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Cabanillas-Lazo M, Benites-Meza JK, Pinedo-Castillo L, Fernandez-Quiroz EL, Pacherres-Lopez A, Herrera-Añazco P, Benites-Zapata VA. Association between self-perceived consultation time and understanding of the prescribed treatment: An analysis of a national survey in Peru. PATIENT EDUCATION AND COUNSELING 2024; 122:108140. [PMID: 38277820 DOI: 10.1016/j.pec.2024.108140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Revised: 07/17/2023] [Accepted: 01/04/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE To assess the relationship between the self-perceived consultation time and the knowledge of the proposed treatment. METHODS Secondary data from a 2015 national survey of health services in Peru were analyzed. The self-perceived consultation time was calculated by asking how long it took from when you entered the consultation until you departed. It was then categorized as low, medium, and high. Five self-reported questions were used to construct a knowledge of the prescribed treatment. Adjusted regression models from the Poisson family models were used to evaluate the relationship. We report adjusted prevalence ratios (aPR) with their 95% confidence intervals (95%CI). RESULTS A total of 9939 outpatients were analyzed, with 58% women; the average age was 44 years; and 45.4% had higher education. Using low self-perceived consultation time as references, medium and high consultation times were associated with understanding the prescribed treatment (aPR=1.17; 95%CI, 1.04-1.33 and aPR=1.30; 95%CI, 1.20-1.40, respectively). CONCLUSION Patients who reported a medium and high self-perceived consultation time better understood the prescribed treatment. IMPLICATIONS FOR PRACTICE Healthcare professionals should strive to maximize consultation time to ensure effective communication and improve patient knowledge of treatments, improving overall patient satisfaction and health outcomes.
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Affiliation(s)
- Miguel Cabanillas-Lazo
- Sociedad Científica de San Fernando, Universidad Nacional Mayor de San Marcos, Lima, Peru; Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru
| | - Jerry K Benites-Meza
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru; Sociedad Científica de Estudiantes de Medicina de la Universidad Nacional de Trujillo, Trujillo, Peru
| | - Liseth Pinedo-Castillo
- Facultad de Ciencias de la Salud, Universidad Señor de Sipán, Chiclayo, Peru; Asociación Científica de Estudiantes de Medicina de la Universidad Señor de Sipán, Chiclayo, Peru
| | - Eliana L Fernandez-Quiroz
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru; Asociación Científica Médico Estudiantil de la Universidad Católica Santo Toribio de Mogrovejo - ASOCIEM USAT, Chiclayo, Peru
| | - Andres Pacherres-Lopez
- Grupo Peruano de Investigación Epidemiológica, Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru; Sociedad Científica de Estudiantes de Medicina de la Universidad de San Martin de Porres, Lima, Peru
| | | | - Vicente A Benites-Zapata
- Unidad de Investigación para la Generación y Síntesis de Evidencias en Salud, Universidad San Ignacio de Loyola, Lima, Peru.
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George T, Manski-Nankervis JA, Klaic M, Kang G, Sudarsanam TD. Interventions in adult patients with multimorbidity in low-income and middle-income countries: protocol for a mixed-methods systematic review. BMJ Open 2024; 14:e074038. [PMID: 38448058 PMCID: PMC10916128 DOI: 10.1136/bmjopen-2023-074038] [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: 03/29/2023] [Accepted: 02/02/2024] [Indexed: 03/08/2024] Open
Abstract
INTRODUCTION Multimorbidity, the coexistence of two or more chronic conditions in the same individual, is a major public health problem in low-income and middle-income countries (LMICs). The use of single-disease guidelines contributes to polypharmacy, fragmented care and increased treatment burden. Health systems in LMICs are very different from those in high-income countries, and adapting interventions from one to the other may not be feasible. This review aims to systematically present the current evidence for interventions for multimorbidity in the LMIC setting. METHODS AND ANALYSIS In this mixed-methods systematic review, we will include all studies of interventions for the care of adults (>18 years of age) with multimorbidity (defined as the presence of two or more chronic illnesses in an individual) in any healthcare organisation (primary, secondary or tertiary care) in an LMIC (as defined by the World Bank), published between 2000 and March 2023. All primary study designs will be included. Studies reported in languages other than English and those describing interventions classified as 'financial' or 'governance arrangement' according to the Cochrane Effective Practice and Organisation of Care classification will be excluded. MEDLINE, PubMed, Cochrane Library, TRIP, SCOPUS and the 3ie databases will be searched. The titles will be screened by one author, and two authors will independently screen all included abstracts and full texts. A third author will resolve conflicts at every stage. Studies will be reviewed for quality of evidence using appropriate tools. Epidemiological, intervention and outcome data will be extracted and summarised. Outcomes of interest for LMICs defined by the Global Alliance for Chronic Diseases research group will be analysed. Subgroup analysis according to study types and study settings will be done. ETHICS AND DISSEMINATION No ethics approval is required for this systematic review. Results will be disseminated through publication in an open-access journal and presentation at conferences. PROSPERO REGISTRATION NUMBER CRD42023391897.
