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Schäfer I, Schulze J, Glassen K, Breckner A, Hansen H, Rakebrandt A, Berg J, Blozik E, Szecsenyi J, Lühmann D, Scherer M. Validation of patient- and GP-reported core sets of quality indicators for older adults with multimorbidity in primary care: results of the cross-sectional observational MULTIqual validation study. BMC Med 2023; 21:148. [PMID: 37069536 PMCID: PMC10111827 DOI: 10.1186/s12916-023-02856-0] [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] [Received: 01/20/2023] [Accepted: 03/30/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND Older adults with multimorbidity represent a growing segment of the population. Metrics to assess quality, safety and effectiveness of care can support policy makers and healthcare providers in addressing patient needs. However, there is a lack of valid measures of quality of care for this population. In the MULTIqual project, 24 general practitioner (GP)-reported and 14 patient-reported quality indicators for the healthcare of older adults with multimorbidity were developed in Germany in a systematic approach. This study aimed to select, validate and pilot core sets of these indicators. METHODS In a cross-sectional observational study, we collected data in general practices (n = 35) and patients aged 65 years and older with three or more chronic conditions (n = 346). One-dimensional core sets for both perspectives were selected by stepwise backward selection based on corrected item-total correlations. We established structural validity, discriminative capacity, feasibility and patient-professional agreement for the selected indicators. Multilevel multivariable linear regression models adjusted for random effects at practice level were calculated to examine construct validity. RESULTS Twelve GP-reported and seven patient-reported indicators were selected, with item-total correlations ranging from 0.332 to 0.576. Fulfilment rates ranged from 24.6 to 89.0%. Between 0 and 12.7% of the values were missing. Seventeen indicators had agreement rates between patients and professionals of 24.1% to 75.9% and one had 90.7% positive and 5.1% negative agreement. Patients who were born abroad (- 1.04, 95% CI = - 2.00/ - 0.08, p = 0.033) and had higher health-related quality of life (- 1.37, 95% CI = - 2.39/ - 0.36, p = 0.008), fewer contacts with their GP (0.14, 95% CI = 0.04/0.23, p = 0.007) and lower willingness to use their GPs as coordinators of their care (0.13, 95% CI = 0.06/0.20, p < 0.001) were more likely to have lower GP-reported healthcare quality scores. Patients who had fewer GP contacts (0.12, 95% CI = 0.04/0.20, p = 0.002) and were less willing to use their GP to coordinate their care (0.16, 95% CI = 0.10/0.21, p < 0.001) were more likely to have lower patient-reported healthcare quality scores. CONCLUSIONS The quality indicator core sets are the first brief measurement tools specifically designed to assess quality of care for patients with multimorbidity. The indicators can facilitate implementation of treatment standards and offer viable alternatives to the current practice of combining disease-related metrics with poor applicability to patients with multimorbidity.
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Affiliation(s)
- Ingmar Schäfer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - Josefine Schulze
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Katharina Glassen
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Amanda Breckner
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Heike Hansen
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Anja Rakebrandt
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Jessica Berg
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Eva Blozik
- Institute of Primary Care, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University Hospital, Heidelberg, Germany
| | - Dagmar Lühmann
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Martin Scherer
- Department of General Practice and Primary Care, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
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Clustering of comorbidities and associated outcomes in people with osteoarthritis - A UK Clinical Practice Research Datalink study. Osteoarthritis Cartilage 2022; 30:702-713. [PMID: 35122943 DOI: 10.1016/j.joca.2021.12.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 12/15/2021] [Accepted: 12/20/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the clusters of chronic conditions present in people with osteoarthritis and the associated risk factors and health outcomes. METHODS Clinical Practice Research Datalink (CPRD) GOLD was used to identify people diagnosed with incident osteoarthritis (n = 221,807) between 1997 and 2017 and age (±2 years), gender, and practice matched controls (no osteoarthritis, n = 221,807) from UK primary care. Clustering of people was examined for 49 conditions using latent class analysis. The associations between cluster membership and covariates were quantified by odds ratios (OR) using multinomial logistic regression. General practice (GP) consultations, hospitalisations, and all-cause mortality rates were compared across the clusters identified at the time of first diagnosis of osteoarthritis (index date). RESULTS In both groups, conditions largely grouped around five clusters: relatively healthy; cardiovascular (CV), musculoskeletal-mental health (MSK-MH), CV-musculoskeletal (CV-MSK) and metabolic (MB). In the osteoarthritis group, compared to the relatively healthy cluster, strong associations were seen for 1) age with all clusters; 2) women with the MB cluster (OR 5.55: 5.14-5.99); 3) obesity with the CV-MSK (OR 2.11: 2.03-2.20) and CV clusters (OR 2.03: 1.97-2.09). The CV-MSK cluster in the osteoarthritis group had the highest number of GP consultations and hospitalisations, and the mortality risk was 2.45 (2.33-2.58) times higher compared to the relatively healthy cluster. CONCLUSIONS Of the five identified clusters, CV-MSK, CV, and MSK-MH are more common in OA and CV-MSK cluster had higher health utilisation. Further research is warranted to better understand the mechanistic pathways and clinical implications.
