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Rockwell MS, Funk AJ, Huffstetler AN, Villalobos G, Britz JB, Webel B, Richards A, Epling JW, Sabo RT, Krist AH. Screening for Unhealthy Alcohol Use Among Patients With Multiple Chronic Conditions in Primary Care. AJPM FOCUS 2024; 3:100233. [PMID: 38947491 PMCID: PMC11214170 DOI: 10.1016/j.focus.2024.100233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Introduction Unhealthy alcohol use increases the risk for and exacerbation of chronic health conditions. As such, screening, prevention, and management of unhealthy alcohol use is especially critical to improving health outcomes for patients with multiple chronic health conditions. It is unclear to what extent multiple chronic condition status is a barrier to screening for unhealthy alcohol use in the primary care setting. The authors hypothesized that patients with multiple chronic conditions would be at lower odds of being screened for unhealthy alcohol use than patients without multiple chronic conditions. Methods The authors performed a secondary analysis of electronic health record data for patients from 67 primary care practices in Virginia (2020-2023). Using the Center for Medicare and Medicaid Services' chronic disease framework, they classified patients by multiple chronic condition status: no multiple chronic conditions, physical multiple chronic conditions, mental health multiple chronic conditions, and physical and mental health multiple chronic conditions. They used multiple logistic regressions with an added practice-level random effect to analyze the relationship between multiple chronic condition status and the odds of receiving an alcohol-related assessment, of being screened for unhealthy alcohol use with a U.S. Preventive Services Task Force-recommended instrument, and of screening positive for unhealthy alcohol use within the past 2 years. Results Within a final cohort of n=11,789, a total of 6,796 patients (58%) had multiple chronic conditions (29% physical multiple chronic conditions, 4% mental health multiple chronic conditions, and 25% physical and mental health multiple chronic conditions). In all, 69% of patients were screened for unhealthy alcohol use, whereas 16% were screened with a U.S. Preventive Services Task Force-recommended instrument, and 7% screened positive for unhealthy alcohol use. Patients with physical and mental health multiple chronic conditions had 0.9 times lower odds of receiving any screening for unhealthy alcohol use than those with no multiple chronic conditions (95% CI=0.8, 1.0; p=0.0240), whereas patients with only physical multiple chronic conditions or only mental health multiple chronic conditions had similar odds. There was no difference in the odds of being screened with a U.S. Preventive Services Task Force-recommended instrument on the basis of multiple chronic condition status. Patients with mental health multiple chronic conditions and physical and mental health multiple chronic conditions had 1.8 and 1.5 times greater odds of screening positive for unhealthy alcohol use, respectively (95% CI=1.3, 2.7; p=0.0014 and 95% CI=1.2, 1.8; p=0.0003). Conclusions Although patients with chronic mental health conditions were more likely to screen positive for unhealthy alcohol use than patients without multiple chronic conditions, Virginia primary care patients with physical and mental health multiple chronic conditions were less likely to receive an alcohol-related assessment during the past 2 years. Given the overall modest rate of screening with a U.S. Preventive Services Task Force-recommended instrument, further efforts are needed to create the conditions for high-quality alcohol-related preventive service delivery in primary care, particularly for patients with high complexity and/or mental health conditions.