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Affiliation(s)
- Tina George
- Department of General Practice and Primary Care, The University of Melbourne,Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Department of General Medicine, Christian Medical College Vellore, Vellore, India
| | - Jo-Anne Manski-Nankervis
- Department of General Practice and Primary Care, The University of Melbourne,Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
- Primary Care and Family Medicine, LKC Medicine, Nanyang Technological University, Singapore
| | - Marlena Klaic
- Melbourne School of Health Sciences, The University of Melbourne, Faculty of Medicine, Dentistry and Health Sciences, Melbourne, Victoria, Australia
| | - Gagandeep Kang
- Division of Gastrointestinal Sciences, Christian Medical College Vellore, Vellore, Tamil Nadu, India
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Allory E, Scheer J, De Andrade V, Garlantézec R, Gagnayre R. Characteristics of self-management education and support programmes for people with chronic diseases delivered by primary care teams: a rapid review. BMC PRIMARY CARE 2024; 25:46. [PMID: 38297228 PMCID: PMC10829293 DOI: 10.1186/s12875-024-02262-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 01/02/2024] [Indexed: 02/02/2024]
Abstract
BACKGROUND Primary care actors can play a major role in developing and promoting access to Self-Management Education and Support (SMES) programmes for people with chronic disease. We reviewed studies on SMES programmes in primary care by focusing on the following dimensions: models of SMES programmes in primary care, SMES team's composition, and participants' characteristics. METHODS For this mixed-methods rapid review, we searched the PubMed and Cochrane Library databases to identify articles in English and French that assessed a SMES programme in primary care for four main chronic diseases (diabetes, cancer, cardiovascular disease and/or respiratory chronic disease) and published between 1 January 2013 and 31 December 2021. We excluded articles on non-original research and reviews. We evaluated the quality of the selected studies using the Mixed Methods Appraisal Tool. We reported the study results following the PRISMA guidelines. RESULTS We included 68 studies in the analysis. In 46/68 studies, a SMES model was described by focusing mainly on the organisational dimension (n = 24). The Chronic Care Model was the most used organisational model (n = 9). Only three studies described a multi-dimension model. In general, the SMES team was composed of two healthcare providers (mainly nurses), and partnerships with community actors were rarely reported. Participants were mainly patients with only one chronic disease. Only 20% of the described programmes took into account multimorbidity. Our rapid review focused on two databases and did not identify the SMES programme outcomes. CONCLUSIONS Our findings highlight the limited implication of community actors and the infrequent inclusion of multimorbidity in the SMES programmes, despite the recommendations to develop a more interdisciplinary approach in SMES programmes. This rapid review identified areas of improvement for SMES programme development in primary care, especially the privileged place of nurses in their promotion. TRIAL REGISTRATION PROSPERO 2021 CRD42021268290 .
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Affiliation(s)
- Emmanuel Allory
- Department of General Practice, Univ Rennes, 2 Av. du Professeur Léon Bernard, Rennes, 35000, France.
- CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, 35000, France.