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Swain S, Kamps A, Runhaar J, Dell'Isola A, Turkiewicz A, Robinson D, Strauss V, Mallen C, Kuo CF, Coupland C, Doherty M, Sarmanova A, Prieto-Alhambra D, Englund M, Bierma-Zeinstra SMA, Zhang W. Comorbidities in osteoarthritis (ComOA): a combined cross-sectional, case-control and cohort study using large electronic health records in four European countries. BMJ Open 2022; 12:e052816. [PMID: 35387809 PMCID: PMC8987784 DOI: 10.1136/bmjopen-2021-052816] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
INTRODUCTION Osteoarthritis (OA) is one of the leading chronic conditions in the older population. People with OA are more likely to have one or more other chronic conditions than those without. However, the temporal associations, clusters of the comorbidities, role of analgesics and the causality and variation between populations are yet to be investigated. This paper describes the protocol of a multinational study in four European countries (UK, Netherlands, Sweden and Spain) exploring comorbidities in people with OA. METHODS AND ANALYSIS This multinational study will investigate (1) the temporal associations of 61 identified comorbidities with OA, (2) the clusters and trajectories of comorbidities in people with OA, (3) the role of analgesics on incidence of comorbidities in people with OA, (4) the potential biomarkers and causality between OA and the comorbidities, and (5) variations between countries.A combined case-control and cohort study will be conducted to find the temporal association of OA with the comorbidities using the national or regional health databases. Latent class analysis will be performed to identify the clusters at baseline and joint latent class analysis will be used to examine trajectories during the follow-up. A cohort study will be undertaken to evaluate the role of non-steroidal anti-inflammatory drugs (NSAIDs), opioids and paracetamol on the incidence of comorbidities. Mendelian randomisation will be performed to investigate the potential biomarkers for causality between OA and the comorbidities using the UK Biobank and the Rotterdam Study databases. Finally, a meta-analyses will be used to examine the variations and pool the results from different countries. ETHICS AND DISSEMINATION Research ethics was obtained according to each database requirement. Results will be disseminated through the FOREUM website, scientific meetings, publications and in partnership with patient organisations.