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Affiliation(s)
- Michelle S. Rockwell
- Department of Family & Community Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Adam J. Funk
- Department of Biostatistics, School of Public Health, Virginia Commonwealth University, Richmond, Virginia
| | - Alison N. Huffstetler
- Department of Family Medicine & Population Health, Virginia Commonwealth University, Richmond, Virginia
- INOVA Family Practice Residency, Fairfax, Virginia
- The Robert Graham Center, Washington, District of Columbia
| | - Gabriela Villalobos
- Department of Family Medicine & Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Jacqueline B. Britz
- Department of Family Medicine & Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Benjamin Webel
- Department of Family Medicine & Population Health, Virginia Commonwealth University, Richmond, Virginia
| | - Alicia Richards
- Department of Biostatistics, School of Public Health, Virginia Commonwealth University, Richmond, Virginia
| | - John W. Epling
- Department of Family & Community Medicine, Carilion Clinic and Virginia Tech Carilion School of Medicine, Roanoke, Virginia
| | - Roy T. Sabo
- Department of Biostatistics, School of Public Health, Virginia Commonwealth University, Richmond, Virginia
| | - Alex H. Krist
- Department of Family Medicine & Population Health, Virginia Commonwealth University, Richmond, Virginia
- INOVA Family Practice Residency, Fairfax, Virginia
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Noordman J, Meurs M, Poortvliet R, Rusman T, Orrego-Villagran C, Ballester M, Ninov L, de Guzmán EN, Alonso-Coello P, Groene O, Suñol R, Heijmans M, Wagner C. Contextual factors for the successful implementation of self-management interventions for chronic diseases: A qualitative review of reviews. Chronic Illn 2024; 20:3-22. [PMID: 36744382 DOI: 10.1177/17423953231153337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To identify and describe the most relevant contextual factors (CFs) from the literature that influence the successful implementation of self-management interventions (SMIs) for patients living with type 2 diabetes mellitus, obesity, COPD and/or heart failure. METHODS We conducted a qualitative review of reviews. Four databases were searched, 929 reviews were identified, 460 screened and 61 reviews met the inclusion criteria. CFs in this paper are categorized according to the Tailored Implementation for Chronic Diseases framework. RESULTS A great variety of CFs was identified on several levels, across all four chronic diseases. Most CFs were on the level of the patient, the professional and the interaction level, while less CFs were obtained on the level of the intervention, organization, setting and national level. No differences in main themes of CFs across all four diseases were found. DISCUSSION For the successful implementation of SMIs, it is crucial to take CFs on several levels into account simultaneously. Person-centered care, by tailoring SMIs to patients' needs and circumstances, may increase the successful uptake, application and implementation of SMIs in real-life practice. The next step will be to identify the most important CFs according to various stakeholders through a group consensus process.
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Affiliation(s)
- Janneke Noordman
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Maaike Meurs
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Rune Poortvliet
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Tamara Rusman
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Carola Orrego-Villagran
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Ballester
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | | | - Ena Niño de Guzmán
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | | | - Rosa Suñol
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Avedis Donabedian Research Institute (FAD), Barcelona, Spain
- Health Services Research Network on Chronic Diseases (REDISSEC), Madrid, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Barcelona, Spain
| | - Monique Heijmans
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
| | - Cordula Wagner
- Netherlands institute for health services research (Nivel), Utrecht, The Netherlands
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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3
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Tetzlaff B, Scherer M, Balzer K, Steyer L, Köpke S, Friede T, Maurer I, Weber CE, König HH, Konnopka A, Ruppel T, Mazur A, Hummers E, Mueller CA. Development of an interprofessional person-centred care concept for persons with care needs living in their own homes ( interprof HOME): study protocol for a mixed-methods study. BMJ Open 2023; 13:e069597. [PMID: 37451715 PMCID: PMC10351233 DOI: 10.1136/bmjopen-2022-069597] [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: 10/27/2022] [Accepted: 06/29/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION People receiving home care usually have complex healthcare needs requiring the involvement of informal caregivers and various health professionals. In this context, successful collaboration is an important element of person-centred care, which is often insufficiently implemented. Consequences might be found in avoidable hospitalisations. The aim of the study is to develop a care concept to improve person-centred interprofessional collaboration for people receiving home care considering the perspectives of all person groups involved. METHODS AND ANALYSIS This study uses a mixed-methods design consisting of a literature review, several qualitative inquiries, a cross-sectional quantitative study and a final structured workshop. After a literature review (work package (WP) 1), we will explore the perspectives of people receiving home care (n=20), their relatives (n=20) and representatives of statutory health insurances (n=5) in semistructured interviews (WP2). Moreover, 100 individuals of each group (people receiving home care, relatives, registered nurses, general practitioners and therapists) involved in home care will answer a survey on collaboration that will be analysed descriptively (WP3). Additionally, monoprofessional focus groups (n=9) of registered nurses, general practitioners and therapists, respectively, will discuss current practices. Data will be analysed by qualitative content analysis. Best practice cases (n=8) will be analysed by a case-based qualitative content analysis based on data of observations of home visits and interviews (WP4). The findings of WP2 will be discussed in mixed focus groups (n=4) with 10 participants each (WP5). Considering the results of joint displays of WP3, WP4 and WP5, the interprofessional care concept and its implementation will be elaborated in an expert workshop (WP6). ETHICS AND DISSEMINATION Ethical approval was obtained from all ethics committees of the project partners. Study results will be disseminated through publications, conference presentations, student education and advanced training of health professionals. TRIAL REGISTRATION NUMBER NCT05149937.
