rijken
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Department of Health and Social Management, University of Eastern Finland, Kuopio, Finland
| | - René Stüssgen
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands.,Zorginstituut Nederland, (National Health Care Institute), Diemen, The Netherlands
| | - Chantal Leemrijse
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
| | - Mieke J L Bogerd
- Department of General Practice & Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, location VUmc, Amsterdam, The Netherlands
| | - Joke C Korevaar
- Nivel (Netherlands Institute for Health Services Research), Utrecht, The Netherlands
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10
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Ricci-Cabello I, Yañez-Juan AM, Fiol-deRoque MA, Leiva A, Llobera Canaves J, Parmentier FBR, Valderas JM. Assessing the Impact of Multi-Morbidity and Related Constructs on Patient Reported Safety in Primary Care: Generalized Structural Equation Modelling of Observational Data. J Clin Med 2021; 10:1782. [PMID: 33923906 PMCID: PMC8073542 DOI: 10.3390/jcm10081782] [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] [Received: 12/29/2020] [Revised: 04/09/2021] [Accepted: 04/13/2021] [Indexed: 01/02/2023] Open
Abstract
We aimed to examine the complex relationships between patient safety processes and outcomes and multimorbidity using a comprehensive set of constructs: multimorbidity, polypharmacy, discordant comorbidity (diseases not sharing either pathogenesis nor management), morbidity burden and patient complexity. We used cross-sectional data from 4782 patients in 69 primary care centres in Spain. We constructed generalized structural equation models to examine the associations between multimorbidity constructs and patient-reported patient safety (PREOS-PC questionnaire). These associations were modelled through direct and indirect (mediated by increased interactions with healthcare) pathways. For women, a consistent association between higher levels of the multimorbidity constructs and lower levels of patient safety was observed via either pathway. The findings for men replicated these observations for polypharmacy, morbidity burden and patient complexity via indirect pathways. However, direct pathways showed unexpected associations between higher levels of multimorbidity and better safety. The consistent association between multimorbidity constructs and worse patient safety among women makes it advisable to target this group for the development of interventions, with particular attention to the role of comorbidity discordance. Further research, particularly qualitative research, is needed for clarifying the complex associations among men.
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Affiliation(s)
- Ignacio Ricci-Cabello
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
- CIBER de Epidemiología y Salud Pública (CIBERESP), 28029 Madrid, Spain
| | - Aina María Yañez-Juan
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Department of Nursing and Physiotherapy and Global Health Research Group, University of the Balearic Islands, 07122 Palma, Spain
| | - Maria A. Fiol-deRoque
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
| | - Alfonso Leiva
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
| | - Joan Llobera Canaves
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Balearic Islands Health Services, Primary Care Research Unit of Mallorca, 07002 Palma, Spain
- Primary Care Prevention and Health Promotion Research Network, RedIAPP, 28029 Madrid, Spain
| | - Fabrice B. R. Parmentier
- Health Research Institute of the Balearic Islands (IdISBa), Carretera de Valldemossa, 79 Hospital Universitario Son Espases, Edificio S, 07120 Palma, Spain; (I.R.-C.); (A.M.Y.-J.); (M.A.F.-d.); (A.L.); (J.L.C.); (F.B.R.P.)
- Department of Psychology and Institute of Health Sciences (iUNICS), University of the Balearic Islands, 07122 Palma, Spain
- School of Psychology, The University of Western Australia, Perth, WA 6009, Australia
| | - Jose M. Valderas
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care, NIHR School for Primary Care Research, University of Exeter, Exeter EX1 2HZ, UK
- NIHR South West Peninsula Applied Research Collaboration, University of Exeter, Exeter EX1 2HZ, UK
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore 119077, Singapore
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11
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Dias Neto D, Nunes da Silva A, Roberto MS, Lubenko J, Constantinou M, Nicolaou C, Lamnisos D, Papacostas S, Höfer S, Presti G, Squatrito V, Vasiliou VS, McHugh L, Monestès JL, Baban A, Alvarez-Galvez J, Paez-Blarrina M, Montesinos F, Valdivia-Salas S, Ori D, Lappalainen R, Kleszcz B, Gloster A, Karekla M, Kassianos AP. Illness Perceptions of COVID-19 in Europe: Predictors, Impacts and Temporal Evolution. Front Psychol 2021; 12:640955. [PMID: 33935893 PMCID: PMC8079952 DOI: 10.3389/fpsyg.2021.640955] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 03/12/2021] [Indexed: 12/23/2022] Open
Abstract
Objective: Illness perceptions (IP) are important predictors of emotional and behavioral responses in many diseases. The current study aims to investigate the COVID-19-related IP throughout Europe. The specific goals are to understand the temporal development, identify predictors (within demographics and contact with COVID-19) and examine the impacts of IP on perceived stress and preventive behaviors. Methods: This was a time-series-cross-section study of 7,032 participants from 16 European countries using multilevel modeling from April to June 2020. IP were measured with the Brief Illness Perception Questionnaire. Temporal patterns were observed considering the date of participation and the date recoded to account the epidemiological evolution of each country. The outcomes considered were perceived stress and COVID-19 preventive behaviors. Results: There were significant trends, over time, for several IP, suggesting a small decrease in negativity in the perception of COVID-19 in the community. Age, gender, and education level related to some, but not all, IP. Considering the self-regulation model, perceptions consistently predicted general stress and were less consistently related to preventive behaviors. Country showed no effect in the predictive model, suggesting that national differences may have little relevance for IP, in this context. Conclusion: The present study provides a comprehensive picture of COVID-19 IP in Europe in an early stage of the pandemic. The results shed light on the process of IP formation with implications for health-related outcomes and their evolution.