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Affiliation(s)
- Subhashisa Swain
- Academic Rheumatology, University of Nottingham School of Medicine, Nottingham, UK
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Anne Kamps
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, The Netherlands, Rotterdam, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, The Netherlands, Rotterdam, The Netherlands
| | - Andrea Dell'Isola
- Department of Clinical Sciences, Clinical Epidemiology Unit, Orthopaedics, Lund University, Lund, Sweden
| | - Aleksandra Turkiewicz
- Department of Clinical Sciences, Clinical Epidemiology Unit, Orthopaedics, Lund University, Lund, Sweden
| | - Danielle Robinson
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
| | - V Strauss
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
| | | | - Chang-Fu Kuo
- Division of Rheumatology, Allergy, and Immunology, Chang Gung Memorial Hospital, Taoyuan, Taiwan
| | - Carol Coupland
- Division of Primary Care, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, University of Nottingham School of Medicine, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Aliya Sarmanova
- Musculoskeletal Research Unit, Bristol Medical School, Translational Health Sciences, University of Bristol, Bristol, UK
| | - Daniel Prieto-Alhambra
- Center for Statistics in Medicine, Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, University of Oxford Nuffield, Oxford, UK
| | - Martin Englund
- Department of Clinical Sciences, Clinical Epidemiology Unit, Orthopaedics, Lund University, Lund, Sweden
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Department of Orthopaedic Surgery & Sports Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Weiya Zhang
- Academic Rheumatology, University of Nottingham School of Medicine, Nottingham, UK
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
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Neves SC, Rodrigues LM, Bento PADSS, Minayo MCDS. Risk factors involved in adolescent obesity: an integrative review. CIENCIA & SAUDE COLETIVA 2021; 26:4871-4884. [PMID: 34787182 DOI: 10.1590/1413-812320212611.3.30852019] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Accepted: 03/02/2020] [Indexed: 02/04/2023] Open
Abstract
The scope of this study was to examine the risk factors for the development of obesity in adolescence. The objective was to identify risk factors for adolescent obesity by means of an Integrative Review of the Literature. The PICO strategy was used to formulate the following central line of inquiry: What are the risk factors for the development of obesity during adolescence? The VHL and EBSCOhost research databases were consulted, resulting in a selection of 25 articles for in-depth study. The phenomenon of obesity was understood as the result of biological, social, psychological, and nutritional factors. The research revealed a lack of consensus on the risks and benefits, which makes evidence-based recommendations difficult. The study identified proposals that can be implemented, such as a change in eating habits, weight control and the practice of physical exercise. Such behavioral changes can be recommended within the context of the family, schools, and health services. The review recommends prevention strategies and the recognition of school as the ideal medium for health promotion through education. From a political and social standpoint, it is necessary to challenge the prevalence of publicity of the food industry that entices adolescents to consume processed foods with high fat and sugar content.
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Affiliation(s)
- Simone Carvalho Neves
- Enfermagem Souza Marques, Fundação Técnico-Educacional Souza Marques. Av. Ernani Cardoso 335/345, Cascadura. 21310.310 Rio de Janeiro RJ Brasil.
| | | | - Paulo Alexandre de Souza São Bento
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira (IFF), Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
| | - Maria Cecília de Souza Minayo
- Departamento de Estudos sobre Violência e Saúde Jorge Careli (Claves), Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz. Rio de Janeiro RJ Brasil
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Heikkala E, Mikkola I, Jokelainen J, Timonen M, Hagnäs M. Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study. BMC Health Serv Res 2021; 21:964. [PMID: 34521389 PMCID: PMC8442281 DOI: 10.1186/s12913-021-06989-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 09/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP). Methods The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets. Results Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72). Conclusions Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.
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Affiliation(s)
- Eveliina Heikkala
- Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland. .,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland. .,Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland.