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Affiliation(s)
- Britta Tetzlaff
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Katrin Balzer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Linda Steyer
- Institute for Social Medicine and Epidemiology, Nursing Research Unit, University of Lübeck, Lübeck, Germany
| | - Sascha Köpke
- Institute of Nursing Science, Medical Faculty & University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Tim Friede
- Department of Medical Statistics, University Medical Center Göttingen, Göttingen, Germany
| | - Indre Maurer
- Chair of Organization and Corporate Development, Faculty of Business and Economics, Georg-August-University Göttingen, Göttingen, Germany
| | - Clarissa E Weber
- Chair of Organization and Corporate Development, Faculty of Business and Economics, Georg-August-University Göttingen, Göttingen, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - A Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Thomas Ruppel
- Kanzlei für Medizinrecht und Gesundheitsrecht Dr. Dr. Thomas Ruppel, Lübeck, Germany
| | - Ana Mazur
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Eva Hummers
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
| | - Christiane A Mueller
- Department of General Practice, University Medical Center Göttingen, Göttingen, Germany
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Laranjeira C, Dourado M. "Dignity as a Small Candle Flame That Doesn't Go Out!": An Interpretative Phenomenological Study with Patients Living with Advanced Chronic Obstructive Pulmonary Disease. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:17029. [PMID: 36554911 PMCID: PMC9778832 DOI: 10.3390/ijerph192417029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 12/10/2022] [Accepted: 12/14/2022] [Indexed: 06/17/2023]
Abstract
Long-term illness, such as chronic obstructive pulmonary disease (COPD), can expose people to existential suffering that threatens their dignity. This qualitative study explored the lived experiences of patients with advanced COPD in relation to dignity. An interpretative phenomenological approach based on lifeworld existentials was conducted to explore and understand the world of the lived experience. Twenty individuals with advanced COPD (GOLD [Global Initiative for Chronic Obstructive Lung Disease] stages III and IV) were selected using a purposive sampling strategy. In-depth interviews were used to collect data, which were then analysed using Van Manen's phenomenology of practice. The existential experience of dignity was understood, in essence, as "a small candle flame that doesn't go out!". Four intertwined constituents illuminated the phenomenon: "Lived body-balancing between sick body and willingness to continue"; "Lived relations-balancing between self-control and belongingness"; "Lived Time-balancing between past, present and a limited future"; and "Lived space-balancing between safe places and non-compassionate places". This study explains how existential life phenomena are experienced during the final phases of the COPD trajectory and provides ethical awareness of how dignity is lived. More research is needed to investigate innovative approaches to manage complex care in advanced COPD, in order to assist patients in discovering their inner resources to develop and promote dignity.
