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Holdroyd I, Chadwick W, Harvey-Sullivan A, Bartholomew T, Massou E, Tzortziou Brown V, Ford J. Single-handed versus multiple-handed general practices: A cross-sectional study of quality outcomes in England. J Health Serv Res Policy 2024; 29:201-209. [PMID: 38091626 PMCID: PMC11151703 DOI: 10.1177/13558196231218830] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2024]
Abstract
OBJECTIVES As general practice increasingly moves towards large group practices, there is debate about the relative benefits, safety and sustainability of different care delivery models. This study investigates the performance of single-handed practices compared to practices with multiple doctors in England, UK. METHODS Practices in England with more than 1000 patients were included. Workforce data and a quality control process classified practices as single-handed or multiple-handed. Outcomes were (i) GP patient survey scores measuring access, continuity, confidence in health professional and overall satisfaction; (ii) reported diabetes and hypertension outcomes; and (iii) emergency department presentation rates and cancer detection (percentage of cancers diagnosed by a 2-week wait). Generalised linear models, controlling for patient and practice characteristics, compared outcomes in single and multiple-handed practices and assessed the effect of GP age in single-handed practices. RESULTS Single-handed practices were more commonly found in areas of high deprivation (41% compared to 20% of multiple-handed practices). Single-handed practices had higher patient-reported access, continuity and overall satisfaction but slightly lower diabetes management and cancer detection rates. Emergency department presentations were higher when controlling for patient characteristics in single-handed practices but not when also controlling for practice rurality and size. Increased deprivation was associated with lower performance in seven out of eight outcomes. CONCLUSIONS We found single-handed practices to be associated with high patient satisfaction while performing slightly less well on selected clinical outcomes. Further research is required to better understand the association between practice size, including increasing multidisciplinary working, on patient experience and outcomes.
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Affiliation(s)
- Ian Holdroyd
- Foundation Doctor, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - William Chadwick
- Foundation Doctor, School of Clinical Medicine, University of Cambridge, Cambridge, UK
| | - Adam Harvey-Sullivan
- Academic Clinical Fellow, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
| | - Theodore Bartholomew
- GP Registrar, General Practice, Royal Surrey NHS Foundation Trust, Guildford, UK
| | - Efthalia Massou
- Research Associate, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Victoria Tzortziou Brown
- Senior Clinical Lecturer, Wolfson Institute for Population Health, Queen Mary University of London, London, UK
| | - John Ford
- Senior Clinical Lecturer in Health Equity, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Jalali-Najafabadi F, Bailey R, Lyons J, Akbari A, Ba Dhafari T, Azadbakht N, Rafferty J, Watkins A, Martin GP, Bowes J, Lyons RA, Barton A, Peek N. 10-year multimorbidity patterns among people with and without rheumatic and musculoskeletal diseases: an observational cohort study using linked electronic health records from Wales, UK. BMJ Open 2024; 14:e079169. [PMID: 38904124 PMCID: PMC11191776 DOI: 10.1136/bmjopen-2023-079169] [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: 08/23/2023] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
OBJECTIVES To compare the patterns of multimorbidity between people with and without rheumatic and musculoskeletal diseases (RMDs) and to describe how these patterns change by age and sex over time, between 2010 and 2019. PARTICIPANTS 103 426 people with RMDs and 2.9 million comparators registered in 395 Wales general practices (GPs). Each patient with an RMD aged 0-100 years between January 2010 and December 2019 registered in Clinical Practice Research Welsh practices was matched with up to five comparators without an RMD, based on age, gender and GP code. PRIMARY OUTCOME MEASURES The prevalence of 29 Elixhauser-defined comorbidities in people with RMDs and comparators categorised by age, gender and GP practices. Conditional logistic regression models were fitted to calculate differences (OR, 95% CI) in associations with comorbidities between cohorts. RESULTS The most prevalent comorbidities were cardiovascular risk factors, hypertension and diabetes. Having an RMD diagnosis was associated with a significantly higher odds for many conditions including deficiency anaemia (OR 1.39, 95% CI (1.32 to 1.46)), hypothyroidism (OR 1.34, 95% CI (1.19 to 1.50)), pulmonary circulation disorders (OR 1.39, 95% CI 1.12 to 1.73) diabetes (OR 1.17, 95% CI (1.11 to 1.23)) and fluid and electrolyte disorders (OR 1.27, 95% CI (1.17 to 1.38)). RMDs have a higher proportion of multimorbidity (two or more conditions in addition to the RMD) compared with non-RMD group (81% and 73%, respectively in 2019) and the mean number of comorbidities was higher in women from the age of 25 and 50 in men than in non-RMDs group. CONCLUSION People with RMDs are approximately 1.5 times as likely to have multimorbidity as the general population and provide a high-risk group for targeted intervention studies. The individuals with RMDs experience a greater load of coexisting health conditions, which tend to manifest at earlier ages. This phenomenon is particularly pronounced among women. Additionally, there is an under-reporting of comorbidities in individuals with RMDs.
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Affiliation(s)
- Farideh Jalali-Najafabadi
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Rowena Bailey
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Jane Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Ashley Akbari
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Thamer Ba Dhafari
- Division of Informatics, Imaging and Data Science, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - Narges Azadbakht
- Division of Informatics, Imaging and Data Science, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - James Rafferty
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Alan Watkins
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Glen Philip Martin
- Division of Informatics, Imaging and Data Science, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - John Bowes
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Ronan A Lyons
- Population Data Science, Swansea University Medical School, Swansea, UK
| | - Anne Barton
- Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Niels Peek
- Division of Informatics, Imaging and Data Science, School of Health Science, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
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Kimura T, Nomura K, Hashimoto M, Shinmura K. Relationship between the characteristics of Japanese physicians involved in medical care for older adults and their approaches to treating older patients with multimorbidity. PLoS One 2024; 19:e0302532. [PMID: 38865339 PMCID: PMC11168666 DOI: 10.1371/journal.pone.0302532] [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: 10/13/2023] [Accepted: 04/09/2024] [Indexed: 06/14/2024] Open
Abstract
One countermeasure against the increasing prevalence of multimorbidity is the need to provide clinical education and training that considers the characteristics of physicians. We conducted a questionnaire survey to determine the relationship between physicians' characteristics and their approach to treating older patients with multimorbidity. A total of 3300 geriatric specialists and primary care specialists in Japan were enrolled. A 4-point Likert scale was used to score the following items: difficult diseases (43 items), difficult patient backgrounds (14 items), important clinical factors (32 items), and important clinical management (32 items). Exploratory factor analysis was performed to examine the constructs in each of the scales Diseases, Backgrounds, Clinical Factors, and Clinical Management, and group comparisons by physician characteristics were conducted. A total of 778 respondents were included in the analysis. Six factors for Diseases, two factors for Patient Background, four factors for Clinical Factors, and two factors for Clinical Management were explored as patterns. Group comparison between mean scores for each factor and the characteristics of responding physicians showed statistically significant differences in at least one factor for all patterns in terms of years of experience as a physician (26 years or less, 27 years or more), the clinical setting (providing or not providing home medical care), and sex (male or female). Our results suggest a need for clinical education and training that takes into account not only physicians' experience and clinical setting, but also their sex.
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Affiliation(s)
- Takuma Kimura
- Department of R&D Innovation for Home Care Medicine, Department of General Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Kyoko Nomura
- Department of Environmental Health Science and Public Health, Akita University Graduate School of Medicine, Akita, Akita, Japan
| | - Masayoshi Hashimoto
- Department of R&D Innovation for Home Care Medicine, Department of General Medicine, Tokyo Medical and Dental University School of Medicine, Tokyo, Japan
| | - Ken Shinmura
- Department of General Internal Medicine, Hyogo Medical University School of Medicine, Nishinomiya, Hyogo, Japan
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Batista SRR, Sousa ALL, Nunes BP, Rodrigues RRD, Jardim PCBV. Regular source of primary care and health services utilisation among Brazilian elderly with mental-physical multimorbidity. BMC Geriatr 2024; 24:430. [PMID: 38750413 PMCID: PMC11094868 DOI: 10.1186/s12877-024-05048-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 05/06/2024] [Indexed: 05/19/2024] Open
Abstract
BACKGROUND In ageing populations, multimorbidity is a complex challenge to health systems, especially when the individuals have both mental and physical morbidities. Although a regular source of primary care (RSPC) is associated with better health outcomes, its relation with health service utilisation in elderly patients with mental-physical multimorbidity (MP-MM) is scarce. OBJECTIVE This study explored the relations among health service utilisation, presence of RSPC and MP-MM among elderly Brazilians. METHODS A national cross-sectional study performed with data from national representative samples from the Brazilian National Health Research (PNS, in Portuguese; Pesquisa Nacional de Saúde) carried out in 2013 with 11,177 elderly Brazilian people. MP-MM was defined as the presence of two or more morbidities, including at least one mental morbidity, and was evaluated using a list of 16 physical and mental morbidities. The RSPC was analysed by the presence of regular font of care in primary care and health service utilisation according to the demand for health services ≤ 15 days, medical consultation ≤ 12 months, and hospitalisation ≤ 1 year. Frequency description of variables and bivariate association were performed using Stata v.15.2 software. RESULTS The majority of individuals was female (56.4%), and their mean age was 69.8 years. The observed prevalence of MP-MM was 12.2%. Individuals with MP-MM had higher utilisation of health services when compared to those without MP-MM. RSPC was present at 36.5% and was higher in women (37.8% vs. 34.9%). There was a lower occurrence of hospitalisation ≤ 1 year among MP-MM individuals with RSPC and without a private plan of health. CONCLUSION Our findings demonstrate that RSPC can be an important component of care in elderly individuals with MP-MM because it was associated with lower occurrence of hospitalisation, mainly in those that have not a private plan of health. Longitudinal studies are necessary to confirm these findings.
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Affiliation(s)
- Sandro Rogério Rodrigues Batista
- Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil.
- Postgraduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil.
- Postgraduate Program in Public Health, Faculty of Health Sciences, University of Brasília, Brasília, Brazil.
| | - Ana Luiza Lima Sousa
- Faculty of Nursing, Federal University of Goiás, Goiânia, Brazil
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
| | | | - Rodolfo Rêgo Deusdará Rodrigues
- Postgraduate Program in Medical Sciences, Faculty of Medicine, University of Brasília, Brasília, Brazil
- Faculty of Medicine, University of Brasília, Brasília, Brazil
| | - Paulo Cesar Brandão Veiga Jardim
- Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
- Postgraduate Program in Health Sciences, Faculty of Medicine, Federal University of Goiás, Goiânia, Brazil
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Woodall AA, Abuzour AS, Wilson SA, Mair FS, Buchan I, Sheard SB, Atkinson P, Joyce DW, Symon P, Walker LE. Management of antipsychotics in primary care: Insights from healthcare professionals and policy makers in the United Kingdom. PLoS One 2024; 19:e0294974. [PMID: 38427674 PMCID: PMC10906843 DOI: 10.1371/journal.pone.0294974] [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: 11/01/2023] [Accepted: 01/26/2024] [Indexed: 03/03/2024] Open
Abstract
INTRODUCTION Antipsychotic medication is increasingly prescribed to patients with serious mental illness. Patients with serious mental illness often have cardiovascular and metabolic comorbidities, and antipsychotics independently increase the risk of cardiometabolic disease. Despite this, many patients prescribed antipsychotics are discharged to primary care without planned psychiatric review. We explore perceptions of healthcare professionals and managers/directors of policy regarding reasons for increasing prevalence and management of antipsychotics in primary care. METHODS Qualitative study using semi-structured interviews with 11 general practitioners (GPs), 8 psychiatrists, and 11 managers/directors of policy in the United Kingdom. Data was analysed using thematic analysis. RESULTS Respondents reported competency gaps that impaired ability to manage patients prescribed antipsychotic medications, arising from inadequate postgraduate training and professional development. GPs lacked confidence to manage antipsychotic medications alone; psychiatrists lacked skills to address cardiometabolic risks and did not perceive this as their role. Communication barriers, lack of integrated care records, limited psychology provision, lowered expectation towards patients with serious mental illness by professionals, and pressure to discharge from hospital resulted in patients in primary care becoming 'trapped' on antipsychotics, inhibiting opportunities to deprescribe. Organisational and contractual barriers between services exacerbate this risk, with socioeconomic deprivation and lack of access to non-pharmacological interventions driving overprescribing. Professionals voiced fears of censure if a catastrophic event occurred after stopping an antipsychotic. Facilitators to overcome these barriers were suggested. CONCLUSIONS People prescribed antipsychotics experience a fragmented health system and suboptimal care. Several interventions could be taken to improve care for this population, but inadequate availability of non-pharmacological interventions and socioeconomic factors increasing mental distress need policy change to improve outcomes. The role of professionals' fear of medicolegal or regulatory censure inhibiting antipsychotic deprescribing was a new finding in this study.
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Affiliation(s)
- Alan A. Woodall
- Department of Primary Care and Mental Health, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
- Powys Teaching Health Board, Bronllys Hospital, Powys, United Kingdom
| | - Aseel S. Abuzour
- Unit for Ageing and Stroke Research, School of Medicine, University of Leeds, West Yorkshire, United Kingdom
| | - Samantha A. Wilson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Frances S. Mair
- General Practice & Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Iain Buchan
- NIHR Mental Health Research for Innovation Centre, University of Liverpool, Liverpool, United Kingdom
| | - Sally B. Sheard
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Paul Atkinson
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, Liverpool, United Kingdom
| | - Dan W. Joyce
- NIHR Mental Health Research for Innovation Centre, University of Liverpool, Liverpool, United Kingdom
| | - Pyers Symon
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Lauren E. Walker
- Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
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Cheng C, Christensen M. Living with Multimorbidity through Time: A Meta-Synthesis of Qualitative Longitudinal Evidence. Healthcare (Basel) 2024; 12:446. [PMID: 38391821 PMCID: PMC10887575 DOI: 10.3390/healthcare12040446] [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: 12/26/2023] [Revised: 01/23/2024] [Accepted: 01/24/2024] [Indexed: 02/24/2024] Open
Abstract
The growing prevalence of multimorbidity places a strain on primary healthcare globally. The current study's aim was to identify, appraise, and synthesize published qualitative longitudinal research on individuals' experiences concerning living with multimorbidity through time. The authors searched two electronic databases, MEDLINE and CINAHL, and performed an additional literature search in Google Scholar. A thematic synthesis approach was used to analyze the qualitative data across the studies. A total of 10 reports that met the inclusion and exclusion criteria were included in the synthesis. Five descriptive themes emerged from the analysis of the living experiences of individuals with multimorbidity: (1) perceiving multimorbidity, (2) managing chronic conditions, (3) emotional struggles in everyday life with multimorbidity, (4) interactions with the healthcare system and healthcare professionals, and (5) family support. This meta-synthesis provides insights into the diverse perceptions of multimorbidity and how individuals cope with their chronic conditions in their daily lives. The findings highlight the importance of establishing effective patient-centered care that acknowledges and supports the multifaceted needs of this population. It is also recommended to involve a psychological component in the care of individuals with multimorbidity, as part of a collaborative and interprofessional approach.