| | - Ilona Mikkola
- Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland
| | - Jari Jokelainen
- Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland
| | - Markku Timonen
- Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland
| | - Maria Hagnäs
- Rovaniemi Health Center, Koskikatu 25, 96200, Rovaniemi, Finland.,Medical Research Center Oulu, University of Oulu and Oulu University Hospital, PO Box 5000, 90014, Oulu, Finland.,Center for Life Course Health Research, University of Oulu, PO Box 5000, 90015, Oulu, Finland
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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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Associations between mental health disorder and management of physical chronic conditions in China: a pooled cross-sectional analysis. Sci Rep 2021; 11:5731. [PMID: 33707604 PMCID: PMC7952541 DOI: 10.1038/s41598-021-85126-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/16/2021] [Indexed: 11/25/2022] Open
Abstract
Physical non-communicable diseases (NCDs) and mental health disorders are a rapidly increasing health burden in low-and middle-income countries. This study aims to examine the relationships between mental health disorders and cascade of care in managing four common physical NCDs (hypertension, diabetes, dyslipidemia, chronic kidney disease) in China. We utilized two waves of nationally-representative China Health and Retirement Longitudinal Study (CHARLS 2011, 2015) of older adult population aged 45 and above. A series of unadjusted and adjusted mixed-effect logistic regression was applied to evaluate the association between presence of mental health disorder and physical chronic disease awareness, treatment, and control. We found that the odds of dyslipidemia (AOR 1.81, 95% CI 1.36–2.39) and kidney disease awareness (AOR 2.88, 95% CI 2.12–3.92) were higher for individuals with mental chronic conditions, compared to those without mental chronic conditions. The odds of having hypertension treatment was higher for subjects with mental health disorder, compared to those without (AOR 1.32, 95% CI 1.02–1.70). The odds of having physical chronic conditions controlled was not significantly associated with having mental chronic conditions (P > 0.05). These results indicated that adults with mental health disorder have a greater likelihood of awareness of having dyslipidemia and kidney disease, and receiving treatment for hypertension. Strategies to address the growing burden of physical-mental NCDs in China should include efforts to improve management of patients with comorbid health condition and improve access to continual high-quality treatment after the first diagnosis.
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Swain S, Sarmanova A, Coupland C, Doherty M, Zhang W. Comorbidities in Osteoarthritis: A Systematic Review and Meta-Analysis of Observational Studies. Arthritis Care Res (Hoboken) 2020; 72:991-1000. [PMID: 31207113 DOI: 10.1002/acr.24008] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 06/11/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Osteoarthritis (OA) is a common chronic condition in older individuals, but its association with other chronic conditions is largely unknown. This study aimed to systematically review the literature on comorbidities in individuals with OA compared to those without. METHODS We searched 4 databases for observational studies on comorbidities in individuals with OA. Studies of OA only or in comparison with non-OA controls were included. The risk of bias and study quality were assessed using the Newcastle-Ottawa Scale. The prevalence of comorbidities in the OA group and the prevalence ratio (PR) and 95% confidence interval (95% CI) between OA and non-OA groups were calculated. RESULTS In all, 42 studies from 16 countries (27 case-only and 15 comparative studies) met the inclusion criteria. The mean age of participants varied from 51 to 76 years. The pooled prevalence of any comorbidity was 67% (95% CI 57-74) in individuals with OA versus 56% (95% CI 44-68) in individuals without OA. The pooled PR for any comorbidity was 1.21 (95% CI 1.02-1.45). The PR increased from 0.73 (95% CI 0.43-1.25) for 1 comorbidity to 1.58 (95% CI 1.03-2.42) for 2, and to 1.94 (95% CI 1.45-2.59) for ≥3 comorbidities. The key comorbidities associated with OA were stroke (PR 2.61 [95% CI 2.13-3.21]), peptic ulcer (PR 2.36 [95% CI 1.71-3.27]), and metabolic syndrome (PR 1.94 [95% CI 1.21-3.12]). CONCLUSION Individuals with OA are more likely to have other chronic conditions. The association is dose-dependent in terms of the number of comorbidities, suggesting multimorbidities. Further studies on the causality of this association and clinical implications are needed.