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Affiliation(s)
- Carlos Laranjeira
- School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena–Alto do Vieiro, Apartado 4137, 2411-901 Leiria, Portugal
- Centre for Innovative Care and Health Technology (ciTechCare), Polytechnic of Leiria, Rua de Santo André—66–68, Campus 5, 2410-541 Leiria, Portugal
- Research in Education and Community Intervention (RECI I&D), Piaget Institute, 3515-776 Viseu, Portugal
- Center for Studies and Development of Continuous and Palliative Care (CEDCCP), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
| | - Marília Dourado
- Center for Studies and Development of Continuous and Palliative Care (CEDCCP), Faculty of Medicine, University of Coimbra, Azinhaga de Santa Comba, Celas, 3000-548 Coimbra, Portugal
- Faculty of Medicine, University of Coimbra, R. Larga, 3004-504 Coimbra, Portugal
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5
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Müller R, Aghdassi AA, Kruse J, Lerch MM, Rach C, Simon P, Salloch S. Lived Experience of Hereditary Chronic Pancreatitis - A Qualitative Interview Study. Chronic Illn 2022; 18:818-833. [PMID: 34559012 PMCID: PMC9643816 DOI: 10.1177/17423953211039774] [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: 11/16/2022]
Abstract
OBJECTIVES Hereditary chronic pancreatitis is a rare condition characterized by intermittent acute episodes of pancreatitis and long-term impairment of pancreatic functions. However, the subjective perspective of individuals affected by hereditary chronic pancreatitis has been little studied. This qualitative study investigates the experience of hereditary chronic pancreatitis patients and their relatives because the awareness of the needs of those affected is an essential component of a patient-centered management of chronic conditions. METHODS Semi-structured qualitative interviews were conducted with hereditary chronic pancreatitis patients and their relatives. Data were analysed using qualitative content analysis. The concepts of 'biographical contingency,' 'biographical disruption' and the 'shifting perspectives model' served as theoretical frameworks. RESULTS A total of 24 participants (17 patients, 7 relatives) were interviewed individually. Four main themes were identified: (1) The unpredictable clinical course of hereditary chronic pancreatitis; (2) hereditary chronic pancreatitis as a devastating experience; (3) hereditary chronic pancreatitis as part of a normal life; and (4) being reduced to hereditary chronic pancreatitis. DISCUSSION The 'shifting perspectives model' of chronic illness covers the four dimensions adequately and can serve as a theoretical model to explain hereditary chronic pancreatitis patients' experience. A better understanding of the patients and their families' experience and the shifting character of hereditary chronic pancreatitis can help healthcare professionals to tailor the care to meet the needs of those affected.
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Affiliation(s)
- Regina Müller
- Institute of Ethics and History of Medicine, University of Tuebingen, Tübingen, Germany.,Institute of Ethics and History of Medicine, 60634University Medicine Greifswald, Greifswald, Germany
| | - Ali A Aghdassi
- Department of Medicine A, 221223University Medicine Greifswald, Greifswald, Germany
| | - Judith Kruse
- Institute of Ethics and History of Medicine, 60634University Medicine Greifswald, Greifswald, Germany
| | - Markus M Lerch
- Department of Medicine A, 221223University Medicine Greifswald, Greifswald, Germany
| | - Christoph Rach
- Department of Psychiatry, Psychotherapy and Psychosomatics, 84491Agaplesion Markus Hospital, Frankfurt am Main, Germany
| | - Peter Simon
- Department of Medicine A, 221223University Medicine Greifswald, Greifswald, Germany
| | - Sabine Salloch
- Institute of Ethics, 88782History and Philosophy of Medicine, Hannover Medical School, Hannover, Germany
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6