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Affiliation(s)
- Cheng Cheng
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- The Interdisciplinary Centre for Qualitative Research, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- School of Nursing, Fudan University, Xuhui District, Shanghai 200032, China
| | - Martin Christensen
- School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- The Interdisciplinary Centre for Qualitative Research, School of Nursing, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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Hill L, McNulty A, McMahon J, Mitchell G, Farrell C, Uchmanowicz I, Castiello T. Heart Failure Nurses within the Primary Care Setting. Card Fail Rev 2024; 10:e01. [PMID: 38464555 PMCID: PMC10918528 DOI: 10.15420/cfr.2023.15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 09/27/2023] [Indexed: 03/12/2024] Open
Abstract
Cardiology services within primary care often focus on disease prevention, early identification of illness and prompt referral for diagnosis and specialist treatment. Due to advances in pharmaceuticals, implantable cardiac devices and surgical interventions, individuals with heart failure are living longer, which can place a significant strain on global healthcare resources. Heart failure nurses in a primary care setting offer a wealth of clinical knowledge and expertise across all phases of the heart failure trajectory and are able to support patients, family members and other community services, including general practitioners. This review examines the recently published evidence on the current and potential future practice of heart failure nurses within primary care.
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Affiliation(s)
- Loreena Hill
- School of Nursing and Midwifery, Queen's University BelfastBelfast, UK
- College of Nursing and Midwifery, Mohammed Bin Rashid UniversityDubai, United Arab Emirates
| | - Anne McNulty
- School of Nursing and Midwifery, Queen's University BelfastBelfast, UK
| | - James McMahon
- School of Nursing and Midwifery, Queen's University BelfastBelfast, UK
| | - Gary Mitchell
- School of Nursing and Midwifery, Queen's University BelfastBelfast, UK
| | - Cathy Farrell
- Errigal Chronic Disease Management Hub, LetterkennyDonegal, Ireland
| | - Izabella Uchmanowicz
- Department of Nursing and Obstetrics, Wrocław Medical UniversityWrocław, Poland
- Institute of Heart Diseases, University HospitalWrocław, Poland
| | - Teresa Castiello
- Department of Cardiovascular Imaging, King's College LondonLondon, UK
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Althoff KN, Stewart C, Humes E, Gerace L, Boyd C, Gebo K, Justice AC, Hyle EP, Coburn SB, Lang R, Silverberg MJ, Horberg MA, Lima VD, Gill MJ, Karris M, Rebeiro PF, Thorne J, Rich AJ, Crane H, Kitahata M, Rubtsova A, Wong C, Leng S, Marconi VC, D’Souza G, Kim HN, Napravnik S, McGinnis K, Kirk GD, Sterling TR, Moore RD, Kasaie P. The forecasted prevalence of comorbidities and multimorbidity in people with HIV in the United States through the year 2030: A modeling study. PLoS Med 2024; 21:e1004325. [PMID: 38215160 PMCID: PMC10833859 DOI: 10.1371/journal.pmed.1004325] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 02/01/2024] [Accepted: 11/22/2023] [Indexed: 01/14/2024] Open
Abstract
BACKGROUND Estimating the medical complexity of people aging with HIV can inform clinical programs and policy to meet future healthcare needs. The objective of our study was to forecast the prevalence of comorbidities and multimorbidity among people with HIV (PWH) using antiretroviral therapy (ART) in the United States (US) through 2030. METHODS AND FINDINGS Using the PEARL model-an agent-based simulation of PWH who have initiated ART in the US-the prevalence of anxiety, depression, stage ≥3 chronic kidney disease (CKD), dyslipidemia, diabetes, hypertension, cancer, end-stage liver disease (ESLD), myocardial infarction (MI), and multimorbidity (≥2 mental or physical comorbidities, other than HIV) were forecasted through 2030. Simulations were informed by the US CDC HIV surveillance data of new HIV diagnosis and the longitudinal North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD) data on risk of comorbidities from 2009 to 2017. The simulated population represented 15 subgroups of PWH including Hispanic, non-Hispanic White (White), and non-Hispanic Black/African American (Black/AA) men who have sex with men (MSM), men and women with history of injection drug use and heterosexual men and women. Simulations were replicated for 200 runs and forecasted outcomes are presented as median values (95% uncertainty ranges are presented in the Supporting information). In 2020, PEARL forecasted a median population of 670,000 individuals receiving ART in the US, of whom 9% men and 4% women with history of injection drug use, 60% MSM, 8% heterosexual men, and 19% heterosexual women. Additionally, 44% were Black/AA, 32% White, and 23% Hispanic. Along with a gradual rise in population size of PWH receiving ART-reaching 908,000 individuals by 2030-PEARL forecasted a surge in prevalence of most comorbidities to 2030. Depression and/or anxiety was high and increased from 60% in 2020 to 64% in 2030. Hypertension decreased while dyslipidemia, diabetes, CKD, and MI increased. There was little change in prevalence of cancer and ESLD. The forecasted multimorbidity among PWH receiving ART increased from 63% in 2020 to 70% in 2030. There was heterogeneity in trends across subgroups. Among Black women with history of injection drug use in 2030 (oldest demographic subgroup with median age of 66 year), dyslipidemia, CKD, hypertension, diabetes, anxiety, and depression were most prevalent, with 92% experiencing multimorbidity. Among Black MSM in 2030 (youngest demographic subgroup with median age of 42 year), depression and CKD were highly prevalent, with 57% experiencing multimorbidity. These results are limited by the assumption that trends in new HIV diagnoses, mortality, and comorbidity risk observed in 2009 to 2017 will persist through 2030; influences occurring outside this period are not accounted for in the forecasts. CONCLUSIONS The PEARL forecasts suggest a continued rise in comorbidity and multimorbidity prevalence to 2030, marked by heterogeneities across race/ethnicity, gender, and HIV acquisition risk subgroups. HIV clinicians must stay current on the ever-changing comorbidities-specific guidelines to provide guideline-recommended care. HIV clinical directors should ensure linkages to subspecialty care within the clinic or by referral. HIV policy decision-makers must allocate resources and support extended clinical capacity to meet the healthcare needs of people aging with HIV.
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Affiliation(s)
- Keri N. Althoff
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cameron Stewart
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Elizabeth Humes
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Lucas Gerace
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Cynthia Boyd
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Kelly Gebo
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Amy C. Justice
- Yale Schools of Medicine and Public Health, New Haven, Connecticut, United States of America
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Emily P. Hyle
- Harvard Medical School and the Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard University Center for AIDS Research, Boston, Massachusetts, United States of America
| | - Sally B. Coburn
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Raynell Lang
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michael J. Silverberg
- Division of Research, Kaiser Permanente Northern California, Oakland, California, USA and Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, United States of America
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California, United States of America
| | - Michael A. Horberg
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic Permanente Medical Group, Rockville, Maryland, United States of America
| | - Viviane D. Lima
- Epidemiology and Population Health Program, British Columbia Centre for Excellence in HIV/AIDS, Vancouver, Canada
| | - M. John Gill
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Maile Karris
- Department of Medicine, University of California San Diego, San Diego, California, United States of America
| | - Peter F. Rebeiro
- Departments of Medicine and Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Jennifer Thorne
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America
| | - Ashleigh J. Rich
- Department of Social Medicine, University of North Carolina, Chapel Hill, North Carolina, United States of America
| | - Heidi Crane
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Mari Kitahata
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Anna Rubtsova
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, Georgia, United States of America
| | - Cherise Wong
- Division of Worldwide Research and Development, Pfizer Inc., New York City, New York, United States of America
| | - Sean Leng
- Division of Geriatric Medicine and Gerontology, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Vincent C. Marconi
- Division of Infectious Disease, Emory School of Medicine, Atlanta, Georgia, United States of America
- Atlanta Veterans Affairs Health Care System, Decatur, Georgia, United States of America
| | - Gypsyamber D’Souza
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
| | - Hyang Nina Kim
- Division of Allergy and Infectious Diseases, Departments of Medicine and Epidemiology, University of Washington, Seattle, Washington, United States of America
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, United States of America
| | - Kathleen McGinnis
- Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, United States of America
| | - Gregory D. Kirk
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
- Division of Infectious Diseases, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Timothy R. Sterling
- Vanderbilt Tuberculosis Center, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
- Division of Infectious Diseases, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, United States of America
| | - Richard D. Moore
- Division of General Internal Medicine, Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland, United States of America
| | - Parastu Kasaie
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America
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Simpson G, Morrison L, Santer M, Hijryana M, Farmer A, Dambha-Miller H. Perceptions and experiences of living with and providing care for multimorbidity: A qualitative interview study. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2024; 14:26335565241240820. [PMID: 38529048 PMCID: PMC10962039 DOI: 10.1177/26335565241240820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 03/03/2024] [Indexed: 03/27/2024]
Abstract
Background Experiences of living with and seeking care for multimorbidity is a relatively under-researched field. By analysing experiences of people with multimorbidity, caregivers and care professionals, we can better understand the complex care needs of those with multimorbidity and identify improvements to care management. This paper reports findings from research that elicited the views of key stakeholders to inform future care practice and policy. Aim To elicit care recipient and care provider views to understand the care needs of those living with and seeking care for multimorbidity. Method A qualitative interview study using purposive sampling of those living with and providing care in multimorbidity. Results Increased support to those with multimorbidity and caregivers to navigate care systems was advocated. Establishing trusting care relationships featured prominently in participants accounts. Fragmented care, inadequate coordination and poor communication between care providers, were identified as system-wide challenges. There was agreement that integrated care models were needed, which delivered personalised care, such as shared decision-making, choice in care options and accessing services, and individualised care plans. Conclusion We found significant agreement among stakeholders on care need and management in multimorbidity. Understanding the experiences of those with multimorbidity, caregivers and care professionals, can inform future improvements in care management.
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Affiliation(s)
- Glenn Simpson
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Leanne Morrison
- Primary Care Research Centre, University of Southampton, Southampton, UK
- School of Psychology, University of Southampton, Southampton, UK
| | - Miriam Santer
- Primary Care Research Centre, University of Southampton, Southampton, UK
| | - Marisza Hijryana
- Institute of Epidemiology and Health Care, University College London (UCL), London, UK
| | - Andrew Farmer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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Gil Conde M, Peyroteo M, Maria A, Maia MR, Gregório J, Paulo MS, Alves M, Papoila AL, Lapão LV, Heleno B. Protocol for a cluster randomised trial of a goal-oriented care approach for multimorbidity patients supported by a digital platform. BMJ Open 2023; 13:e070044. [PMID: 37977860 PMCID: PMC10660818 DOI: 10.1136/bmjopen-2022-070044] [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: 01/04/2023] [Accepted: 10/12/2023] [Indexed: 11/19/2023] Open
Abstract
INTRODUCTION Health information systems represent an opportunity to improve the care provided to people with multimorbidity. There is a pressing need to assess their impact on clinical outcomes to validate this intervention. Our study will determine whether using a digital platform (Multimorbidity Management Health Information System, METHIS) to manage multimorbidity improves health-related quality of life (HR-QoL). METHODS AND ANALYSIS A superiority, cluster randomised trial will be conducted at primary healthcare practices (1:1 allocation ratio). All public practices in the Lisbon and Tagus Valley (LVT) Region, Portugal, not involved in a previous pilot trial, will be eligible. At the participant level, eligible patients will be people with complex multimorbidity, aged 50 years or older, with access to an internet connection and a communication technology device. Participants who cannot sign/read/write and who do not have access to an email account will not be included in the study. The intervention combines a training programme and a customised information system (METHIS). Both are designed to help clinicians adopt a goal-oriented care model approach and to encourage patients and carers to play a more active role in autonomous healthcare. The primary outcome is HR-QoL, measured at 12 months with the physical component scale of the 12-item Short Form questionnaire (SF-12). Secondary outcomes will also be measured at 12 months and include mental health (mental component Scale SF-12, Hospital Anxiety and Depression Scale). We will also assess serious adverse events during the trial, including hospitalisation and emergency services. Finally, at 18 months, we will ask the general practitioners for any potentially missed diagnoses. ETHICS AND DISSEMINATION The Research and Ethics Committee (LVT Region) approved the trial protocol. Clinicians and patients will sign an informed consent. A data management officer will handle all data, and the publication of several scientific papers and presentations at relevant conferences/workshops is envisaged. TRIAL REGISTRATION NUMBER NCT05593835.
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Affiliation(s)
- Margarida Gil Conde
- USF Jardins da Encarnação, ACeS Lisboa Central/ Research and Ethics Committee, ARSLVT, Lisboa, Portugal
- University Clinic of Family Medicine, Faculty of Medicine of the University of Lisbon, Lisbon, Portugal
| | - Mariana Peyroteo
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- Laboratório Associado de Sistemas Inteligentes, LASI, 4800-058 Guimarães, Portugal
| | - Ana Maria
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Mélanie Raimundo Maia
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- Laboratório Associado de Sistemas Inteligentes, LASI, 4800-058 Guimarães, Portugal
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - João Gregório
- CBIOS, Universidade Lusófona de Humanidades e Tecnologias Escola de Ciências e Tecnologias da Saúde, Lisboa, Portugal
| | - Marilia Silva Paulo
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
- Institute of Public Health, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, UAE
| | - Marta Alves
- CEAUL, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Ana Luísa Papoila
- CEAUL, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
| | - Luís Velez Lapão
- UNIDEMI, Department of Mechanical and Industrial Engineering, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Caparica, Portugal
- Laboratório Associado de Sistemas Inteligentes, LASI, 4800-058 Guimarães, Portugal
- WHO Collaborating Center on Health Workforce Policy and Planning, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisbon, Portugal
| | - Bruno Heleno
- CHRC, NOVA Medical School, Faculdade de Ciências Médicas, NMS, FCM, Universidade NOVA de Lisboa, Lisboa, Portugal
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Roskoschinski A, Liang W, Duan Y, Al-Salehi H, Lippke S. Loneliness and depression in older adults with multimorbidity: the role of self-efficacy and social support. Front Psychiatry 2023; 14:1232067. [PMID: 37965359 PMCID: PMC10642299 DOI: 10.3389/fpsyt.2023.1232067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 10/09/2023] [Indexed: 11/16/2023] Open
Abstract
Introduction As relatively little is known about self-efficacy and social support in individuals aged 65 years and older and whether they are facing a decline in life due to multimorbidity and previous COVID-19 infection, this study investigated hypotheses based on Social Cognitive Theory. Methods It was tested whether depressive symptoms in multimorbid patients who were hospitalized for COVID-19 infection, and recover post infection during their hospital stay, do not differ from those of multimorbid patients hospitalized for other conditions. Furthermore, we tested whether depressive symptoms are associated with increased loneliness scores, low self-efficacy beliefs, and poorly perceived social support. Additionally, it was investigated whether self-efficacy is a mediator variable, and social support is a moderator variable between loneliness and depression. N = 135 patients with or without previous COVID-19 infection (mean age 64.76) were recruited. Paper questionnaires were collected at the time of inpatient hospital admission in the year 2021 and in a cross-sectional study design. The study compared n = 45 multimorbid patients who survived COVID-19 infection with those n = 90 who were not infected before. Results No significant difference in depressive symptomology between these two groups revealed [t(133) = 130, p = 0.90, d = 0.024); F(3, 122) = 0.255, p = 0.86]. The study found a positive correlation between loneliness and anxiety and depression in both groups (rdepression = 0.419 and ranxiety = 0.496). Self-efficacy mediated the relation between loneliness and depression. The completely standardized indirect effect was β = 0.111, percentile Bootstrap 95% CI 0.027-0.201. Discussion The research findings suggest the importance of self-efficacy, and loneliness in the development of depressive symptoms, and have several practical implications for improving the mental health of multimorbid patients: Prospectively, treatment should not only focus on physical and cognitive health, but also on promoting self-efficacy and perceived social support, as well as address loneliness with psychoeducational interventions. Replication of the findings and conducting interventional research also employing lifestyle components should follow up, as this study tested associations but no causal relationships.