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Affiliation(s)
| | | | - Carol Coupland
- School of Medicine, University of Nottingham, Nottingham, UK
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Riordan F, McHugh SM, O'Donovan C, Mtshede MN, Kearney PM. The Role of Physician and Practice Characteristics in the Quality of Diabetes Management in Primary Care: Systematic Review and Meta-analysis. J Gen Intern Med 2020; 35:1836-1848. [PMID: 32016700 PMCID: PMC7280455 DOI: 10.1007/s11606-020-05676-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 12/03/2019] [Accepted: 01/19/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Despite evidence-based guidelines, high-quality diabetes care is not always achieved. Identifying factors associated with the quality of management in primary care may inform service improvements, facilitating the tailoring of quality improvement interventions to practice needs and resources. METHODS We searched MEDLINE, EMBASE, CINAHL and Web of Science from January 1990 to March 2019. Eligible studies were cohort studies, cross-sectional studies and randomised controlled trials (baseline data) conducted among adults with diabetes, which examined the relationship between any physician and/or practice factors and any objective measure(s) of quality. Studies which examined patient factors only were ineligible. Where possible, data were pooled using random-effects meta-analysis. RESULTS In total, 82 studies were included. The range of individual quality measures and the construction of composite measures varied considerably. Female physicians compared with males ((odds ratio (OR) = 1.07, 95% CI: 1.04, 1.10), 8 studies), physicians with higher diabetes volume compared with lower volume (OR = 1.24, 95% CI: 1.05-1.47, 4 studies) and practices with Electronic Health Records (EHR) versus practices without (OR = 1.43, 95% CI: 1.11-1.84, 4 studies) were associated with a higher quality of care. There was no association between physician experience, practice location and type of practice and quality. Based on the narrative synthesis, increasing physician age and higher practice socio-economic deprivation may be associated with lower quality of care. DISCUSSION Identification of physician- and practice-level factors associated with the quality of care (female gender, younger age, physician-level diabetes volume, practice deprivation and EHR use) may explain differences across practices and physicians, provide potential targets for quality improvement interventions and indicate which practices need specific supports to deliver improvements in diabetes care.
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Affiliation(s)
- F Riordan
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland.
| | - S M McHugh
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | | | - Mavis N Mtshede
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - P M Kearney
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
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Sum G, Koh GCH, Mercer SW, Wei LY, Majeed A, Oldenburg B, Lee JT. Patients with more comorbidities have better detection of chronic conditions, but poorer management and control: findings from six middle-income countries. BMC Public Health 2020; 20:9. [PMID: 31906907 PMCID: PMC6945654 DOI: 10.1186/s12889-019-8112-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 12/19/2019] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND The burden of non-communicable diseases (NCDs) is rising rapidly in middle-income countries (MICs), where NCDs are often undiagnosed, untreated and uncontrolled. How comorbidity impacts diagnosis, treatment, and control of NCDs is an emerging area of research inquiry and have important clinical implications as highlighted in the recent National Institute for Health and Care Excellence guidelines for treating patients suffering from multiple NCDs. This is the first study to examine the association between increasing numbers of comorbidities with being undiagnosed, untreated, and uncontrolled for NCDs, in 6 large MICs. METHODS Cross-sectional analysis of the World Health Organisation Study of Global Ageing and Adult Health (WHO SAGE) Wave 1 (2007-10), which consisted of adults aged ≥18 years from 6 populous MICs, including China, Ghana, India, Mexico, Russia and South Africa (overall n = 41, 557). RESULTS A higher number of comorbidities was associated with better odds of diagnosis for hypertension, angina, and arthritis, and higher odds of having treatment for hypertension and angina. However, more comorbidities were associated with increased odds of uncontrolled hypertension, angina, arthritis, and asthma. Comorbidity with concordant conditions was associated with improved diagnosis and treatment of hypertension and angina. CONCLUSION Patients with more comorbidities have better diagnosis of chronic conditions, but this does not translate into better management and control of these conditions. Patients with multiple NCDs are high users of health services and are at an increased risk of adverse health outcomes. Hence, improving their access to care is a priority for healthcare systems.
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Affiliation(s)
- Grace Sum
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir Foundation Building, Singapore, 117549, Singapore.