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Uhlin K, Persson E, Stålnacke BM, Löfgren M. Healthcare professionals' experiences and perspectives of team-based interdisciplinary pain rehabilitation with immigrants requiring an interpreter. A qualitative study. Disabil Rehabil 2022:1-12. [PMID: 35996890 DOI: 10.1080/09638288.2022.2111608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE There is a lack of knowledge about interprofessional rehabilitation for culturally diverse patients with chronic pain. This study explores experiences of healthcare professionals developing and working with rehabilitation with patients in need of an interpreter and their experience of working with interpreters. METHODS Twelve healthcare professionals at two Swedish specialist rehabilitation centres were interviewed. Grounded theory principles were used for the data collection and analysis. RESULTS The main category "Demanding and Meaningful Work" represents three concurrently interacting categories: "Frustration" includes the informants' doubts regarding the benefits of the rehabilitation, lack of care for patients and cultural dissonance between professionals and patients. "Challenges" describes problems in the rehabilitation work due to the need for interpreted mediated communication, the complexity in health status and social aspects among the patients. "Solutions" represents practical working methods and personal approaches developed by the informants for managing frustrations and challenges. CONCLUSIONS The informants' frustration and challenges when working with a new group of patients, vulnerable and different in their preconceptions, led to new solutions in working methods and approaches. When starting a pain rehabilitation programme for culturally diverse patients, it is important to consider the rehabilitation team's need for additional time and support.IMPLICATIONS FOR REHABILITATIONHealthcare professionals who encounter immigrants with chronic pain need resources to develop their own skills in order to handle complex ethical questions as the patients represent a vulnerable patient group with many low status identitiesIn order to adapt rehabilitation programmes to patient groups with different languages and pre-understandings of chronic pain, there is a need for a team with specific qualities, i.e., close cooperation, an innovative atmosphere, time and also support from expertsFor appropriate language interpretation it is important to have a professional interpreter and a healthcare professional who are aware of and adopt the rules, possibilities and restrictions of interpretationThe rehabilitation of patients in need of language interpretation needs more time and organisation compared to the rehabilitation of patients who speak the national language.
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Affiliation(s)
- Karin Uhlin
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
| | - Elisabeth Persson
- Department of Pain Rehabilitation, Skåne University Hospital, Lund, Sweden
| | - Britt-Marie Stålnacke
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Community Medicine and Rehabilitation, Rehabilitation Medicine, Umeå University, Umeå, Sweden
| | - Monika Löfgren
- Division of Rehabilitation Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden
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7
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[Long-term physical and psychological consequences of chronic kidney disease]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2022; 65:488-497. [PMID: 35312814 PMCID: PMC8935884 DOI: 10.1007/s00103-022-03515-0] [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: 11/07/2021] [Accepted: 02/23/2022] [Indexed: 11/28/2022]
Abstract
Aufgrund der verbesserten Behandlungsoptionen können Patient:innen mit chronischen Nierenerkrankungen heute deutlich länger überleben als noch vor 10 Jahren. Das Überleben ist für die Betroffenen jedoch immer mit einem Verlust an Lebensqualität verbunden. In diesem Beitrag wird eine kurze Übersicht über die körperlichen und psychischen Erkrankungsfolgen, Begleiterkrankungen und Therapienebenwirkungen bei chronischen Nierenerkrankungen gegeben. Auf bisher bekannte Auswirkungen der COVID-19-Pandemie wird hingewiesen. Abschließend wird aufgezeigt, wie die Langzeitbehandlung weiterentwickelt werden sollte, um die Lebensqualität der Patient:innen zu erhöhen. Funktionseinschränkungen der Niere haben aufgrund der Kontamination des Blutes mit harnpflichtigen Substanzen (Urämie) schwere Auswirkungen auf den Gesamtorganismus. Zusätzlich sind die Patient:innen von Nebenwirkungen betroffen, die im Zusammenhang mit der medikamentösen Therapie, Dialyse oder Nierentransplantation auftreten können. Patient:innen und Angehörige sind einer großen psychischen Belastung ausgesetzt. Infektionen mit SARS-CoV‑2 können die Nierenfunktion beeinträchtigen und auch die Prognose einer bereits bestehenden Erkrankung verschlechtern. Die ganzheitliche Versorgung der Patient:innen mit chronischen Nierenerkrankungen muss neben der medizinischen Versorgung auch die psychologischen und psychosozialen Aspekte berücksichtigen. Nephrologie und Psychonephrologie müssen Hand in Hand weiterentwickelt werden, um die medizinische Versorgung und Lebensqualität der betroffenen Patient:innen zu verbessern.