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Affiliation(s)
- Annika Roskoschinski
- Unit for Geriatrics and Physical Medicine, Helios Klinikum Berlin-Buch, Berlin, Germany
- Constructor University Bremen, Bremen, Germany
| | - Wei Liang
- School of Physical Education, Shenzhen University, Shenzhen, China
| | - Yanping Duan
- Hong Kong Baptist University, Kowloon, Hong Kong SAR, China
| | - Hayl Al-Salehi
- Constructor University Bremen, Bremen, Germany
- Bremen International Graduate School of Social Sciences (BIGSSS), Bremen, Germany
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Lawless MT, Archibald MM, Ambagtsheer RC, Pinero de Plaza MA, Kitson AL. My Wellbeing Journal: Development of a communication and goal-setting tool to improve care for older adults with chronic conditions and multimorbidity. Health Expect 2023; 27:e13890. [PMID: 37830439 PMCID: PMC10726145 DOI: 10.1111/hex.13890] [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: 06/17/2023] [Revised: 09/21/2023] [Accepted: 10/02/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Chronic conditions and multimorbidity, the presence of two or more chronic conditions, are increasingly common in older adults. Effective management of chronic conditions and multimorbidity in older adults requires a collaborative and person-centred approach that considers the individual's goals, preferences and priorities. However, ensuring high-quality personalised care for older adults with multimorbidity can be challenging due to the complexity of their care needs, limited time and a lack of patient preparation to discuss their personal goals and preferences with their healthcare team. OBJECTIVE To codesign a communication and goal-setting tool, My Wellbeing Journal, to support personalised care planning for older adults with chronic conditions and multimorbidity. DESIGN We drew on an experience-based codesign approach to develop My Wellbeing Journal. This article reports on the final end-user feedback, which was collected via an online survey with older adults and their carers. SETTING AND PARTICIPANTS Older adults with chronic conditions, multimorbidity and informal carers living in Australia. Personalised care planning was considered in the context of primary care. RESULTS A total of 88 participants completed the online survey. The survey focused on participants' feedback on the tool in terms of effectiveness, efficiency, satisfaction and errors encountered. This feedback resulted in modifications to My Wellbeing Journal, which can be used during clinical encounters to facilitate communication, goal setting and progress tracking. DISCUSSION AND CONCLUSIONS Clinicians and carers can use the tool to guide discussions with older adults about their care planning and help them set realistic goals that are meaningful to them. The findings of this study could be used to inform the development of recommendations for healthcare providers to implement person-centred, goal-oriented care for older adults with chronic conditions and multimorbidity. PATIENT OR PUBLIC CONTRIBUTION Older adults living with chronic conditions and multimorbidity and their carers have contributed to the development of a tool that has the potential to significantly enhance the experience of personalised care planning. Their direct involvement as collaborators has ensured that the tool is optimised to meet the standards of effectiveness and usability.
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Affiliation(s)
- Michael T. Lawless
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
| | - Mandy M. Archibald
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
- Helen Glass Centre for NursingCollege of NursingWinnipegManitobaCanada
| | | | | | - Alison L. Kitson
- Caring Futures Institute, College of Nursing and Health SciencesFlinders UniversityBedford ParkSouth AustraliaAustralia
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Jønsson ABR, Martiny FHJ, Søndergaard MK, Brodersen JB, Due TD, Nielsen MH, Bakkedal C, Bardram JE, Bissenbakker K, Christensen I, Doherty K, Kjellberg P, Mercer SW, Reventlow S, Rozing MP, Møller A. Introducing extended consultations for patients with severe mental illness in general practice: Results from the SOFIA feasibility study. BMC PRIMARY CARE 2023; 24:206. [PMID: 37798651 PMCID: PMC10552249 DOI: 10.1186/s12875-023-02152-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2022] [Accepted: 09/05/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND People with a severe mental illness (SMI) have shorter life expectancy and poorer quality of life compared to the general population. Most years lost are due to cardiovascular disease, respiratory disease, and various types of cancer. We co-designed an intervention to mitigate this health problem with key stakeholders in the area, which centred on an extended consultations for people with SMI in general practice. This study aimed to1) investigate general practitioners' (GPs) experience of the feasibility of introducing extended consultations for patients with SMI, 2) assess the clinical content of extended consultations and how these were experienced by patients, and 3) investigate the feasibility of identification, eligibility screening, and recruitment of patients with SMI. METHODS The study was a one-armed feasibility study. We planned that seven general practices in northern Denmark would introduce extended consultations with their patients with SMI for 6 months. Patients with SMI were identified using practice medical records and screened for eligibility by the patients' GP. Data were collected using case report forms filled out by practice personnel and via qualitative methods, including observations of consultations, individual semi-structured interviews, a focus group with GPs, and informal conversations with patients and general practice staff. RESULTS Five general practices employing seven GPs participated in the study, which was terminated 3 ½ month ahead of schedule due to the COVID-19 pandemic. General practices attempted to contact 57 patients with SMI. Of these, 38 patients (67%) attended an extended consultation, which led to changes in the somatic health care plan for 82% of patients. Conduct of the extended consultations varied between GPs and diverged from the intended conduct. Nonetheless, GPs found the extended consultations feasible and, in most cases, beneficial for the patient group. In interviews, most patients recounted the extended consultation as beneficial. DISCUSSION Our findings suggest that it is feasible to introduce extended consultations for patients with SMI in general practice, which were also found to be well-suited for eliciting patients' values and preferences. Larger studies with a longer follow-up period could help to assess the long-term effects and the best implementation strategies of these consultations.
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Affiliation(s)
- A B R Jønsson
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Center for Health and Society, Department of People and Technology, Roskilde University, Roskilde, Denmark
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
| | - F H J Martiny
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
- Center for Social Medicine, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.
| | - M K Søndergaard
- The Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | - J B Brodersen
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Community Medicine, The Arctic University of Norway, Tromsø, Norway
- Primary Health Care, Region Zealand, Denmark
| | - T D Due
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M H Nielsen
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - C Bakkedal
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - J E Bardram
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - K Bissenbakker
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - I Christensen
- The Danish Centre for Social Science Research, Copenhagen, Denmark
| | - K Doherty
- Department of Health Technology, Technical University of Denmark, Kongens Lyngby, Denmark
| | - P Kjellberg
- The Danish Centre for Social Science Research, Copenhagen, Denmark
| | - S W Mercer
- Usher Institute, College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, Denmark
| | - S Reventlow
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - M P Rozing
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - A Møller
- The Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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14
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Dinh TS, Brünn R, Schwarz C, Brueckle MS, Dieckelmann M, González González AI, van den Akker M. How do middle-aged patients and their healthcare providers manage multimorbidity? Results of a qualitative study. PLoS One 2023; 18:e0291065. [PMID: 37651435 PMCID: PMC10470875 DOI: 10.1371/journal.pone.0291065] [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: 02/24/2023] [Accepted: 08/20/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND It is particularly difficult for healthcare providers to deliver optimal medical care to multimorbid middle-aged persons because patients' professional activities, family lives, and other everyday responsibilities hinder them from making necessary lifestyle changes. Our aim was to find out how patients and healthcare providers view and manage the problems of dealing with multimorbidity in middle age. METHODS AND FINDINGS This qualitative study consisted of three steps. First, we conducted semi-structured in-depth interviews with 15 purposively sampled middle-aged persons living with multimorbidity to explore the experiences of care in the context of their leisure time, family lives, and work. Second, further individual interviews were carried out to find out the views of 14 healthcare providers. Third, the results of the interviews with patients and healthcare providers were presented to and discussed with four healthcare providers at an interprofessional workshop. Interview data was coded using an inductive-deductive approach and analyzed using content analysis. While patients reflected on challenges in several life domains, healthcare providers differentiated between levels of challenges. Both shared recommendations for better care including i) helping patients cope, ii) providing relief in activities of daily living, iii) continuity of care, iv) interprofessional cooperation, v) health promotion/prevention, vi) expansion of health services and vii) general system-level changes. Furthermore, the healthcare provider workshop highlighted the importance of increasing patient-centeredness, reducing complexity through a care coordinator and promoting interprofessional cooperation/networking. CONCLUSIONS To further improve the care of patients living with multimorbidity, barriers to managing multiple chronic conditions and facilitators to navigating complex care scenarios should be explored not only for people beyond working age, but for individuals in their mid-life specifically.
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Affiliation(s)
- Truc Sophia Dinh
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Robin Brünn
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | | | | | - Mirjam Dieckelmann
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
| | - Ana I. González González
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
- Red de Investigación en Cronicidad, Atención Primaria y Promoción de la Salud (RICAPPS), Madrid, Spain
| | - Marjan van den Akker
- Institute of General Practice, Goethe University, Frankfurt am Main, Germany
- Department of Family Medicine, School CAPHRI, Maastricht University, Maastricht, The Netherlands
- Academic Center for General Practice, Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium
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15
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Olsen JK, Wehberg S, Waldorff FB, Henriksen DP, Lykkegaard J. Variation in daytime general practice services and association with out-of-hours use for older patients: protocol for a Danish cohort study. BMJ Open 2023; 13:e073229. [PMID: 37500276 PMCID: PMC10387735 DOI: 10.1136/bmjopen-2023-073229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Abstract
INTRODUCTION Out-of-hours primary care services cannot provide the same continuity and coordination of care as general practice. Thus, patients with high risk of complex care trajectories should, when possible, be treated by the general practitioner during daytime opening hours. This study aims to analyse the variation among general practices in the frequencies of daytime services for persons aged ≥75 years and how it relates to the patients' use of out-of-hours services. METHODS AND ANALYSIS Register-based cohort study of all Danish citizens aged ≥75 years, of whom >98% are listed with a general practice. Using Poisson regression, we will estimate each practice's excess variation in delivered daytime services compared with the expected based on the characteristics of its listed patients. Delivered daytime services will be analysed overall and separately for face-to-face, phone, email, home visit and preventive services. The association with the use of out-of-hours services will be analysed by Poisson regression. ETHICS AND DISSEMINATION Complying with European data protection rules, the legal services at University of Southern Denmark (Research & Innovation Organisation) approved the data processing activities regarding this project (journal number 11.593). According to section 14.2 of the Act on Research Ethics Review of Health Research Projects, because the study is based solely on register data, approval from the ethics committee and informed consent are not required. Results from the study will be disseminated as publications in peer-reviewed scientific journals and at international conferences.
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Affiliation(s)
- Jonas K Olsen
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Sonja Wehberg
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Frans Boch Waldorff
- Section of General Practice and Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | | | - Jesper Lykkegaard
- Research Unit for General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
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Zelenak C, Nagel J, Bersch K, Derendorf L, Doyle F, Friede T, Herbeck Belnap B, Kohlmann S, Skou ST, Velasco CA, Albus C, Asendorf T, Bang CA, Beresnevaite M, Bruun NE, Burg MM, Buhl SF, Gæde PH, Lühmann D, Markser A, Nagy KV, Rafanelli C, Rasmussen S, Søndergaard J, Sørensen J, Stauder A, Stock S, Urbinati S, Riva DD, Wachter R, Walker F, Pedersen SS, Herrmann‐Lingen C. Integrated care for older multimorbid heart failure patients: protocol for the ESCAPE randomized trial and cohort study. ESC Heart Fail 2023; 10:2051-2065. [PMID: 36907651 PMCID: PMC10192276 DOI: 10.1002/ehf2.14294] [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: 10/25/2022] [Revised: 12/02/2022] [Accepted: 01/09/2023] [Indexed: 03/13/2023] Open
Abstract
ESCAPE Evaluation of a patient-centred biopsychosocial blended collaborative care pathway for the treatment of multimorbid elderly patients. THERAPEUTIC AREA Healthcare interventions for the management of older patients with multiple morbidities. AIMS Multi-morbidity treatment is an increasing challenge for healthcare systems in ageing societies. This comprehensive cohort study with embedded randomized controlled trial tests an integrated biopsychosocial care model for multimorbid elderly patients. HYPOTHESIS A holistic, patient-centred pro-active 9-month intervention based on the blended collaborative care (BCC) approach and enhanced by information and communication technologies can improve health-related quality of life (HRQoL) and disease outcomes as compared with usual care at 9 months. METHODS Across six European countries, ESCAPE is recruiting patients with heart failure, mental distress/disorder plus ≥2 medical co-morbidities into an observational cohort study. Within the cohort study, 300 patients will be included in a randomized controlled assessor-blinded two-arm parallel group interventional clinical trial (RCT). In the intervention, trained care managers (CMs) regularly support patients and informal carers in managing their multiple health problems. Supervised by a clinical specialist team, CMs remotely support patients in implementing the treatment plan-customized to the patients' individual needs and preferences-into their daily lives and liaise with patients' healthcare providers. An eHealth platform with an integrated patient registry guides the intervention and helps to empower patients and informal carers. HRQoL measured with the EQ-5D-5L as primary endpoint, and secondary outcomes, that is, medical and patient-reported outcomes, healthcare costs, cost-effectiveness, and informal carer burden, will be assessed at 9 and ≥18 months. CONCLUSIONS If proven effective, the ESCAPE BCC intervention can be implemented in routine care for older patients with multiple morbidities across the participating countries and beyond.