- LEPS (Laboratoire d'Education Et Promotion en Santé), University of Sorbonne Paris Nord, Villetaneuse, UR, 3412, F-93430, France.
| | - Jordan Scheer
- Department of General Practice, Univ Rennes, 2 Av. du Professeur Léon Bernard, Rennes, 35000, France
- CHU Rennes, Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), Rennes, 35000, France
| | - Vincent De Andrade
- LEPS (Laboratoire d'Education Et Promotion en Santé), University of Sorbonne Paris Nord, Villetaneuse, UR, 3412, F-93430, France
| | - Ronan Garlantézec
- CHU de Rennes, Univ Rennes, Inserm, EHESP (Ecole Des Hautes Etudes en Santé Publique), Irset - UMR_S 1085, Rennes, 35000, France
| | - Rémi Gagnayre
- LEPS (Laboratoire d'Education Et Promotion en Santé), University of Sorbonne Paris Nord, Villetaneuse, UR, 3412, F-93430, France
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León-García M, Wieringa TH, Espinoza Suárez NR, Hernández-Leal MJ, Villanueva G, Singh Ospina N, Hidalgo J, Prokop LJ, Rocha Calderón C, LeBlanc A, Zeballos-Palacios C, Brito JP, Montori VM. Does the duration of ambulatory consultations affect the quality of healthcare? A systematic review. BMJ Open Qual 2023; 12:e002311. [PMID: 37875307 PMCID: PMC10603464 DOI: 10.1136/bmjoq-2023-002311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 09/23/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND The objective is to examine and synthesise the best available experimental evidence about the effect of ambulatory consultation duration on quality of healthcare. METHODS We included experimental studies manipulating the length of outpatient clinical encounters between adult patients and clinicians (ie, therapists, pharmacists, nurses, physicians) to determine their effect on quality of care (ie, effectiveness, efficiency, timeliness, safety, equity, patient-centredness and patient satisfaction). INFORMATION SOURCES Using controlled vocabulary and keywords, without restriction by language or year of publication, we searched MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials and Database of Systematic Reviews and Scopus from inception until 15 May 2023. RISK OF BIAS Cochrane Risk of Bias instrument. DATA SYNTHESIS Narrative synthesis. RESULTS 11 publications of 10 studies explored the relationship between encounter duration and quality. Most took place in the UK's general practice over two decades ago. Study findings based on very sparse and outdated evidence-which suggested that longer consultations improved indicators of patient-centred care, education about prevention and clinical referrals; and that consultation duration was inconsistently related to patient satisfaction and clinical outcomes-warrant low confidence due to limited protections against bias and indirect applicability to current practice. CONCLUSION Experimental evidence for a minimal or optimal duration of an outpatient consultation is sparse and outdated. To develop evidence-based policies and practices about encounter length, randomised trials of different consultation lengths-in person and virtually, and with electronic health records-are needed. TRIAL REGISTRATION NUMBER OSF Registration DOI:10.17605/OSF.IO/EUDK8.