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Mengshoel AM, Skarbø Å, Hasselknippe E, Petterson T, Brandsar NL, Askmann E, Ildstad R, Løseth L, Sallinen MH. Enabling personal recovery from fibromyalgia - theoretical rationale, content and meaning of a person-centred, recovery-oriented programme. BMC Health Serv Res 2021; 21:339. [PMID: 33853607 PMCID: PMC8045361 DOI: 10.1186/s12913-021-06295-6] [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: 06/23/2020] [Accepted: 03/18/2021] [Indexed: 12/27/2022] Open
Abstract
Background Fibromyalgia (FM) is a contested, chronic widespread pain syndrome on which recommended therapies have short-lasting, moderate effects. Nevertheless, some patients become symptom-free, and their recovery experiences inspired us to develop a patient-centred recovery-oriented programme (PROP) delivered in a group format. Presently, we describe the theoretical rationale, purpose and content of the PROP, and its meanings for clinicians and patients. Methods A multidisciplinary clinical team, a leader of a rehabilitation unit, and two researchers coproduced the PROP. Five full-day seminars were arranged to bridge research and clinical experiences. Qualitative studies about patients’ illness and recovery experiences and questions by researchers facilitated reflections on clinical experiences. The meaning of the PROP was examined using focus group and individual interviews with patients and clinicians immediately after completing the course and after 1–1.5 years. Results The biopsychosocial model displays the research evidence across biological, mental and social impacts of FM, justifying that life stress can be an illness-maintaining factor in FM. The content addresses enabling patients to heal their own life and self by modifying life stress. Patients engage in making sense of the relationship between FM, themselves, and life through exploring, discovering and creating appropriate solutions for their daily social life. The PROP reduced uncertainties and brought a positive attitude and hope to the groups. After 1 year, patients are still engaged in recovery work, experience more good days, and maintain hope for further recovery. By sharing and reflecting on clinical experiences, a unified clinical team was established that continues to develop their competency. Conclusion To our knowledge, the PROP is the first programme for patients with FM that results from a process of coproducing knowledge, is based on explicit theoretical rationale, and facilitates a personal experiential recovery process. PROP is found to be meaningful and to work by patients and clinicians. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-06295-6.
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Affiliation(s)
- Anne Marit Mengshoel
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, Box 1089, Blindern, 0317, Oslo, Norway.
| | - Åse Skarbø
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | | | - Tamara Petterson
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Nina Linnea Brandsar
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Ellen Askmann
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Ragnhild Ildstad
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Lena Løseth
- Hospital for Rheumatic Diseases, Margrethe Grundtvigsvei 6, 2609, Lillehammer, Norway
| | - Merja Helena Sallinen
- Department of Interdisciplinary Health Sciences, Faculty of Medicine, Institute of Health and Society, University of Oslo, Box 1089, Blindern, 0317, Oslo, Norway.,Faculty of Health and Welfare, Satakunta University of Applied Sciences, Pori, Finland
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9
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Lundell S, Pesola UM, Nyberg A, Wadell K. Groping around in the dark for adequate COPD management: a qualitative study on experiences in long-term care. BMC Health Serv Res 2020; 20:1025. [PMID: 33167968 PMCID: PMC7653885 DOI: 10.1186/s12913-020-05875-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Accepted: 10/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Chronic obstructive pulmonary disease (COPD) is one of the most common and deadliest chronic diseases worldwide. Since COPD is a chronic and progressive disease, treatment is necessary throughout life. For people with COPD who cannot live independently, long-term care facilities are often required. However, knowledge is very limited about aspects of importance for effective COPD management in these settings in accordance with current treatment guidelines. The aim of this study was to explore aspects of importance in long-term care facilities