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir Foundation Building, Singapore, 117549, Singapore
| | - Stewart W Mercer
- Primary Care and Multimorbidity, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland
| | - Lim Yee Wei
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Azeem Majeed
- Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England
| | - Brian Oldenburg
- Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - John Tayu Lee
- Saw Swee Hock School of Public Health, National University of Singapore, 12 Science Drive 2, Tahir Foundation Building, Singapore, 117549, Singapore.,Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, England.,Nossal Institute for Global Health, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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11
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Nowakowska M, Zghebi SS, Ashcroft DM, Buchan I, Chew-Graham C, Holt T, Mallen C, Van Marwijk H, Peek N, Perera-Salazar R, Reeves D, Rutter MK, Weng SF, Qureshi N, Mamas MA, Kontopantelis E. The comorbidity burden of type 2 diabetes mellitus: patterns, clusters and predictions from a large English primary care cohort. BMC Med 2019; 17:145. [PMID: 31345214 PMCID: PMC6659216 DOI: 10.1186/s12916-019-1373-y] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/20/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The presence of additional chronic conditions has a significant impact on the treatment and management of type 2 diabetes (T2DM). Little is known about the patterns of comorbidities in this population. The aims of this study are to quantify comorbidity patterns in people with T2DM, to estimate the prevalence of six chronic conditions in 2027 and to identify clusters of similar conditions. METHODS We used the Clinical Practice Research Datalink (CPRD) linked with the Index of Multiple Deprivation (IMD) data to identify patients diagnosed with T2DM between 2007 and 2017. 102,394 people met the study inclusion criteria. We calculated the crude and age-standardised prevalence of 18 chronic conditions present at and after the T2DM diagnosis. We analysed longitudinally the 6 most common conditions and forecasted their prevalence in 2027 using linear regression. We used agglomerative hierarchical clustering to identify comorbidity clusters. These analyses were repeated on subgroups stratified by gender and deprivation. RESULTS More people living in the most deprived areas had ≥ 1 comorbidities present at the time of diagnosis (72% of females; 64% of males) compared to the most affluent areas (67% of females; 59% of males). Depression prevalence increased in all strata and was more common in the most deprived areas. Depression was predicted to affect 33% of females and 15% of males diagnosed with T2DM in 2027. Moderate clustering tendencies were observed, with concordant conditions grouped together and some variations between groups of different demographics. CONCLUSIONS Comorbidities are common in this population, and high between-patient variability in comorbidity patterns emphasises the need for patient-centred healthcare. Mental health is a growing concern, and there is a need for interventions that target both physical and mental health in this population.
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Affiliation(s)
- Magdalena Nowakowska
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK. .,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.
| | - Salwa S Zghebi
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK
| | - Darren M Ashcroft
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Pharmacy and Optometry, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK.,NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK
| | - Iain Buchan
- Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK.,Department of Public Health and Policy, Institute of Population Health Sciences, University of Liverpool, Liverpool, L69 3BX, UK
| | - Carolyn Chew-Graham
- Research Institute for Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, DJW 1.54a, Staffordshire, ST5 5BJ, UK
| | - Tim Holt
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Christian Mallen
- Research Institute for Primary Care and Health Sciences, Faculty of Medicine and Health Sciences, Keele University, DJW 1.54a, Staffordshire, ST5 5BJ, UK
| | - Harm Van Marwijk
- Division of Primary Care and Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, BN1 9PH, UK
| | - Niels Peek
- NIHR Greater Manchester Patient Safety Translational Research Centre, University of Manchester, Manchester, M13 9PL, UK.,Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK.,NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK
| | - Rafael Perera-Salazar
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - David Reeves
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Centre for Biostatistics, Division of Population Health, Health Services Research and Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, M13 9PL, UK
| | - Martin K Rutter
- Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medicine, Biology and Health, University of Manchester, Manchester, M13 9PL, UK.,Manchester Diabetes Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester, M13 0JE, UK
| | - Stephen F Weng
- Primary Care Stratified Medicine (PRISM), Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Nadeem Qureshi
- Primary Care Stratified Medicine (PRISM), Division of Primary Care, School of Medicine, University of Nottingham, Nottingham, NG7 2RD, UK
| | - Mamas A Mamas
- Keele Cardiovascular Research Group, Centre for Prognosis Research, Institute for Primary Care and Health Sciences, Keele University, Stoke-on-Trent, ST4 7QB, UK
| | - Evangelos Kontopantelis