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Affiliation(s)
- Christine Zelenak
- Department of Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
| | - Jonas Nagel
- Department of Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
| | - Kristina Bersch
- Clinical Trial Unit of the University Medical Center GöttingenGöttingenGermany
| | - Lisa Derendorf
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical EpidemiologyUniversity of CologneCologneGermany
| | - Frank Doyle
- Royal College of Surgeons in IrelandDublinIreland
| | - Tim Friede
- Department of Medical StatisticsUniversity of Göttingen Medical CentreGöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
| | - Birgit Herbeck Belnap
- Department of Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
- Center for Behavioral Health, Media, and Technology, Division of General Internal MedicineUniversity of Pittsburgh School of MedicinePittsburghPAUSA
| | - Sebastian Kohlmann
- Clinic for Psychosomatic Medicine and PsychotherapyUniversity Hospital Hamburg EppendorfHamburgGermany
| | - Søren T. Skou
- The Research Unit PROgrez, Department of Physiotherapy and Occupational TherapyNæstved‐Slagelse‐Ringsted Hospitals, Region ZealandSlagelseDenmark
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical BiomechanicsUniversity of Southern DenmarkOdenseDenmark
| | - Carlos A. Velasco
- Fraunhofer Institute for Applied Information Technology FITSchloss BirlinghovenSankt AugustinGermany
| | - Christian Albus
- Faculty of Medicine and University Hospital of Cologne, Department of Psychosomatics and PsychotherapyUniversity of CologneCologneGermany
| | - Thomas Asendorf
- Clinical Trial Unit of the University Medical Center GöttingenGöttingenGermany
| | | | - Margarita Beresnevaite
- Laboratory of Clinical Cardiology, Institute of CardiologyLithuanian University of Health SciencesKaunasLithuania
| | - Niels Eske Bruun
- Department of CardiologyZealand University HospitalRoskildeDenmark
- Clinical InstitutesCopenhagen and Aalborg UniversitiesCopenhagenDenmark
| | | | - Sussi Friis Buhl
- Research Unit of General Practice, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Peter H. Gæde
- Department of Cardiology and EndocrinologySlagelse HospitalSlagelseDenmark
- Institute of Regional HealthUniversity of Southern DenmarkOdenseDenmark
| | | | - Anna Markser
- Faculty of Medicine and University Hospital of Cologne, Department of Psychosomatics and PsychotherapyUniversity of CologneCologneGermany
| | | | | | - Sanne Rasmussen
- Research Unit of General Practice, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Jens Søndergaard
- Research Unit of General Practice, Department of Public HealthUniversity of Southern DenmarkOdenseDenmark
| | - Jan Sørensen
- Healthcare Outcomes Research CentreDublinIreland
| | - Adrienne Stauder
- Institute of Behavioural SciencesSemmelweis UniversityBudapestHungary
| | - Stephanie Stock
- Faculty of Medicine and University Hospital of Cologne, Institute of Health Economics and Clinical EpidemiologyUniversity of CologneCologneGermany
| | | | | | | | - Florian Walker
- Clinical Trial Unit of the University Medical Center GöttingenGöttingenGermany
| | - Susanne S. Pedersen
- Department of PsychologyUniversity of Southern DenmarkOdenseDenmark
- Department of CardiologyOdense University HospitalOdenseDenmark
| | - Christoph Herrmann‐Lingen
- Department of Psychosomatic Medicine and PsychotherapyUniversity of Göttingen Medical CentreGöttingenGermany
- German Centre for Cardiovascular Research (DZHK), partner site GöttingenGöttingenGermany
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Hempel S, Ganz D, Saluja S, Bolshakova M, Kim T, Turvey C, Cordasco K, Basu A, Page T, Mahmood R, Motala A, Barnard J, Wong M, Fu N, Miake-Lye IM. Care coordination across healthcare systems: development of a research agenda, implications for practice, and recommendations for policy based on a modified Delphi panel. BMJ Open 2023; 13:e060232. [PMID: 37197809 DOI: 10.1136/bmjopen-2021-060232] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/19/2023] Open
Abstract
OBJECTIVE For large, integrated healthcare delivery systems, coordinating patient care across delivery systems with providers external to the system presents challenges. We explored the domains and requirements for care coordination by professionals across healthcare systems and developed an agenda for research, practice and policy. DESIGN The modified Delphi approach convened a 2-day stakeholder panel with moderated virtual discussions, preceded and followed by online surveys. SETTING The work addresses care coordination across healthcare systems. We introduced common care scenarios and differentiated recommendations for a large (main) healthcare organisation and external healthcare professionals that contribute additional care. PARTICIPANTS The panel composition included health service providers, decision makers, patients and care community, and researchers. Discussions were informed by a rapid review of tested approaches to fostering collaboration, facilitating care coordination and improving communication across healthcare systems. OUTCOME MEASURES The study planned to formulate a research agenda, implications for practice and recommendations for policy. RESULTS For research recommendations, we found consensus for developing measures of shared care, exploring healthcare professionals' needs in different care scenarios and evaluating patient experiences. Agreed practice recommendations included educating external professionals about issues specific to the patients in the main healthcare system, educating professionals within the main healthcare system about the roles and responsibilities of all involved parties, and helping patients better understand the pros and cons of within-system and out-of-system care. Policy recommendations included supporting time for professionals with high overlap in patients to engage regularly and sustaining support for care coordination for high-need patients. CONCLUSIONS Recommendations from the stakeholder panel created an agenda to foster further research, practice and policy innovations in cross-system care coordination.
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Affiliation(s)
- Susanne Hempel
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - David Ganz
- Geriatrics Research, Education and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
| | - Sonali Saluja
- Gehr Family Center for Health Systems Science and Innovation, University of Southern California, Los Angeles, California, USA
| | - Maria Bolshakova
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Timothy Kim
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
| | - Carolyn Turvey
- Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine at the University of Iowa, Iowa City, Iowa, USA
- Rural Health Resource Center, Iowa City Veterans Affairs Healthcare System, Iowa City, Iowa, USA
| | - Kristina Cordasco
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aashna Basu
- Department of Medicine, David Geffen School of Medicine at the University of California at Los Angeles, Los Angeles, California, USA
- Care in the Community Service, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Tonya Page
- Office of Community, Clinical Integration & Field Support, Veteran Affairs Central Office, Kentucky City, Kentucky, USA
| | - Reshma Mahmood
- Santa Maria and San Luis Obispo Community Outpatient Clinics, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Aneesa Motala
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
| | - Jenny Barnard
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Michelle Wong
- VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
| | - Ning Fu
- Southern California Evidence Review Center, University of Southern California, Los Angeles, California, USA
- School of Public Administration and Emergency Management, Jinan University, Guangzhou, Guangdong, China
| | - Isomi M Miake-Lye
- VA West Los Angeles Evidence-based Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA
- Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA
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18
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Kappelin C, Sandlund C, Westman J, Wachtler C. Dancing with the patient: a qualitative study of general practitioners' experiences of managing patients with multimorbidity and common mental health problems. BMC PRIMARY CARE 2023; 24:104. [PMID: 37081385 PMCID: PMC10117273 DOI: 10.1186/s12875-023-02056-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Accepted: 04/11/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Patients with multimorbidity, having two or more chronic diseases, suffer frequently from undiagnosed common mental health problems and are an increasing challenge in primary care. There is a call to improve care delivery to address all these patients' needs at the same time. The aim of this study was to identify general practitioners' experiences of managing patients with multimorbidity and common mental health problems in primary care. METHODS We conducted five focus group interviews with 28 physicians (3-8 participants in each group) in 5 primary care practices in and outside of Stockholm, Sweden. We used a semi-structured interview guide, and we analysed the data using reflexive thematic analysis. The methodological orientation of the study was inductive, latent constructivism. RESULTS We generated two themes from the data: Unmet patient needs and fragmented care send patients and physicians off balance and Dancing with the patient individually and together with others leads to confident and satisfied patients and physicians. The two themes are related as general practitioners expressed a need to shift from disease-specific fragmentation to relational continuity, teamwork, and flexibility to meet the needs of patients with multimorbidity and common mental health problems. CONCLUSIONS These findings can provide guidance in developing future interventions for patients with multimorbidity and common mental health problems in primary care in general, and in Sweden in particular.
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Affiliation(s)
- C Kappelin
- Department of Neurobiology, Care Sciences, and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Alfred Nobel's Allé 23, S-141 52, Huddinge, 141 52, Sweden.
| | - C Sandlund
- Department of Neurobiology, Care Sciences, and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Alfred Nobel's Allé 23, S-141 52, Huddinge, 141 52, Sweden
- Academic Primary Healthcare Centre, Solnavägen 1E, Stockholm, 113 65, Sweden
| | - J Westman
- Marie Cederschiöld University, Stigbergsgatan 30, Stockholm, 116 28, Sweden
| | - C Wachtler
- Department of Neurobiology, Care Sciences, and Society, Division of Family Medicine and Primary Care, Karolinska Institute, Alfred Nobel's Allé 23, S-141 52, Huddinge, 141 52, Sweden
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19
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Bell C, Vedsted P, Kraus DGA, Fredberg U, Jeffery L, Dahlgaard MB, Aarhus R, Appel CW. Clinic for Multimorbidity: An Innovative Approach to Integrate General Practice and Specialized Health Care Services. Int J Integr Care 2023; 23:25. [PMID: 37333774 PMCID: PMC10275160 DOI: 10.5334/ijic.7015] [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: 08/29/2022] [Accepted: 06/01/2023] [Indexed: 06/20/2023] Open
Abstract
Introduction Caring for patients with multimorbidity in general practice is increasing in amount and complexity. To integrate care for patients with multimorbidity and to support general practitioners (GPs), the Clinic for Multimorbidity (CM) was established in 2012 at Silkeborg Regional Hospital, Denmark. This case study aims to describe the CM and the patients seen in it. Results CM is an outpatient clinic that offers a comprehensive one-day assessment of the patient's complete health status and medication. GPs can refer patients with complex multimorbidity (≥2 chronic conditions). It involves collaboration across medical specialties and healthcare professions. The assessment is completed with a multidisciplinary conference and recommendation.In all, 141 patients were referred to the CM between May 2012 and November 2017. The median age was 70 years, 80% had more than five diagnoses, and in median patients had a usage of 11 drugs (IQI, 7-15). Physical and mental health was reported low (SF-12 score: 26 and 42). In median four specialties were involved and 4 examinations (IQI, 3-5) conducted. Conclusion The CM offers innovative care by bridging and exceeding conventional boundaries of disciplines, professions, organizations, and primary and specialized care. The patients represented a very complex group, requiring many examinations and involvement of several specialists.
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Affiliation(s)
- Cathrine Bell
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Peter Vedsted
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Research Unit for General Practice, Faculty of Health, Aarhus University, Denmark
| | - Dorte Gunver Adsersen Kraus
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Ulrich Fredberg
- Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Linda Jeffery
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
- Hospital Pharmacy, Central Jutland Region, Denmark
| | - Marianne Bjørn Dahlgaard
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Rikke Aarhus
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
| | - Charlotte Weiling Appel
- Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Silkeborg, Denmark
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20
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Interventions and management on multimorbidity: An overview of systematic reviews. Ageing Res Rev 2023; 87:101901. [PMID: 36905961 DOI: 10.1016/j.arr.2023.101901] [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: 11/02/2022] [Revised: 02/08/2023] [Accepted: 03/02/2023] [Indexed: 03/11/2023]
Abstract
BACKGROUND Multimorbidity poses an immense burden on the healthcare systems globally, whereas the management strategies and guidelines for multimorbidity are poorly established. We aim to synthesize current evidence on interventions and management of multimorbidity. METHODS We searched four electronic databases (PubMed, Embase, Web of Science, and the Cochrane Database of Systematic Reviews). Systematic reviews (SRs) on interventions or management of multimorbidity were included and evaluated. The methodological quality of each SR was assessed by the AMSTAR-2 tool, and the quality of evidence on the effectiveness of interventions was assessed by the grading of recommendations assessment, development and evaluation (GRADE) system. RESULTS A total of 30 SRs (464 unique underlying studies) were included, including 20 SRs of interventions and 10 SRs summarizing evidence on management of multimorbidity. Four categories of interventions were identified: patient-level interventions, provider-level interventions, organization-level interventions, and combined interventions (combining the aforementioned two or three- level components). The outcomes were categorized into six types: physical conditions/outcomes, mental conditions/outcomes, psychosocial outcomes/general health, healthcare utilization and costs, patients' behaviors, and care process outcomes. Combined interventions (with patient-level and provider-level components) were more effective in promoting physical conditions/outcomes, while patient-level interventions were more effective in promoting mental conditions/outcomes and psychosocial outcomes/general health. As for healthcare utilization and care process outcomes, organization-level and combined interventions (with organization-level components) were more effective. The challenges in the management of multimorbidity at the patient, provider and organizational levels were also summarized. CONCLUSION Combined interventions for multimorbidity at different levels would be favored to promote different types of health outcomes. Challenges exist in the management at the patient, provider, and organization levels. Therefore, a holistic and integrated approach of patient-, provider- and organization- level interventions is required to address the challenges and optimize care of patients with multimorbidity.
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21
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O'Brien E, Duffy S, Harkins V, Smith SM, O'Herlihy N, Walsh A, Clyne B, Wallace E. A scoping review of evidence-based guidance and guidelines published by general practice professional organizations. Fam Pract 2023:cmad015. [PMID: 36812366 DOI: 10.1093/fampra/cmad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
BACKGROUND General practitioners (GPs) need robust, up-to-date evidence to deliver high-quality patient care. There is limited literature regarding the role of international GP professional organizations in developing and publishing clinical guidelines to support GPs clinical decision making. OBJECTIVE To identify evidence-based guidance and clinical guidelines produced by GP professional organizations and summarize their content, structure, and methods of development and dissemination. METHODS Scoping review of GP professional organizations following Joanna Briggs Institute guidance. Four databases were searched and a grey literature search was conducted. Studies were included if they were: (i) evidence-based guidance documents or clinical guidelines produced de novo by a national GP professional organization, (ii) developed to support GPs clinical care, and (iii) published in the last 10 years. GP professional organizations were contacted to provide supplementary information. A narrative synthesis was performed. RESULTS Six GP professional organizations and 60 guidelines were included. The most common de novo guideline topics were mental health, cardiovascular disease, neurology, pregnancy and women's health and preventive care. All guidelines were developed using a standard evidence-synthesis method. All included documents were disseminated through downloadable pdfs and peer review publications. GP professional organizations indicated that they generally collaborate with or endorse guidelines developed by national or international guideline producing bodies. CONCLUSION The findings of this scoping review provide an overview of de novo guideline development by GP professional organizations and can support collaboration between GP organizations worldwide thus reducing duplication of effort, facilitating reproducibility, and identifying areas of standardization. PROTOCOL REGISTRATION Open Science Framework: https://doi.org/10.17605/OSF.IO/JXQ26.
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Affiliation(s)
- Emer O'Brien
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Seamus Duffy
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Velma Harkins
- Irish College of General Practitioners, Dublin, Ireland
| | - Susan M Smith
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of Public Health and Primary Care, Trinity College Dublin, Dublin Ireland
| | | | - Aisling Walsh
- Department of Public Health and Epidemiology, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Ireland
- Department of General Practice, University College Cork, Cork, Ireland
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22
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Gehrke-Beck S, Petersen M, Herrmann WJ, Zimmermann N, Daub E, Seeger J, Schulz J, Czimmeck C, Lauterbach N, Peters H, Kloft C, Schulz M, Siebenbrodt I, Behrend R. Development of a project for interprofessional collaboration between medical and pharmacy students to improve medication safety in polypharmacy (PILLE). GMS JOURNAL FOR MEDICAL EDUCATION 2023; 40:Doc3. [PMID: 36923317 PMCID: PMC10010767 DOI: 10.3205/zma001585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 08/18/2022] [Accepted: 10/31/2022] [Indexed: 06/18/2023]
Abstract
AIM Interprofessional collaboration is particularly relevant to patient safety in outpatient care with polypharmacy. The educational project "PILLE" is meant to give medical and pharmacy students an understanding of the roles and competencies needed for cooperation in the provision of healthcare and to enable interprofessional learning. METHOD The curriculum is aimed at pharmacy and medical students and was developed in six steps according to the Kern cycle. It is comprised of an interprofessional seminar, a joint practical training in a simulated pharmacy, and a tandem job shadowing at a primary care practice. The project was implemented in three stages due to the pandemic: The interprofessional online seminar based on the ICAP model and the digital inverted classroom was held in the 2020 winter semester; the interprofessional practical training was added in the 2021 summer semester; and the interprofessional tandem job shadowing at a primary care practice in the 2021 winter semester. Attitudes toward interprofessional learning, among other things, was measured in the evaluation using the SPICE-2D questionnaire (Student Perceptions of Physician-Pharmacist Interprofessional Clinical Education). RESULTS In the first three semesters, a total of 105 students (46 pharmacy, 59 medicine) participated in the project, of which 78 participated in the evaluation (74% response rate). The students stated, in particular, that they had learned about the competencies and roles of the other profession and desired additional and more specific preparatory materials for the course sessions. The SPICE-2D questionnaire showed high values for both groups of students already in the pre-survey and these increased further as a result of the project. CONCLUSION Joint case-based learning could be implemented under the conditions imposed by the pandemic. Online teaching is a low-threshold means to enable interprofessional exchange.