for providing interventions according to treatment guidelines for people with COPD, from the perspective of healthcare professionals, in an effort to prove novel knowledge that could be used to facilitate implementation of treatment guidelines in these settings. Methods A qualitative study was performed in northern Sweden. In Sweden, municipalities are responsible for providing long-term care. Interviews with 36 healthcare professionals (nurses, physiotherapists, occupational therapists and dieticians) in municipal healthcare were conducted and analysed using qualitative content analysis with triangulation by the authors. Results The overarching theme that emerged from the analysis was Groping around in the dark for adequate COPD management. This represents healthcare professionals’ experiences of working with a complex diagnosis somewhat overlooked in the municipal healthcare, an underdog in the healthcare system. The groping around in the dark theme further represents the healthcare professionals’ lack of COPD-related competence, lack of interprofessional collaboration, and insufficient communication with the county council. The fragile group of people with COPD and their relatives were considered in need of support adapted to their context, but routines and resources for COPD management were limited. This lack of routines and resources also resulted in professionals being pragmatic and adopting short-term solutions without focusing on specific needs related to the diagnosis. Conclusions The COPD management in long-term care settings showed several insufficiencies, indicating a large gap between clinical practice and treatment guidelines for COPD. It is crucial to improve COPD management in long-term care settings. Consequently, several actions are needed, such as increasing professional competence, establishing new routines, acknowledging and making COPD a higher priority, as well as adapting treatment guidelines to the context.
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Affiliation(s)
- Sara Lundell
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 901 87, Umeå, Sweden.
| | - Ulla-Maija Pesola
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 901 87, Umeå, Sweden
| | - André Nyberg
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 901 87, Umeå, Sweden
| | - Karin Wadell
- Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 901 87, Umeå, Sweden.,Department of Public Health and Clinical Medicine, Division of Medicine, Umeå University, 901 87, Umeå, Sweden
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Premature birth, low birth weight, small for gestational age and chronic non-communicable diseases in adult life: A systematic review with meta-analysis. Early Hum Dev 2020; 149:105154. [PMID: 32799034 DOI: 10.1016/j.earlhumdev.2020.105154] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 07/31/2020] [Accepted: 08/04/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Individuals who were born prematurely (PT), with low birth weight (LBW), or small for gestational age (SGA) appear to present a set of permanent changes that make them more susceptible to develop chronic non-communicable diseases (CNCD) in adult life. AIM Investigating the association between PT birth, LBW or SGA at birth and CNCD incidence in adult life. METHODS Systematic review with meta-analysis of studies available in three databases - two of them are official (PubMed and Web of Science) and one is gray literature (OpenGrey) - based on pre-established search and eligibility criteria. RESULTS Sixty-four studies were included in the review, 93.7% of them only investigated one of the exposure variables (46.7% LBW, 35.0% PT and 18.3% SGA at birth), whereas 6.3% investigated more than one exposure variable (50.0% LBW and PT; 50.0% SGA and PT). There was association among all exposure variables in the following outcomes: cardiometabolic (CMD) and glycidic metabolism (GMD) disorders, changes in body composition and risk of developing metabolic syndrome (MS). Female sex was identified as risk factor in the exposure-outcome association. Eighteen (18) articles were included in the meta-analysis. There was positive association between LBW and incidence of CMD (OR: 1.25 [95%CI: 1.11; 1.41]; 07 studies), GMD (OR: 1.70 [95%CI: 1.25; 2.30]; 03 studies) and MS (OR: 1.75 [95%CI: 1.27; 2.40]; 02 studies) in adult life. PT was positively associated with CMD (OR: 1.38 [95%CI: 1.27; 1.51]; 05 studies). CONCLUSIONS LBW and PT are associated with CMD and GMD development, as well as with the risk of developing MS in adult life.
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