- NIHR School for Primary Care Research, Centre for Primary Care and Health Services Research, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Population Health, Health Services Research & Primary Care, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, 5th floor Williamson Building, Manchester, M13 9PL, UK.,Division of Informatics, Imaging, and Data Science, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre (MAHSC), University of Manchester, Manchester, M13 9PL, UK
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12
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Aga F, Dunbar SB, Kebede T, Gary RA. The role of concordant and discordant comorbidities on performance of self-care behaviors in adults with type 2 diabetes: a systematic review. Diabetes Metab Syndr Obes 2019; 12:333-356. [PMID: 31114271 PMCID: PMC6497834 DOI: 10.2147/dmso.s186758] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 02/11/2019] [Indexed: 01/26/2023] Open
Abstract
Background: Most patients with Type 2 diabetes (T2D) have high number of comorbid chronic conditions that can affect their self-care abilities. Guidelines for diabetes self-care behaviors are disease specific with little attention given to managing T2D with other comorbidities. Identifying comorbidities that either improve or potentially diminish the individual's capacity to perform effective self-care behaviors is essential to enhance clinical outcomes. One such framework conceptualizes comorbidities as concordant or discordant with diabetes pathophysiological pathways and care goals. Objective: The purpose of this systematic review was to examine the role of diabetes-concordant and discordant chronic conditions on the performance of self-care behaviors in adults with T2D. Methods: A comprehensive literature search was undertaken to identify published English language articles through the following five electronic databases: PubMed, CINAHL, PsycINFO, ISI Web of Science, and EMBASE. Quantitative studies published from March 2006 to April 2018 were included. Quality of evidence was evaluated using the Joanna Briggs Institutes Critical Appraisal Tools (JBI-CAT) and rated using Quality Assessment Tool for Quantitative Studies (QATQS). Results: The initial database search identified 1,136 articles but only 33 studies that met the inclusion criteria were included. The most common concordant comorbidity was hypertension while depression was the most common discordant condition. Adherence to medications was the most frequent diabetes self-care behavior reported and tended to be higher among concordant comorbidities. The findings showed mixed results concerning the effect of some concordant comorbidities such as hypertension, hyperlipidemia, retinopathy, and heart failure on diabetes self-care behaviors. But, there is agreement across studies that diabetes-discordant comorbidities have a more detrimental effect on self-care behaviors. Conclusions: Concordant comorbidities may improve diabetes self-care, but the evidence is inconclusive. Future research using well designed studies are needed to examine the complex relationship between diabetes self-care and comorbidities.
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Affiliation(s)
- Fekadu Aga
- Department of Nursing, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- Correspondence: Fekadu AgaDepartment of Nursing, School of Nursing & Midwifery, College of Health Sciences, Addis Ababa University, P.O. Box 9083, Addis AbabaTel +125 191 103 3684Email
| | - Sandra B Dunbar
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA30322, USA
| | - Tedla Kebede
- Tikur Anbessa Specialized Hospital, Diabetes & Endcrinology Unit, Department of Internal Medicine School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rebecca A Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, GA30322, USA
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13
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Outcomes of preexisting diabetes mellitus in breast, colorectal, and prostate cancer. J Cancer Surviv 2017; 11:604-613. [PMID: 28735467 PMCID: PMC5602069 DOI: 10.1007/s11764-017-0631-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 07/11/2017] [Indexed: 12/31/2022]
Abstract
Purpose Preexisting diabetes is associated with increased morbidity and mortality in cancer. We examined the impact of incident cancer on the long-term outcomes of diabetes. Methods Using the United Kingdom Clinical Practice Research Datalink, we identified three cohorts of diabetes patients subsequently diagnosed with breast, colorectal, or prostate cancer, each matched to diabetic noncancer controls. Patients were required to have survived at least 1 year after cancer diagnosis (cases) or a matched index date (controls), and were followed up to 10 years for incident microvascular and macrovascular complications and mortality. Multivariate competing risks regression analyses were used to compare outcomes between cancer patients and controls. Results Overall, there were 3382 cancer patients and 11,135 controls with 59,431 person-years of follow-up. In adjusted analyses, there were no statistically significant (p ≤ 0.05) differences in diabetes complication rates between cancer patients and their controls in any of the three cancer cohorts. Combined, cancer patients were less likely (adjusted hazard ratio [HR] 0.88; 95% CI = 0.79–0.98) to develop retinopathy. Cancer patients were more likely to die of any cause (including cancer), but prostate cancer patients were less likely to die of causes associated with diabetes (HR 0.61; 95% CI = 0.43–0.88). Conclusions and implications There is no evidence that incident cancer had an adverse impact on the long-term outcomes of preexisting diabetes. Implications for Cancer Survivors These findings are important for cancer survivors with preexisting diabetes because they suggest that substantial improvements in the relative survival of several of the most common types of cancer are not undermined by excess diabetes morbidity and mortality.