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Affiliation(s)
- Sabine Gehrke-Beck
- Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Institut für Allgemeinmedizin, Berlin, Germany
| | - Maike Petersen
- Freie Universität Berlin, Institut für Pharmazie, Berlin, Germany
- ABDA - Bundesvereinigung Deutscher Apothekerverbände e. V., Berlin, Germany
| | - Wolfram J. Herrmann
- Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Institut für Allgemeinmedizin, Berlin, Germany
| | | | - Eva Daub
- Charité - Universitätsmedizin Berlin, Charité Campus Mitte, Institut für Allgemeinmedizin, Berlin, Germany
| | - Johanna Seeger
- Freie Universität Berlin, Institut für Pharmazie, Berlin, Germany
| | - Josefine Schulz
- Freie Universität Berlin, Institut für Pharmazie, Berlin, Germany
| | | | - Noemi Lauterbach
- Freie Universität Berlin, Institut für Pharmazie, Berlin, Germany
| | - Harm Peters
- Charité - Universitätsmedizin Berlin, Dieter Scheffner Fachzentrum für medizinische Hochschullehre und evidenzbasierte Ausbildungsforschung, Berlin, Germany
| | - Charlotte Kloft
- Freie Universität Berlin, Institut für Pharmazie, Berlin, Germany
| | - Martin Schulz
- Freie Universität Berlin, Institut für Pharmazie, Berlin, Germany
- ABDA - Bundesvereinigung Deutscher Apothekerverbände e. V., Berlin, Germany
| | - Ingo Siebenbrodt
- Freie Universität Berlin, Institut für Pharmazie, Berlin, Germany
| | - Ronja Behrend
- Charité - Universitätsmedizin Berlin, Prodekanat für Studium und Lehre, Semesterkoordination Modellstudiengang Medizin, Berlin, Germany
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23
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Boeykens D, Sirimsi MM, Timmermans L, Hartmann ML, Anthierens S, De Loof H, De Vliegher K, Foulon V, Huybrechts I, Lahousse L, Pype P, Schoenmakers B, Van Bogaert P, Van den Broeck K, Van Hecke A, Verhaeghe N, Vermandere M, Verté E, Van de Velde D, De Vriendt P. How do people living with chronic conditions and their informal caregivers experience primary care? A phenomenological-hermeneutical study. J Clin Nurs 2023; 32:422-437. [PMID: 35178849 DOI: 10.1111/jocn.16243] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/24/2022] [Accepted: 01/26/2022] [Indexed: 01/17/2023]
Abstract
AIMS AND OBJECTIVES Gaining insight in how people living with chronic conditions experience primary healthcare within their informal network. BACKGROUND The primary healthcare system is challenged by the increasing number of people living with chronic conditions. To strengthen chronic care management, literature and policy plans point to a person-centred approach of care (PCC). A first step to identify an appropriate strategy to implement PCC is to gain more insight into the care experiences of these people and their informal caregivers. DESIGN A phenomenological-hermeneutical philosophy is used. The study is in line with the Consolidated Criteria for Reporting Qualitative Research Guidelines (COREQ). METHOD In-depth, semi-structured interviews with people living with chronic conditions and informal caregiver dyads (PCDs) (n = 16; 32 individuals) were conducted. An open-ended interview guide was used to elaborate on the PCDs' experiences regarding primary care. A purposive, maximal variation sampling was applied to recruit the participants. RESULTS Based on sixteen PCDs' reflections, ten themes were identified presenting their experiences with primary care and described quality care as listening and giving attention to what people with chronic conditions want, to what they strive for, and above all to promote their autonomy in a context wherein they are supported by a team of formal caregivers, family and friends. CONCLUSION To meet the PCDs' needs, self-management should be addressed in an interprofessional environment in which the PCD is an important partner. The findings may facilitate a shift to encourage PCDs in their strengths by enabling them to share their personal goals and by working towards meaningful activities in team collaboration. RELEVANCE TO CLINICAL PRACTICE Three strategies-self-management support, goal-oriented care, and interprofessional collaboration-have been suggested to improve the PCDs' primary care experiences. These strategies could guide nursing practice in using more and improve high-quality nursing care.
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Affiliation(s)
- Dagje Boeykens
- Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Muhammed Mustafa Sirimsi
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium.,Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lotte Timmermans
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Maja Lopez Hartmann
- Department of Welfare and Health, Karel de Grote University of Applied Sciences and Arts, Antwerp, Belgium
| | - Sibyl Anthierens
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium
| | - Hans De Loof
- Laboratory of Physiopharmacology, Faculty of Pharmaceutical, Biomedical and Veterinary Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Veerle Foulon
- Department of Pharmaceutical and Pharmacological Sciences, Faculty of Pharmaceutical Sciences, KU Leuven, Leuven, Belgium
| | - Ine Huybrechts
- Department of Family Medicine and Population Health, University of Antwerp, Antwerp, Belgium.,Department of Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Lies Lahousse
- Department of Bioanalysis, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Peter Pype
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Birgitte Schoenmakers
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Peter Van Bogaert
- Faculty of Medicine and Health Sciences, Centre for Research and Innovation in Care, University of Antwerp, Antwerp, Belgium
| | - Kris Van den Broeck
- Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Ann Van Hecke
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Faculty of Medicine and Health Sciences, University Centre of Nursing and Midwifery, Ghent University, Ghent, Belgium
| | - Nick Verhaeghe
- Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Research group Social and Economic Policy and Social Inclusion, Research Institute for Work and Society, KU Leuven - HIVA, Leuven, Belgium
| | - Mieke Vermandere
- Department of Public Health and Primary Care, Faculty of Medicine, Academic Centre for General Practice, KU Leuven, Leuven, Belgium
| | - Emily Verté
- Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.,Department of Family Medicine and Chronic Care, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Dominique Van de Velde
- Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Patricia De Vriendt
- Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium.,Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium.,Frailty in Ageing (FRIA) Research Group, Department of Gerontology and Mental Health and Wellbeing (MENT) research group, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussels, Belgium
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24
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Boeykens D, Haverals R, Sirimsi MM, Timmermans L, Van de Velde D, De Vriendt P, Boeckxstaens P, Verté E, Van Bogaert P, De Loof H, Van den Broeck K, Anthierens S, Huybrechts I, Raeymaeckers P, Buffel V, Devroey D, Aertgeerts B, Schoenmakers B, Timmermans L, Foulon V, Declerq A, Verhaeghe N, De Sutter A, Lahousse L, Pype P, Van Hecke A, Decat P, Roose R, Martin S, Rutten E, Pless S, Gauwe V, Reynaert D, Van Landschoot L, Hartmann ML, Claeys T, Vandenhoudt H, De Vliegher K. Creating space to talk about patients' personal goals: experiences from primary care stakeholders. BMC PRIMARY CARE 2023; 24:11. [PMID: 36641431 PMCID: PMC9840292 DOI: 10.1186/s12875-022-01956-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 12/23/2022] [Indexed: 01/15/2023]
Abstract
BACKGROUND To address the many challenges health systems and communities face, primary care is constantly searching for new strategies to improve quality of care. One of the strategies is to focus on patients' personal goals to direct the care process. To adopt an explicit focus on patients' personal goals, actions at different levels are required. As a first step in this process, this study aims to explore the experiences of primary care stakeholders (i.e., scholars, primary care providers, and policy makers) and develop a comprehensive understanding on the idea 'putting patients' goals first'. This will help to formulate suggestions about what these actions should include. METHOD In this study, 41 primary care stakeholders participating in six focus groups between January 2020 and September 2020, were recruited via maximal variation purposive sampling. Data collection was done through an open-ended semi-structured interview guide. Focus groups were audio-recorded, transcribed verbatim, and analyzed following a phenomenological-hermeneutical philosophy of Lindseth and Norberg. RESULTS All participants expressed a strong fundamental belief for putting patients' personal goals first. The primary care providers shared that they created space for patients' personal goals by letting them talk about their values and stories. They reported to integrate their medical expertise with patients' personal goals in order to develop a balanced relationship. In this context, they also talked about the importance of taking into account the perspectives of patients' significant others. Primary care providers also talked about how they used patients' personal goals as a guide in interprofessional collaboration. Scholars denoted that (future) care providers need more training to acquire competencies to discuss patients' personal goals. The providers and policy makers talked about organizational limitations in terms of time restrictions and the lack of registration systems to support a workflow oriented towards patients' personal goals. CONCLUSIONS This study can be used to support the coherence of the development of different actions and strategies to get primary care stakeholders fully on board to support the adoption of patients' personal goals in care delivery at different levels. However, models of practice and policy plans are needed to work towards a person-centered integrated system.
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Affiliation(s)
- Dagje Boeykens
- grid.5342.00000 0001 2069 7798Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Reini Haverals
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Muhammed Mustafa Sirimsi
- grid.5284.b0000 0001 0790 3681Centre for Research and Innovation in Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium ,grid.5284.b0000 0001 0790 3681Department of Primary Care and Interdisciplinary Care, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Lotte Timmermans
- grid.5596.f0000 0001 0668 7884Academic Centre of General Practice, KU Leuven, Louvain, Belgium
| | - Dominique Van de Velde
- grid.5342.00000 0001 2069 7798Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
| | - Patricia De Vriendt
- grid.5342.00000 0001 2069 7798Department of Rehabilitation Sciences, Occupational Therapy, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium ,Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium ,grid.8767.e0000 0001 2290 8069Frailty in Ageing (FRIA) Research Group, Department of Gerontology and Mental Health and Wellbeing (MENT) Research Group, Faculty of Medicine and Pharmacy, Vrije Universiteit, Brussels, Belgium
| | - Pauline Boeckxstaens
- grid.5342.00000 0001 2069 7798Department of Public Health and Primary Care, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
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Wong PYA, Chan FYS, Ong L, Lee KH. A qualitative study of challenges and enablers faced by private general practitioners providing primary care to patients with complex needs in Singapore. BMC PRIMARY CARE 2022; 23:14. [PMID: 35172750 PMCID: PMC8767740 DOI: 10.1186/s12875-022-01625-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 01/06/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Singapore faces an ageing population with increasingly complex healthcare needs, a problem which could be addressed by high quality primary care. Many patients with complex needs are not managed by private general practitioners (GPs) who form the majority of the primary care workforce. Currently, there is paucity of literature describing the needs of these private GPs in providing such care.
Aim
Understand the challenges, enablers and possible solutions from the perspective of private GPs in providing primary care of patients with complex needs.
Method
We conducted a qualitative study using an inductive approach. Private GPs were interviewed using a semi-structured question guide with convenience sampling until thematic saturation was reached. These 12 interviewees were part of a network of clinics that provide primary care for complex patients who were recently discharged from a community hospital providing post-acute care. Data was transcribed prior to a process of familiarisation, coded and analysed using thematic analysis by three independent investigators.
Results
Three themes emerged in the analysis. From a micro-organizational standpoint, private GPs and patients with complex needs must be willing to accept each other to have a therapeutic encounter (e.g., patients’ multidimensional needs, GP clinic set-up is simple yet busy). Next, from a meso-organizational view, trust and good communication channels between the referring doctors and private GPs must exist for effective collaboration in managing complex care. Lastly, macro-organizationally, external stakeholders (e.g., policy-makers) should fund care models, which are financially viable to both patients, and private GPs (e.g., via adequate subsidies and renumeration respectively) as such complex care require many resources.
Conclusion
Multiple factors exist which influence the ability of private GPs in Singapore to care for patients with complex needs. Addressing these factors may reduce the over dependence on high-cost hospitals for care delivery in similar healthcare systems.
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Giunta S, Butow P, Juraskova I, Sharpe L, Ferguson E, Laidsaar-Powell R. Empowering family carers of people with multimorbidity as partners in chronic health care: Insights from health professionals. PATIENT EDUCATION AND COUNSELING 2022; 105:3550-3557. [PMID: 36096983 DOI: 10.1016/j.pec.2022.08.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 08/25/2022] [Accepted: 08/27/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES People living with multimorbidity often rely on the support of informal family carers, yet challenges frequently arise when carers of people with multimorbidity (PwM) interact with health professionals (HPs) and healthcare systems. This study aimed to provide insights into the experiences and challenges involved in working with carers of PwM, from HPs' perspectives. METHODS Twenty-one HPs (11 doctors, 5 nurses and 5 allied health professionals) from varying specialities participated in semi-structured interviews. Interviews were transcribed and qualitatively analysed using thematic analysis. RESULTS Five themes were identified: carer involvement makes multimorbidity easier to manage, differing views on HP's responsibilities to carers, multimorbidity makes management harder for HPs, strategies to support carers of PwM, and multimorbidity is one aspect of complexity. CONCLUSIONS HPs recognise unique needs of carers of PwM, yet perceive challenges addressing these needs and supporting this commonly overlooked group. PRACTICE IMPLICATIONS The unmet needs of carers of PwM that HPs identified in this study suggest pathways for future improvements and interventions, including HP education and training, and appropriate referral pathways for carers of PwM to access supportive services. Underpinning these findings is the need for greater recognition and respect for the critical work of family carers in healthcare.
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Affiliation(s)
- Sarah Giunta
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia
| | - Phyllis Butow
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; The University of Sydney, Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, Sydney, Australia
| | - Ilona Juraskova
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; The University of Sydney, Centre for Medical Psychology & evidence-based Decision-making (CeMPED), School of Psychology, Faculty of Science, Sydney, Australia; The University of Sydney, Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, Sydney, Australia
| | - Louise Sharpe
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia
| | - Eliza Ferguson
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia
| | - Rebekah Laidsaar-Powell
- The University of Sydney, Faculty of Science, School of Psychology, Sydney, Australia; The University of Sydney, Centre for Medical Psychology & evidence-based Decision-making (CeMPED), School of Psychology, Faculty of Science, Sydney, Australia; The University of Sydney, Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, Faculty of Science, Sydney, Australia.
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Schuttner L, Hockett Sherlock S, Simons CE, Johnson NL, Wirtz E, Ralston JD, Rosland AM, Nelson K, Sayre G. My Goals Are Not Their Goals: Barriers and Facilitators to Delivery of Patient-Centered Care for Patients with Multimorbidity. J Gen Intern Med 2022; 37:4189-4196. [PMID: 35606644 PMCID: PMC9126696 DOI: 10.1007/s11606-022-07533-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
BACKGROUND Patient-centered care reflecting patient preferences and needs is integral to high-quality care. Individualized care is important for psychosocially complex or high-risk patients with multiple chronic conditions (i.e., multimorbidity), given greater potential risks of interventions and reduced benefits. These patients are increasingly prevalent in primary care. Few studies have examined provision of patient-centered care from the clinician perspective, particularly from primary care physicians serving in integrated, patient-centered medical home settings within the US Veterans Health Administration. OBJECTIVE We sought to clarify facilitators and barriers perceived by primary care physicians in the Veterans Health Administration to delivering patient-centered care for high-risk or complex patients with multimorbidity. DESIGN We conducted semi-structured telephone interviews from April to July 2020 among physicians across 20 clinical sites. Findings were analyzed with deductive content analysis based on conceptual models of patient-centeredness and hierarchical factors affecting care delivery. PARTICIPANTS Of 23 physicians interviewed, most were female (n = 14/23, 61%), serving in hospital-affiliated outpatient clinics (n = 14/23, 61%). Participants had a mean of 21 (SD = 11.3) years of experience. KEY RESULTS Facilitators included the following: effective physician-patient communication to individualize care, prioritize among multiple needs, and elicit goals to improve patient engagement; access to care, enabled by interdisciplinary teams, and dictating personalized care planning; effortful but worthwhile care coordination and continuity; meeting complex needs through effective teamwork; and integrating medical and non-medical care aspects in recognition of patients' psychosocial contexts. Barriers included the following: intra- and interpersonal (e.g., perceived patient reluctance to engage in care); organizational (e.g., limited encounter time); and community or policy impediments (e.g., state decisional capacity laws) to patient-centered care. CONCLUSIONS Physicians perceived individual physician-patient interactions were the greatest facilitators or barriers to patient-centered care. Efforts to increase primary care patient-centeredness for complex or high-risk patients with multimorbidity could focus on targeting physician-patient communication and reducing interpersonal conflict.