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Affiliation(s)
- Montserrat León-García
- Biomedical Research Institute Sant Pau (IIB Sant Pau), Hospital de la Santa Creu i Sant Pau, Barcelona, Catalunya, Spain
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
| | - Thomas H Wieringa
- Medical Decision Making, Department of Biomedical Data Sciences, Leiden University, Leiden, Netherlands
| | - Nataly R Espinoza Suárez
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
- VITAM Research Center for Sustainable Health, Quebec Integrated University Health and Social Services; Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - María José Hernández-Leal
- Department of Economics. Research Centre on Economics and Sustainability (ECO-SOS). Research Group on Statistics, Economic Evaluation and Health (GRAEES), Faculty of Business and Economics. Rovira i Virgili University, Reus, Spain
| | - Gemma Villanueva
- Department of Pediatrics, Obstetrics, Gynaecology and Preventive Medicine, Universidad Autónoma de Barcelona, Barcelona, Spain
- Cochrane Response, London, UK
| | - Naykky Singh Ospina
- Division of Endocrinology, Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Jessica Hidalgo
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Larry J Prokop
- Mayo Clinic Libraries, Mayo Clinic, Mayo Clinic, Rochester, Minnesota, USA
| | - Claudio Rocha Calderón
- Department of Preventive Medicine, University Hospital of Bellvitge, IDIBELL, Barcelona, Catalunya, Spain
| | - Annie LeBlanc
- VITAM Research Center for Sustainable Health, Quebec Integrated University Health and Social Services; Faculty of Medicine, Université Laval, Quebec, Quebec, Canada
| | - Claudia Zeballos-Palacios
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Juan Pablo Brito
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Victor M Montori
- Knowledge and Evaluation Research Unit, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Feng X, Kelly M, Sarma H. The association between educational level and multimorbidity among adults in Southeast Asia: A systematic review. PLoS One 2021; 16:e0261584. [PMID: 34929020 PMCID: PMC8687566 DOI: 10.1371/journal.pone.0261584] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/03/2021] [Indexed: 12/27/2022] Open
Abstract
Background In Southeast Asia, the prevalence of multimorbidity is gradually increasing. This paper aimed to investigate the association between educational level and multimorbidity among over 15-years old adults in Southeast Asia. Methods We conducted a systematic review of published observational studies. Studies were selected according to eligibility criteria of addressing definition and prevalence of multimorbidity and associations between level of education and multimorbidity in Southeast Asia. The Newcastle-Ottawa Scale (NOS) was used to measure the quality and risk of bias. The methodology has been published in PROSPERO with registered number ID: CRD42021259311. Results Eighteen studies were included in the data synthesis. The results are presented using narrative synthesis due to the heterogeneity of differences in exposures, outcomes, and methodology. The prevalence of multimorbidity ranged from 1.7% to 72.6% among over 18 years-old adults and from 1.5% to 51.5% among older people (≥ 60 years). There were three association patterns linking between multimorbidity and education in these studies: (1) higher education reducing odds of multimorbidity, (2) higher education increasing odds of multimorbidity and (3) education having no association with multimorbidity. The association between educational attainment and multimorbidity also varies widely across countries. In Singapore, three cross-sectional studies showed that education had no association with multimorbidity among adults. However, in Indonesia, four cross-sectional studies found higher educated persons to have higher odds of multimorbidity among over 40-years-old persons. Conclusions Published studies have shown inconsistent associations between education and multimorbidity because of different national contexts and the lack of relevant research in the region concerned. Enhancing objective data collection such as physical examinations would be necessary for studies of the connection between multimorbidity and education. It can be hypothesised that more empirical research would reveal that a sound educational system can help people prevent multimorbidity.
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Affiliation(s)
- Xiyu Feng
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
| | - Matthew Kelly
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
- * E-mail:
| | - Haribondhu Sarma
- Department of Global Health, Research School of Population Health, The Australian National University, Canberra, Australia
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Nguyen VC, Park J. Relationships between Demographic Factors and Chronic Conditions with Disease Severities. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182111469. [PMID: 34769985 PMCID: PMC8583414 DOI: 10.3390/ijerph182111469] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Revised: 10/15/2021] [Accepted: 10/29/2021] [Indexed: 11/29/2022]
Abstract
Disease severities are the outcomes of an inpatient visit classification that assigns a diagnostic related group, including risk of mortality and severity of illness. Although widely used in healthcare, the analysis of factors affecting disease severities has not been adequately studied. In this study, we analyze the relationships between demographics and chronic conditions and specify their influence on disease severities. Descriptive statistics are used to investigate the relationships and the prevalence of chronic conditions. To evaluate the influence of demographic factors and chronic conditions on disease severities, several multinomial logistic regression models are performed and prediction models for disease severities are conducted based on National Inpatient Sample data for 2016 provided by the Healthcare Cost and Utilization Project database in the United States. The rate of patients with a chronic illness is 88.9% and the rate of patients with more than two chronic conditions is 67.6%; further, the rate is 62.7% for females, 73.9% for males, and 90% for the elderly. A high level of disease severity commonly appears in patients with more than two chronic conditions, especially in the elderly. For patients without chronic conditions, disease severities show a lower or safe level, even in the elderly.
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