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Affiliation(s)
- David Dias Neto
- ISPA - Instituto Universitário, Lisboa, Portugal.,Applied Psychology Research Center Capabilities & Inclusion, Lisboa, Portugal
| | | | | | - Jelena Lubenko
- Psychological Laboratory, Faculty of Public Health and Social Welfare, Riga Stradiṇš University, Riga, Latvia
| | - Marios Constantinou
- Department of Social Sciences (Cyprus), School of Humanities and Social Sciences, University of Cyprus, Nicosia, Cyprus
| | - Christiana Nicolaou
- Department of Nursing (Cyprus), Cyprus University of Technology, Limassol, Cyprus
| | - Demetris Lamnisos
- Department of Health Sciences, European University Cyprus, Nicosia, Cyprus
| | - Savvas Papacostas
- The Cyprus Institute of Neurology and Genetics, The University of Nicosia Medical School, Nicosia, Cyprus
| | - Stefan Höfer
- Medical University Innsbruck, Innsbruck, Austria
| | - Giovambattista Presti
- Department of Human and Social Sciences, Kore University Behavioral Lab (KUBeLab), Kore University of Enna, Enna, Italy
| | - Valeria Squatrito
- Kore University Behavioral Lab (KUBeLab), Faculty of Human and Social Sciences, Kore University of Enna, Enna, Italy
| | | | - Louise McHugh
- School of Psychology (Ireland), University College Dublin, Dublin, Ireland
| | | | - Adriana Baban
- Department of Psychology, Babes-Bolyai University, Cluj-Napoca, Romania
| | - Javier Alvarez-Galvez
- Department of Biomedicine, Biotechnology and Public Health, University of Cadiz, Cádiz, Spain
| | | | | | | | - Dorottya Ori
- Vadaskert Child and Adolescent Psychiatric Hospital, Budapest, Hungary
| | - Raimo Lappalainen
- Department of Psychology, University of Jyväskylä, Jyväskylä, Finland
| | | | - Andrew Gloster
- Division of Clinical Psychology & Intervention Science, Department of Psychology, University of Basel, Basel, Switzerland
| | - Maria Karekla
- Department of Psychology, University of Cyprus, Nicosia, Cyprus
| | - Angelos P Kassianos
- Department of Psychology, University of Cyprus, Nicosia, Cyprus.,Department of Applied Health Research, University College London (UCL), London, United Kingdom
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12
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Kohler H, Bäuerle A, Schweda A, Weismüller B, Fink M, Musche V, Robitzsch A, Pfeiffer C, Benecke AV, Dörrie N, Führer D, Taube C, Rassaf T, Teufel M, Skoda EM. Increased COVID-19-related fear and subjective risk perception regarding COVID-19 affects behavior in individuals with internal high-risk diseases. J Prim Care Community Health 2021; 12:2150132721996898. [PMID: 33719697 PMCID: PMC8851367 DOI: 10.1177/2150132721996898] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Since December 2019, the coronavirus disease-2019 (COVID-19) has been keeping the world in suspense. Proven risk factors for a severe course of COVID-19 are common diseases like diabetes, hypertension, cardiovascular or respiratory disorders. Until today, little is known about the psychological burden of individuals suffering from these high-risk diseases regard to COVID-19. The aim of the study was to define the impact of the coronavirus pandemic on behavior and mental health in individuals at high risk for developing a severe COVID-19 course. Items assessed generalized anxiety (GAD-7), COVID-19-related fear, adherent/dysfunctional safety behavior, and the subjective risk perception of regarding symptoms, having a severe course and dying because of COVID-19. Data were compared between participants with the high risk diseases and individuals without any of those diseases. 16,983 respondents completed the study. Generalized anxiety, COVID-19-related fear, adherent/dysfunctional safety behavior and subjective risk perception were elevated in participants with high-risk diseases. The increased COVID-19-related fear as a functional concern is a conclusion on the increased risk of a severe course. The functionality of the fear is reflected in people’s increased need for security and includes an increase in both adherent and dysfunctional safety behavior that underlines the need for psychological support strategies.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Nora Dörrie
- University of Duisburg-Essen, Essen, Germany
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