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Affiliation(s)
- Linnaea Schuttner
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA. .,Department of Medicine, University of Washington School of Medicine, Seattle, USA.
| | - Stacey Hockett Sherlock
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA.,Carver College of Medicine, University of Iowa, Iowa City, USA
| | - Carol E Simons
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA
| | - Nicole L Johnson
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA
| | - Elizabeth Wirtz
- Center for Access & Delivery Research and Evaluation (CADRE), VA Iowa City Health Care System, Iowa City, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, USA.,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
| | - Ann-Marie Rosland
- Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, USA.,Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, USA
| | - Karin Nelson
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Medicine, University of Washington School of Medicine, Seattle, USA
| | - George Sayre
- Health Services Research & Development, VA Puget Sound Health Care System, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington School of Public Health, Seattle, USA
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Hurley E, Walsh E, Foley T, Heinrich CH, Byrne S, Dalton K. General practitioners' perceptions of pharmacists working in general practice: a qualitative interview study. Fam Pract 2022; 40:377-386. [PMID: 36242543 PMCID: PMC10047619 DOI: 10.1093/fampra/cmac115] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pharmacists are being increasingly employed as part of general practice teams globally, and their input has been associated with several clinical and economic benefits. However, there is a paucity of research focussing on general practitioners' (GPs') perceptions of pharmacist integration into practices in countries where this novel role for pharmacists is yet to become commonplace. OBJECTIVE To explore GPs' perceptions of integrating pharmacists into general practices and to identify the behavioural determinants of GPs integrating pharmacists into practices. METHODS Semistructured interviews were conducted with GPs practising in Ireland, who were sampled using a combination of purposive, convenience, and snowball sampling. Interviews were audio-recorded and transcribed verbatim, which then were analysed using conventional content analysis and directed content analysis employing the Theoretical Domains Framework (TDF). RESULTS Seventeen GPs were interviewed between November 2021 and February 2022. Seven TDF domains were identified as predominant in influencing GPs' perceptions of pharmacist integration into general practices. These perceptions were mostly positive, especially regarding patient outcomes, cost savings, and improving access to care. However, there were concerns about funding the role, affecting others' workloads, and pharmacists' training needs to work in practices. CONCLUSION This study's theory-informed insight provides a deeper understanding of GPs' perceptions of pharmacists working in general practice and behaviours which can be targeted to help optimize integration. These findings should be utilized in future service development to preempt and address GPs' concerns ahead of pharmacist integration, as well as to inform the development of general practice-based pharmacist roles going forward.
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Affiliation(s)
- Eoin Hurley
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Elaine Walsh
- Department of General Practice, University College Cork, Cork, Ireland
| | - Tony Foley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Clara H Heinrich
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Stephen Byrne
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
| | - Kieran Dalton
- Pharmaceutical Care Research Group, School of Pharmacy, University College Cork, Cork, Ireland
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Jin H, Wang Z, Guo A, Zhang H, Liu W, Zhu Y, Hua M, Shi J, Shi J, Yu D. Patterns of multimorbidity in community health centres in Shanghai, China: a retrospective, cross-sectional study based on outpatient data from 2014 to 2018. BMJ Open 2022; 12:e048727. [PMID: 36198446 PMCID: PMC9535180 DOI: 10.1136/bmjopen-2021-048727] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE Caring for patients with multimorbidity is an important part of primary care. It has become increasingly relevant that understanding the spectrum of multimorbidity will help general practitioners (GPs) acquire working knowledge and improve management skills. However, there was little research on characteristics of multimorbidity in primary care in China. This study aimed to identify the spectrum of frequency, proportion and ranking of multimorbidity patterns in adult patients seen at community health centres (CHCs) in Shanghai, China. DESIGN AND SETTING This was an observational, retrospective, cross-sectional study analysis of outpatient data of 244 CHCs in Shanghai, China. PARTICIPANTS Adult patients with chronic disease who visited Shanghai CHCs during 2014-2018 were selected from Shanghai CHC electronic medical records database using the International Classification of Diseases 10th Revision codes matched to the Second Version of International Classification of Primary Care codes. PRIMARY AND SECONDARY OUTCOME MEASURES A number of adult patients with chronic disease were counted. Then frequency, proportion and rank of disease patterns of multimorbidity were analysed. RESULTS Analysis of 301 651 158 electronic health records of 5 909 280 adult patients (54.2% females) found the multimorbidity proportion to be 81.2%. The prevalence of multimorbidity increased with age, which climbed from 43.7% among those aged 19-34 to 94.9% among those more than 80 years of age. The proportion of multimorbidity was higher in females (83.2%) than males (79.7%). Vascular and metabolic diseases were the most frequent diseases for patients over 45 years old. CONCLUSIONS Multimorbidity has brought huge challenges to primary care practice in Shanghai. The Shanghai government should strengthen its support for the multitargeted prevention of chronic diseases and the improvement of GPs' management capabilities.
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Affiliation(s)
- Hua Jin
- Department of General Practice,Clinical Research Center for General Practice, Yangpu Hospital,School of Medicine,Tongji University, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Zhaoxin Wang
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
- Department of Social Medicine and Health Management, School of Public Health,Shanghai Jiaotong University School of Medicine, Shanghai, China
- School of Management, Hainan Medical University, Haikou, China
| | - Aizhen Guo
- Department of General Practice,Clinical Research Center for General Practice, Yangpu Hospital,School of Medicine,Tongji University, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Hanzhi Zhang
- Department of General Practice,Clinical Research Center for General Practice, Yangpu Hospital,School of Medicine,Tongji University, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Wei Liu
- Huangpu District Dapuqiao Community Health Center, Shanghai, China
| | - Yuqin Zhu
- Department of Emergency, Yangpu Hospital, School of Medicine, Tongji University, Shanghai, China
| | - Ming Hua
- Jing'an District Daning Community Health Center, Shanghai, China
| | - Jianjun Shi
- Department of General Practice,Clinical Research Center for General Practice, Yangpu Hospital,School of Medicine,Tongji University, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
| | - Jianwei Shi
- Department of Social Medicine and Health Management, School of Public Health,Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Dehua Yu
- Department of General Practice,Clinical Research Center for General Practice, Yangpu Hospital,School of Medicine,Tongji University, Shanghai, China
- Shanghai General Practice and Community Health Development Research Center, Shanghai, China
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Moody E, Martin-Misener R, Baxter L, Boulos L, Burge F, Christian E, Condran B, MacKenzie A, Michael E, Packer T, Peacock K, Sampalli T, Warner G. Patient perspectives on primary care for multimorbidity: An integrative review. Health Expect 2022; 25:2614-2627. [PMID: 36073315 DOI: 10.1111/hex.13568] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 07/09/2022] [Accepted: 07/11/2022] [Indexed: 11/26/2022] Open
Abstract
INTRODUCTION Improving healthcare for people with multiple chronic or ongoing conditions is receiving increased attention, particularly due to the growing number of people experiencing multimorbidity (MM) and concerns about the sustainability of the healthcare system. Primary care has been promoted as an important resource for supporting people with MM to live well with their conditions and to prevent unnecessary use of health care services. However, traditional primary care has been criticized for not centring the needs and preferences of people with MM themselves. Our aim was to conduct a review that centred on the perspective of people with MM in multiple ways, including having patient partners co-lead the design, conduct and reporting of findings, and focusing on literature that reported the perspective of people with MM, irrespective of it being experimental or nonexperimental. METHODS We searched for published literature in CINAHL with Full Text (EBSCOhost) and MEDLINE All (Ovid). Findings from experimental and nonexperimental studies were integrated into collaboration with patient partners. RESULTS Twenty-nine articles were included in the review. Findings are described in five categories: (1) Care that is tailored to my unique situation; (2) meaningful inclusion in the team; (3) a healthcare team that is ready and able to address my complex needs; (4) supportive relationships and (5) access when and where I need it. CONCLUSION This review supports a reorientation of primary care systems to better reflect the experiences and perspectives of people with MM. This can be accomplished by involving patient partners in the design and evaluation of primary care services and incentivizing collaboration among health and social supports and services for people with MM. PATIENT OR PUBLIC CONTRIBUTION Patient partners were involved in the design and conduct of this review, and in the preparation of the manuscript. Their involvement is further elucidated in the manuscript text.
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Affiliation(s)
- Elaine Moody
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Larry Baxter
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Leah Boulos
- Maritime SPOR SUPPORT Unit, Halifax, Nova Scotia, Canada
| | - Fred Burge
- Department of Family Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | | | - Brian Condran
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | | | - Tanya Packer
- School of Health Administration, Dalhousie University, Halifax, Nova Scotia, Canada.,School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Kylie Peacock
- School of Nursing, Dalhousie University, Halifax, Nova Scotia, Canada.,Canadian Center for Vaccinology, IWK Health Centre, Halifax, Nova Scotia, Canada
| | | | - Grace Warner
- School of Occupational Therapy, Dalhousie University, Halifax, Nova Scotia, Canada
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Damarell RA, Morgan DD, Tieman JJ, Senior T. Managing multimorbidity: a qualitative study of the Australian general practitioner experience. Fam Pract 2022; 40:360-368. [PMID: 36063437 DOI: 10.1093/fampra/cmac096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Multimorbidity is prevalent in general practice and general practitioners internationally report challenges in its management. Understanding the perspectives of general practitioners at the frontline of care is important for system sustainability and accessibility as populations age. OBJECTIVE To explore Australian general practitioner perspectives on managing multimorbidity, the factors supporting their work, and those impeding their ability to meet their own standards of care provision. METHOD A qualitative study conducted with Australian general practitioners using semistructured, in-depth interviews and inductive thematic data analysis. RESULTS Twelve interviews with general practitioners were conducted. Three main themes were constructed from the data: Multimorbidity as an encounter with complexity and contingency; Evidence constraints in multimorbidity care; and Concerns for patient safety. System structure and the Australian general practice model restrict general practitioners' ability to provide care to their level of satisfaction by linking short consultation times to practice remuneration. Attitudes toward the applicability of guideline evidence were mixed despite most general practitioners questioning its generalizability. Patient safety concerns pervaded most interviews and largely centered on system fragmentation and insufficient intersectoral communication. General practitioners rely on multiple sources of information to provide patient-centered care but chiefly the accumulated knowledge of their patients. CONCLUSIONS Australian general practitioners share many multimorbidity concerns with international colleagues. While multimorbidity-specific evidence may be unrealistic to expect in the immediate term, system investment and adaptation is needed to support general practice sustainability and clinician ability to provide adequate multimorbidity care, suitably remunerated, into the future.
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Affiliation(s)
- Raechel A Damarell
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Deidre D Morgan
- Tharawal Aboriginal Corporation/School of Medicine. Western Sydney University, Sydney, NSW, Australia
| | - Jennifer J Tieman
- Research Centre for Palliative Care, Death and Dying, College of Nursing and Health Sciences, Flinders University, Adelaide, SA, Australia
| | - Tim Senior
- Tharawal Aboriginal Corporation/School of Medicine. Western Sydney University, Sydney, NSW, Australia
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Alyousef M, Naughton C, Bradley C, Savage E. Primary healthcare reform for chronic conditions in countries with high or very high human development index: A systematic review. Chronic Illn 2022; 18:469-487. [PMID: 34841923 PMCID: PMC9397395 DOI: 10.1177/17423953211059143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To address the growing burden of chronic disease globally, many countries have developed a national policy for primary healthcare reform. In some countries with high and very high human development index, evaluations of the implementation of these reforms have been published. To date, there has been no systematic review of these evaluations. The objectives of this review are to identify: (a) the vision for primary healthcare; (b) the features of primary healthcare reforms; and (c) evaluation findings of primary healthcare reforms. METHODS A systematic literature review was conducted guided by the PRISMA statement. We searched for academic articles and grey literature from 1 March 2008 to 1 September 2020. Screening and data extraction were conducted by two authors. Descriptive analysis and narrative synthesis were applied. RESULTS A vision for integrated primary healthcare shifting chronic disease management from specialist hospital services to primary care was found to require new organization and funding models such as collaborative primary healthcare networks and commissioning along with shared governance across health sectors. The need for general practitioner leadership and engagement to support primary healthcare reform was identified. Although there was evidence of barriers in progressing primary healthcare reform, evaluation results showed some positive outcomes, most notably shifts in services towards increased primary care access and utilization. DISCUSSION A challenge in undertaking the review was the heterogeneity of articles with little consistency in how primary healthcare reform was evaluated and reported on across countries. Evaluation of national health reforms involves complex system-wide projects and is an area that needs further exploration and discussion to determine the most appropriate methodologies for collecting and analysing large-scale data with consideration for service and health outcomes.
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Affiliation(s)
- Mohammed Alyousef
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland.,Department of Health Services Administration and Hospitals, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Corina Naughton
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland
| | - Colin Bradley
- The Department of General Practice, 8795University College Cork, Cork, Ireland
| | - Eileen Savage
- School of Nursing and Midwifery, 8795University College Cork, Cork, Ireland
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Im JHB, Rodrigues R, Anderson KK, Wilk P, Stranges S, Nicholson K. Examining the prevalence and correlates of multimorbidity among community-dwelling older adults: cross-sectional evidence from the Canadian Longitudinal Study on Aging (CLSA) first-follow-up data. Age Ageing 2022; 51:6653483. [PMID: 35930724 DOI: 10.1093/ageing/afac165] [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: 12/01/2021] [Revised: 05/06/2022] [Indexed: 01/25/2023] Open
Abstract
INTRODUCTION multimorbidity has become an increasingly important issue for many populations around the world, including Canada. The objectives of this study were to estimate the prevalence of multimorbidity at first follow-up and to identify factors associated with multimorbidity using data from the Canadian Longitudinal Study on Aging (CLSA). METHODS this study included 27,701 community-dwelling participants in the first follow-up of the CLSA. Multimorbidity was operationalised using two definitions (Public Health and Primary Care), as well as the cut-points of two or more chronic conditions (MM2+) and three or more chronic conditions (MM3+). The prevalence of multimorbidity was calculated at first follow-up and multivariable regression models were used to identify correlates of multimorbidity occurrence. RESULTS the prevalence of multimorbidity at first follow-up was 32.3% among males and 39.3% among females when using the MM2+ Public Health definition, whereas the prevalence was 67.2% among males and 75.8% among females when using the MM2+ Primary Care definition. Older age, lower alcohol consumption, lower physical activity levels, dissatisfaction with sleep quality, dissatisfaction with life and experiencing social limitations due to health conditions were significantly associated with increased odds of multimorbidity for both males and females, regardless of the definition of multimorbidity used. CONCLUSION various sociodemographic, behavioural and psychosocial factors are associated with multimorbidity. Future research should continue to examine how the prevalence of multimorbidity changes with time and how these changes may be related to specific risk factors. This future research should be supplemented with studies examining the longitudinal impacts of multimorbidity over time.
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Affiliation(s)
- James H B Im
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Rebecca Rodrigues
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Kelly K Anderson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Department of Psychiatry, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Piotr Wilk
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada.,Department of Paediatrics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Saverio Stranges
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,Department of Precision Health, Luxembourg Institute of Health, Strassen, Luxembourg
| | - Kathryn Nicholson
- Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
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Ebron K, Andenoro AC. Empowering Women in Healthcare Leadership: A Transformational Approach to Addressing Human Trafficking in Africa. JOURNAL OF LEADERSHIP STUDIES 2022. [DOI: 10.1002/jls.21804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Kutisha Ebron
- WEI Forward & Urban Health 360 College Park MD USA
- Institute for Ethical Leadership St. Thomas University Miami FL USA
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35
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Litchfield I, Kingston B, Narga D, Turner A. The move towards integrated care: Lessons learnt from managing patients with multiple morbidities in the UK. Health Policy 2022; 126:777-785. [DOI: 10.1016/j.healthpol.2022.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/18/2022] [Accepted: 05/20/2022] [Indexed: 11/30/2022]
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36
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van der Steen JT, Tong WH, Groothuijse J, Ommering BWC. Perceptions and Motivation Regarding Performing Research in Physicians Specializing in Care for Older Adults Involved in a Mandatory Evidence-Based Medicine Training Study: A Mixed-Methods Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:217-224. [PMID: 35300225 PMCID: PMC8922237 DOI: 10.2147/amep.s348735] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 02/23/2022] [Indexed: 06/14/2023]
Abstract
PURPOSE Evidence underpinning treatment of older persons with complex conditions is often sparse, and involving more early career physicians committed to optimizing care for older adults may help increase a relevant evidence base. We examined perception of and motivation to conduct research in physicians (residents) specializing in care of older adults. SUBJECTS AND METHODS Residents of an academic medical centre in the Netherlands enrolled in a 3-year training programme. The programme includes a mandatory evidence-based medicine (EBM) training study on pain and discomfort in cognitively impaired nursing home patients, in which residents perform their research over the 3-year duration of the programme. We employed a mixed-methods design with survey and qualitative interviews (December 2019-April 2020). The survey included validated scales with agreement response options rated 1-7. Qualitative interviews were underpinned by interpretative phenomenological analysis. RESULTS Of 38 invited residents, 23 (15 females) participated. The mean score on perceptions of research was 4.1 (SD 0.8); on intrinsic motivation 4.8 (SD 1.0); on extrinsic motivation 4.3, with a higher SD of 1.4. Eight interviews also showed diversity in the extent to which residents felt equipped to conduct the mandatory EBM training study, and research more generally, which was related to previous experiences performing research. The residents generally did not anticipate conducting research themselves despite recognizing the benefits of training in research. CONCLUSION Perceptions and motivation of the residents specializing in care of older people to conduct research, although considered relevant to their practice, were not very positive. The study results in recommendations to motivate physicians in geriatrics training to conduct research, eg through personalized boosting of self-efficacy. This is crucial to motivate future physicians to contribute to research relevant to older people in more ways than just delivering data for research conceived by (non-clinical) researchers.
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Affiliation(s)
- Jenny T van der Steen
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands
- Department of Primary and Community Care, Radboud university medical center, Nijmegen, the Netherlands
| | - Wing H Tong
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands
- Argos Zorggroep “DrieMaasStede”, Center for Specialized Geriatric Care, Schiedam, the Netherlands
| | - Janneke Groothuijse
- Department of Public Health and Primary Care (PHEG), Leiden University Medical Center, Leiden, the Netherlands
| | - Belinda W C Ommering
- Center for Innovation in Medical Education, Leiden University Medical Center, Leiden, the Netherlands
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Shared decision-making between older people with multimorbidity and GPs: focus group study. Br J Gen Pract 2022; 72:e609-e618. [PMID: 35379603 PMCID: PMC8999685 DOI: 10.3399/bjgp.2021.0529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 02/06/2022] [Indexed: 11/04/2022] Open
Abstract
Background Shared decision making (SDM), utilising the expertise of both patient and clinician, is a key feature of good-quality patient care. Multimorbidity can complicate SDM, yet few studies have explored this dynamic for older patients with multimorbidity in general practice. Aim To explore factors influencing SDM from the perspectives of older patients with multimorbidity and GPs, to inform improvements in personalised care. Design and setting Qualitative study. General practices (rural and urban) in Devon, England. Method Four focus groups: two with patients (aged ≥65 years with multimorbidity) and two with GPs. Data were coded inductively by applying thematic analysis. Results Patient acknowledgement of clinician medicolegal vulnerability in the context of multimorbidity, and their recognition of this as a barrier to SDM, is a new finding. Medicolegal vulnerability was a unifying theme for other reported barriers to SDM. These included expectations for GPs to follow clinical guidelines, challenges encountered in applying guidelines and in communicating clinical uncertainty, and limited clinician self-efficacy for SDM. Increasing consultation duration and improving continuity were viewed as facilitators. Conclusion Clinician perceptions of medicolegal vulnerability are recognised by both patients and GPs as a barrier to SDM and should be addressed to optimise delivery of personalised care. Greater awareness of multimorbidity guidelines is needed. Educating clinicians in the communication of uncertainty should be a core component of SDM training. The incorrect perception that most clinicians already effectively facilitate SDM should be addressed to improve the uptake of personalised care interventions.
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Alfano P, Cuttitta G, Audino P, Fazio G, La Grutta S, Marcantonio S, Bucchieri S. Relationship between Multimorbidity and Quality of Life in a Primary Care Setting: The Mediating Role of Dyspnea. J Clin Med 2022; 11:jcm11030656. [PMID: 35160105 PMCID: PMC8837036 DOI: 10.3390/jcm11030656] [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: 12/21/2021] [Revised: 01/17/2022] [Accepted: 01/24/2022] [Indexed: 11/25/2022] Open
Abstract
Multimorbidity is known to impair Quality of Life (QoL) in patients in a primary setting. Poor QoL is associated with higher dyspnea perception. How multimorbidity and dyspnea perception are related to QoL needs clarification. The aim of the present study is to evaluate the mediating role of dyspnea perception in the relationship between multimorbidity and QoL in adults with and without airflow obstruction in a primary care setting. Seventeen general practitioners participated in the study: a total of 912 adult patients attending the practitioner’s surgery for a generic consultation completed a preliminary respiratory screening; 566 of them answered a respiratory questionnaire between January and June 2014, and 259 of the latter (148 M, aged 40–88) agreed to go through all the of procedures including spirometry, the IMCA and QoL (SF-36 through Physical Health “PCS” and Mental Health components) questionnaires, evaluation of comorbidities and the mMRC Dyspnea Scale. For screening purpose, a cut-off of FEV1/FVC < 70% was considered a marker of airflow obstruction (AO). Of the sample, 25% showed airflow obstruction (AO). No significant difference in mMRC score regarding the number of comorbidities and the PCS was found between subjects with and without AO. Multimorbidity and PCS were inversely related in subjects with (p < 0.001) and without AO (p < 0.001); mMRC and PCS were inversely related in subjects with (p = 0.001) and without AO (p < 0.001). A mediation analysis showed that the relation between number of comorbidities and PCS was totally mediated by mMRC in subjects with AO and partially in subjects without AO. We conclude that the effect of multimorbidity on PCS is totally mediated by mMRC only in AO. Detecting and monitoring mMRC in a primary care setting may be a useful indicator for evaluating a patient’s global health.
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Affiliation(s)
- Pietro Alfano
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
- Correspondence:
| | - Giuseppina Cuttitta
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
| | - Palma Audino
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
| | - Giovanni Fazio
- Triolo Zanca Clinic, Piazza Fonderia 23, 90133 Palermo, Italy;
| | - Sabina La Grutta
- Department of Psychology, Educational Science and Human Movement, University of Palermo, 90128 Palermo, Italy;
| | - Salvatore Marcantonio
- Quality, Planning and Strategic Support Area, University of Palermo, Piazza Marina 61, 90133 Palermo, Italy;
| | | | - Salvatore Bucchieri
- Institute for Biomedical Research and Innovation (IRIB), National Research Council of Italy, 90146 Palermo, Italy; (G.C.); (P.A.); (S.B.)
- Institute of Traslational Pharmacology (IFT), National Research Council of Italy, Via Fosso del Cavaliere 100, 00133 Roma, Italy
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Using discrete-choice experiments to elicit preferences for digital wearable health technology for self-management of chronic kidney disease. Int J Technol Assess Health Care 2022; 38:e77. [DOI: 10.1017/s0266462322003233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Objectives
Wearable digital health technologies (DHTs) have the potential to improve chronic kidney disease (CKD) management through patient engagement. This study aimed to investigate and elicit preferences of individuals with CKD toward wearable DHTs designed to support self-management of their condition.
Methods
Using the results of our review of the published literature and after conducting qualitative patient interviews, five-choice attributes were identified and included in a discrete-choice experiment. The design consisted of 10-choice tasks, each comprising two hypothetical technologies and one opt-out scenario. We collected data from 113 adult patients with CKD stages 3–5 not on dialysis and analyzed their responses via a latent class model to explore preference heterogeneity.
Results
Two patient segments were identified. In all preference segments, the most important attributes were the device appearance, format, and type of information provided. Patients within the largest preference class (70 percent) favored information provided in any format except the audio, while individuals in the other class preferred information in text format. In terms of the style of engagement with the device, both classes wanted a device that provides options rather than telling them what to do.
Conclusions
Our analysis indicates that user preferences differ between patient subgroups, supporting the case for offering a different design of the device for different patients’ strata, thus moving away from a one-size-fits-all service provision. Furthermore, we showed how to leverage the information from user preferences early in the R&D process to inform and support the provision of nuanced person-centered wearable DHTs.
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Spiers G, Boulton E, Corner L, Craig D, Parker S, Todd C, Hanratty B. What matters to people with multiple long-term conditions and their carers? Postgrad Med J 2021; 99:postgradmedj-2021-140825. [PMID: 34921067 DOI: 10.1136/postgradmedj-2021-140825] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 12/01/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND The number of people living with multiple long-term conditions is increasing worldwide. This presents challenges for health and care systems, which must adapt to meet the needs of this population. This study drew on existing data to understand what matters to people living with multiple long-term conditions and identify priorities for future research. METHODS Two studies were conducted. (1) A secondary thematic analysis of interview, survey and workshop data collected from the 2017 James Lind Alliance Priority Setting Partnership for Older People with Multiple Conditions, and patient and public involvement workshops; (2) a review of ongoing research and published research priorities, relating to older people (80+) living with multiple long-term conditions. FINDINGS Older people with multiple long-term conditions identified a number of key concerns: access to care, support for both the patient and their carer, physical and mental health and well-being and identifying opportunities for early prevention. The review identified no published research priorities or ongoing research focusing specifically on populations aged over 80 years with multiple long-term conditions. CONCLUSION Older people living with multiple long-term conditions experience care that is inadequate for their needs. A holistic approach to care that extends beyond treating single conditions will ensure wide-ranging needs are met. As multimorbidity rises worldwide, this is a critical message for practitioners across health and care settings. We also recommend key areas that should be given greater focus in future research and policy to inform effective and meaningful forms of support for people living with multiple long-term conditions.
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Affiliation(s)
- Gemma Spiers
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Elisabeth Boulton
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Lynne Corner
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Dawn Craig
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Stuart Parker
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
| | - Chris Todd
- Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Barbara Hanratty
- Faculty of Medical Sciences, Newcastle University, Newcastle upon Tyne, UK
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Breckner A, Roth C, Glassen K, Wensing M. Self-management perspectives of elderly patients with multimorbidity and practitioners - status, challenges and further support needed? BMC FAMILY PRACTICE 2021; 22:238. [PMID: 34836506 PMCID: PMC8624621 DOI: 10.1186/s12875-021-01584-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/19/2021] [Accepted: 11/09/2021] [Indexed: 11/10/2022]
Abstract
Background Patients with multimorbidity (here defined as three or more chronic conditions) require constant treatment and care. Furthermore, they have to manage their health and diseases in daily life. Offering support to patients’ medical self-management is an important task of primary care. The aim of this study was to explore, what further support is needed from the perspective of patients’ and primary care practitioners. Methods A qualitative study using individual semi-structed interviews with 17 patients with multimorbidity and 7 practitioners (4 primary care physicians and 3 practice assistants) was conducted in Germany. Data were audio-recorded, pseudonymised and transcribed verbatim. Data analysis was performed using qualitative content analysis to structure data into themes and subthemes. All data were managed and organised in MAXQDA. Results The three broad themes: current status, challenges and further support emerged. Patients reported on unfulfilled needs regarding role or emotional management, like coping with loneliness, loss of independence and, changing habits. The importance of social contact was highlighted by patients and practitioners. Patients articulated further support from their primary care practitioners on coping with the disease. Practitioners’ wished for further support in aspects of social participation, public transport, and community resources. Conclusion Challenges regarding self-management of elderly patients with multimorbidity may be addressed by harnessing social support and community initiatives.
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Affiliation(s)
- Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany.
| | - Catharina Roth
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Katharina Glassen
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Marsilius Arcades, West Tower, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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Dixon BE, Judon KM, Schwartzkopf AL, Guerrero VM, Koufacos NS, May J, Schubert CC, Boockvar KS. Impact of event notification services on timely follow-up and rehospitalization among primary care patients at two Veterans Affairs Medical Centers. J Am Med Inform Assoc 2021; 28:2593-2600. [PMID: 34597411 DOI: 10.1093/jamia/ocab189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/17/2021] [Accepted: 08/20/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE To examine the effectiveness of event notification service (ENS) alerts on health care delivery processes and outcomes for older adults. MATERIALS AND METHODS We deployed ENS alerts in 2 Veterans Affairs (VA) medical centers using regional health information exchange (HIE) networks from March 2016 to December 2019. Alerts targeted VA-based primary care teams when older patients (aged 65+ years) were hospitalized or attended emergency departments (ED) outside the VA system. We employed a concurrent cohort study to compare postdischarge outcomes between patients whose providers received ENS alerts and those that did not (usual care). Outcome measures included: timely follow-up postdischarge (actual phone call within 7 days or an in-person primary care visit within 30 days) and all-cause inpatient or ED readmission within 30 days. Generalized linear mixed models, accounting for clustering by primary care team, were used to compare outcomes between groups. RESULTS Compared to usual care, veterans whose primary care team received notification of non-VA acute care encounters were 4 times more likely to have phone contact within 7 days (AOR = 4.10, P < .001) and 2 times more likely to have an in-person visit within 30 days (AOR = 1.98, P = .007). There were no significant differences between groups in hospital or ED utilization within 30 days of index discharge (P = .057). DISCUSSION ENS was associated with increased timely follow-up following non-VA acute care events, but there was no associated change in 30-day readmission rates. Optimization of ENS processes may be required to scale use and impact across health systems. CONCLUSION Given the importance of ENS to the VA and other health systems, this study provides guidance for future research on ENS for improving care coordination and population outcomes. TRIAL REGISTRATION ClinicalTrials.gov NCT02689076. "Regional Data Exchange to Improve Care for Veterans After Non-VA Hospitalization." Registered February 23, 2016.
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Affiliation(s)
- Brian E Dixon
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, Indianapolis, Indiana, USA.,Fairbanks School of Public Health, Indiana University, Indianapolis, Indiana, USA.,Center for Biomedical Informatics, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Kimberly M Judon
- Department of Veterans Affairs, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Ashley L Schwartzkopf
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, Indianapolis, Indiana, USA
| | - Vivian M Guerrero
- Department of Veterans Affairs, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Nicholas S Koufacos
- Department of Veterans Affairs, James J. Peters VA Medical Center, Bronx, New York, USA
| | - Justine May
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, Indianapolis, Indiana, USA
| | - Cathy C Schubert
- Department of Veterans Affairs, Health Services Research & Development Service, Center for Health Information and Communication, Indianapolis, Indiana, USA.,Division of Geriatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Kenneth S Boockvar
- Department of Veterans Affairs, James J. Peters VA Medical Center, Bronx, New York, USA.,Department of Geriatrics and Palliative Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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Lawn S, Kaine C, Stevenson J, McMahon J. Australian Mental Health Consumers' Experiences of Service Engagement and Disengagement: A Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910464. [PMID: 34639765 PMCID: PMC8508315 DOI: 10.3390/ijerph181910464] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/03/2021] [Accepted: 09/30/2021] [Indexed: 12/11/2022]
Abstract
Mental health issues are a severe global concern with significant personal, social, and economic consequences and costs. This paper reports results of an online survey disseminated across the Australian community investigating why people with mental health issues choose particular mental health services over others, what causes them to disengage from services, and what factors and qualities of services are important to consumers to support their continued engagement or re-engagement with mental health services. The importance of GPs was evident, given their key role in providing mental healthcare, especially to those referred to as “the missing middle”—consumers with mental health issues who fall through the gaps in care in other parts of the healthcare system. The study found that many respondents chose to engage with mental healthcare providers primarily due to accessibility and affordability, but also because of the relational qualities that they displayed as part of delivering care. These qualities fostered consumers’ sense of trust, feeling listened to, and not being stigmatized as part of help seeking and having their mental health needs met. Implications for education and practice are offered.
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Affiliation(s)
- Sharon Lawn
- Lived Experience Australia Ltd., Adelaide, SA 5070, Australia; (C.K.); (J.M.)
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia;
- Correspondence: ; Tel.: +61-459-098-772
| | - Christine Kaine
- Lived Experience Australia Ltd., Adelaide, SA 5070, Australia; (C.K.); (J.M.)
| | - Jeremy Stevenson
- College of Medicine and Public Health, Flinders University, Adelaide, SA 5042, Australia;
| | - Janne McMahon
- Lived Experience Australia Ltd., Adelaide, SA 5070, Australia; (C.K.); (J.M.)
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Bjørk E, Thompson W, Ryg J, Gaardboe O, Jørgensen TL, Lundby C. Patient Preferences for Discussing Life Expectancy: a Systematic Review. J Gen Intern Med 2021; 36:3136-3147. [PMID: 34338978 PMCID: PMC8481511 DOI: 10.1007/s11606-021-06973-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 06/07/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Discussing life expectancy helps inform decisions related to preventive medication, screening, and personal care planning. Our aim was to systematically review the literature on patient preferences for discussing life expectancy and to identify predictors for these preferences. METHODS We searched PubMed, Cochrane Library, Embase, MEDLINE, PsycInfo, and gray literature from inception until 17 February 2021. Two authors screened titles/abstracts and full texts, and extracted data and one author assessed quality. The outcome of interest was the proportion of patients willing to discuss life expectancy. We reported descriptive statistics, performed a narrative synthesis, and explored sub-groups of patients according to patient characteristics. RESULTS A total of 41 studies with an accumulated population of 27,570 participants were included, comprising quantitative survey/questionnaire studies (n=27) and qualitative interview studies (n=14). Willingness to discuss life expectancy ranged from 19 to 100% (median 61%, interquartile range (IQR) 50-73) across studies, with the majority (77%) reporting more than half of subjects willing to discuss. There was considerable heterogeneity in willingness to discuss life expectancy, even between studies from patients with similar ages, diseases, and cultural profiles. The highest variability in willingness to discuss was found among patients with cancer (range 19-100%, median 61%, IQR 51-81) and patients aged 50-64 years (range 19-97%, median 61%, IQR 45-87). This made it impossible to determine predictors for willingness to discuss life expectancy. DISCUSSION Most patients are willing to discuss life expectancy; however, a substantial proportion is not. Heterogeneity and variability in preferences make it challenging to identify clear predictors of willingness to discuss. Variability in preferences may to some extent be influenced by age, disease, and cultural differences. These findings highlight the individual and complex nature in which patients approach this topic and stress the importance of clinicians considering eliciting patient's individual preferences when initiating discussions about life expectancy.
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Affiliation(s)
- Emma Bjørk
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark.
| | - Wade Thompson
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark
- Odense Deprescribing Initiative (ODIN), Odense C, Denmark
| | - Jesper Ryg
- Odense Deprescribing Initiative (ODIN), Odense C, Denmark
- Department of Geriatric Medicine, Odense University Hospital, Odense C, Denmark
- Geriatric Research Unit, Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense C, Denmark
| | - Ove Gaardboe
- Danish Society for Patient Safety, Frederiksberg, Denmark
| | - Trine Lembrecht Jørgensen
- Academy of Geriatric Cancer Research (AgeCare), Odense University Hospital, Odense C, Denmark
- Department of Oncology, Odense University Hospital, Odense C, Denmark
- Institute of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Carina Lundby
- Clinical Pharmacology, Pharmacy and Environmental Medicine, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense C, Denmark
- Hospital Pharmacy Funen, Odense University Hospital, Odense C, Denmark
- Odense Deprescribing Initiative (ODIN), Odense C, Denmark
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Corry DAS, Carter G, Doyle F, Fahey T, Gillespie P, McGlade K, O'Halloran P, O'Neill N, Wallace E, Brazil K. Successful implementation of a trans-jurisdictional, primary care, anticipatory care planning intervention for older adults at risk of functional decline: interviews with key health professionals. BMC Health Serv Res 2021; 21:871. [PMID: 34433441 PMCID: PMC8387014 DOI: 10.1186/s12913-021-06896-1] [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: 02/16/2021] [Accepted: 08/12/2021] [Indexed: 02/07/2023] Open
Abstract
Background Aging populations present a challenge to health systems internationally, due to the increasing complexity of care for older adults living with functional decline. This study aimed to elicit expert views of key health professionals on effective and sustainable implementation of a nurse-led, person-centred anticipatory care planning (ACP) intervention for older adults at risk of functional decline in a primary care setting. Methods We examined the feasibility of an ACP intervention in a trans-jurisdictional feasibility cluster randomized controlled trial consisting of home visits by research nurses who assessed participants’ health, discussed their health goals and devised an anticipatory care plan following consultation with participants’ GPs and adjunct clinical pharmacist. As part of the project, we elicited the views and recommendations of experienced key health professionals working with the target population who were recruited using a ‘snowballing technique’ in cooperation with older people health networks in the Republic of Ireland (ROI) and Northern Ireland (NI), United Kingdom [n = 16: 7 ROI, 9 NI]. Following receipt of written information about the intervention and the provision of informed consent, the health professionals were interviewed to determine their expert views on the feasibility of the ACP intervention and recommendations for successful implementation. Data were analyzed using thematic analysis. Results The ACP intervention was perceived to be beneficial for most older patients with multimorbidity. Effective and sustainable implementation was said to be facilitated by accurate and timely patient selection, GP buy-in, use of existing structures within health systems, multidisciplinary and integrated working, ACP nurse training, as well as patient health literacy. Barriers emerged as significant work already undertaken, increasing workload, lack of time, funding and resources, fragmented services, and geographical inequalities. Conclusions The key health professionals perceived the ACP intervention to be highly beneficial to patients, with significant potential to prevent or avoid functional decline and hospital admissions. They suggested that successful implementation of this primary care based, whole-person approach would involve integrated and multi-disciplinary working, GP buy in, patient health education, and ACP nurse training. The findings have potential implications for a full trial, and patient care and health policy. Trial registration Clinicaltrials.gov, ID: NCT03902743. Registered on 4 April 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06896-1.
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Affiliation(s)
- Dagmar Anna S Corry
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK. .,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
| | - Gillian Carter
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Frank Doyle
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Tom Fahey
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland
| | - Patrick Gillespie
- Health Economics and Policy Analysis Centre, National University of Ireland, Galway (NUI Galway), Galway, Republic of Ireland
| | - Kieran McGlade
- School of Medicine, Dentistry, and Biomedical Sciences, Dunluce Health Centre, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Peter O'Halloran
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Nina O'Neill
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK.,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK
| | - Emma Wallace
- Department of General Practice, RCSI University of Medicine and Health Sciences, Dublin, Republic of Ireland.,Department of Health Psychology, Royal College of Surgeons in Ireland, Dublin, Republic of Ireland
| | - Kevin Brazil
- Centre for Evidence and Social Innovation, Queen's University Belfast, Belfast, Northern Ireland, UK. .,School of Nursing and Midwifery, Queen's University Belfast, Belfast, Northern Ireland, UK.
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Madsen K, Wibe T, Bye A, Debesay J, Bergland A. Top 10 research priorities to improve the everyday life of older patients with multimorbidity: A James Lind Alliance (JLA) inspired Priority Setting Partnership (PSP). TIDSSKRIFT FOR OMSORGSFORSKNING 2021. [DOI: 10.18261/issn.2387-5984-2021-02-05] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Kuipers SJ, Nieboer AP, Cramm JM. Easier Said Than Done: Healthcare Professionals' Barriers to the Provision of Patient-Centered Primary Care to Patients with Multimorbidity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18116057. [PMID: 34199866 PMCID: PMC8200113 DOI: 10.3390/ijerph18116057] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 05/31/2021] [Accepted: 06/01/2021] [Indexed: 12/18/2022]
Abstract
Patient-centered care (PCC) has the potential to entail tailored primary care delivery according to the needs of patients with multimorbidity (two or more co-existing chronic conditions). To make primary care for these patients more patient centered, insight on healthcare professionals’ perceived PCC implementation barriers is needed. In this study, healthcare professionals’ perceived barriers to primary PCC delivery to patients with multimorbidity were investigated using a constructivist qualitative design based on semi-structured interviews with nine general and nurse practitioners from seven general practices in the Netherlands. Purposive sampling was used, and the interview content was analyzed to generate themes representing experienced barriers. Barriers were identified in all eight PCC dimensions (patient preferences, information and education, access to care, physical comfort, emotional support, family and friends, continuity and transition, and coordination of care). They include difficulties achieving mutual understanding between patients and healthcare professionals, professionals’ lack of training and education in new skills, data protection laws that impede adequate documentation and information sharing, time pressure, and conflicting financial incentives. These barriers pose true challenges to effective, sustainable PCC implementation at the patient, organizational, and national levels. Further improvement of primary care delivery to patients with multimorbidity is needed to overcome these barriers.
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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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Akintayo-Usman NO. Fragmentation of care: a major challenge for older people living with multimorbidity. GERIATRICS, GERONTOLOGY AND AGING 2021. [DOI: 10.53886/gga.0210030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
As the world’s aging population is rising, so too is the prevalence of multimorbidity increasing among older adults. Multimorbidity is therefore a growing public health challenge among the older population. Researchers have reported fragmentation of care to be one of the major problems facing this population. The leading factors responsible for this issue are use of disease-centered approaches and specialism to manage people living with multimorbidity; poor communication between professionals and people with multimorbidity; and poor communication among the professionals caring for these people. Failure to address this problem leads to increased treatment burden, including polypharmacy. There is therefore a need for all healthcare professionals caring for older people living with multimorbidity to address this problem by providing continuous, coordinated person-centered care. For the person-centered care approach to be well-coordinated and continuous, there is a need for effective means of sharing information among healthcare providers, to facilitate inter-professional collaboration; extension of consultation time to better enable healthcare providers to understand the patient's needs; review of organizational frameworks and policies where necessary; and development of new guidelines for the management of multimorbidity.
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Leiva-Fernández F, González-Hevilla A, Prados-Torres JD, Casas-Galán F, García-Domingo E, Ortiz-Suárez P, López-Rodríguez JA, Pico-Soler MV. Identification of the multimorbidity training needs of primary care professionals: Protocol of a survey. JOURNAL OF MULTIMORBIDITY AND COMORBIDITY 2021; 11:26335565211024791. [PMID: 34422674 PMCID: PMC8371279 DOI: 10.1177/26335565211024791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 05/18/2021] [Indexed: 11/16/2022]
Abstract
Current epidemiological situation has prompted the consideration of multimorbility (MM) as a prevalent condition, influenced by age, educational level and social support, related to unfavorable social and health determinants. Primary Care (PC) has a key role in its approach but further training of professionals in MM is required. The evidence on the effectiveness of training interventions in MM is still limited. Knowing the experiences, opinions and training needs of professionals is essential to enhance training interventions. OBJECTIVES Identify perceived training needs by PC health professionals (doctors and nurses) in MM and polypharmacy. METHODS Design: Cross-sectional study based on an online survey (anonymous-ad hoc questionnaire). Participants and recruitment: 384 doctors and nurses working in healthcare centers and out-of-hospital emergencies of the Spanish National Health System. Non-probabilistic convenience sampling via email addressed to Health Institutions, and social networks. DATA Demographic characteristics and professional profile data (close-ended and multiple-choice questions) will be collected. Open-ended questions will be used to identify training needs, difficulties and resources about MM; required skills to care patients with MM will be assessed using a 4-item ordinal scale. ANALYSIS Coding of data prior to analysis. Descriptive statistical analysis, participation and completion rates of the questionnaire and estimation of absolute and relative frequencies and 95% confidence intervals in close-ended questions. Content analysis with inductive methodology in open-ended questions. Ethics: Ethical approval, Online informed consent. CONCLUSIONS The identification of training needs of health professionals who care for patients with MM will be necessary data for developing highly effective training activities.
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Affiliation(s)
- Francisca Leiva-Fernández
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
| | - Alba González-Hevilla
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Juan Daniel Prados-Torres
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
| | - Fuensanta Casas-Galán
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Eva García-Domingo
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Paula Ortiz-Suárez
- Teaching Unit for Family and Community Primary Care Health District
Málaga/Guadalhorce, Andalusian Health Service, Málaga, Spain
- Biomedical Research Institute of Málaga –IBIMA-, Univesity of
Malaga, Malaga, Spain
| | - Juan Antonio López-Rodríguez
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
- Research Unit, Primary Health Care Management of Madrid, Madrid
Health Service, Madrid, Spain
- Public Health and Preventive Medicine Area, University Rey Juan
Carlos, Madrid, Spain
| | - Maria Victoria Pico-Soler
- Health Services and Chronic conditions Research Network (REDISSEC),
Health Institute Carlos III, Madrid, Spain
- EpiChron Research Group, Aragon Health Sciences Institute (IACS),
IIS Aragón, Miguel Servet University Hospital, Zaragoza, Spain
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