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14
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Comorbid conditions delay diagnosis of colorectal cancer: a cohort study using electronic primary care records. Br J Cancer 2017; 116:1536-1543. [PMID: 28494470 PMCID: PMC5518856 DOI: 10.1038/bjc.2017.127] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 04/11/2017] [Accepted: 04/12/2017] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Pre-existing non-cancer conditions may complicate and delay colorectal cancer diagnosis. METHOD Incident cases (aged ⩾40 years, 2007-2009) with colorectal cancer were identified in the Clinical Practice Research Datalink, UK. Diagnostic interval was defined as time from first symptomatic presentation of colorectal cancer to diagnosis. Comorbid conditions were classified as 'competing demands' (unrelated to colorectal cancer) or 'alternative explanations' (sharing symptoms with colorectal cancer). The association between diagnostic interval (log-transformed) and age, gender, consultation rate and number of comorbid conditions was investigated using linear regressions, reported using geometric means. RESULTS Out of the 4512 patients included, 72.9% had ⩾1 competing demand and 31.3% had ⩾1 alternative explanation. In the regression model, the numbers of both types of comorbid conditions were independently associated with longer diagnostic interval: a single competing demand delayed diagnosis by 10 days, and four or more by 32 days; and a single alternative explanation by 9 days. For individual conditions, the longest delay was observed for inflammatory bowel disease (26 days; 95% CI 14-39). CONCLUSIONS The burden and nature of comorbidity is associated with delayed diagnosis in colorectal cancer, particularly in patients aged ⩾80 years. Effective clinical strategies are needed for shortening diagnostic interval in patients with comorbidity.
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15
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Langton JM, Wong ST, Johnston S, Abelson J, Ammi M, Burge F, Campbell J, Haggerty J, Hogg W, Wodchis WP, McGrail K. Primary Care Performance Measurement and Reporting at a Regional Level: Could a Matrix Approach Provide Actionable Information for Policy Makers and Clinicians? Healthc Policy 2016; 12:33-51. [PMID: 28032823 PMCID: PMC5221710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Primary care services form the foundation of modern healthcare systems, yet the breadth and complexity of services and diversity of patient populations may present challenges for creating comprehensive primary care information systems. Our objective is to develop regional-level information on the performance of primary care in Canada. METHODS A scoping review was conducted to identify existing initiatives in primary care performance measurement and reporting across 11 countries. The results of this review were used by our international team of primary care researchers and clinicians to propose an approach for regional-level primary care reporting. RESULTS We found a gap between conceptual primary care performance measurement frameworks in the peer-reviewed literature and real-world primary care performance measurement and reporting activities. We did not find a conceptual framework or analytic approach that could readily form the foundation of a regional-level primary care information system. Therefore, we propose an approach to reporting comprehensive and actionable performance information according to widely accepted core domains of primary care as well as different patient population groups. CONCLUSIONS An approach that bridges the gap between conceptual frameworks and real-world performance measurement and reporting initiatives could address some of the potential pitfalls of existing ways of presenting performance information (i.e., by single diseases or by age). This approach could produce meaningful and actionable information on the quality of primary care services.
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Affiliation(s)
- Julia M. Langton
- Research Associate, Centre for Health Services and Policy Research, University of British, Columbia Vancouver, BC
| | - Sabrina T. Wong
- Professor, Centre for Health Services and Policy Research & School of Nursing, University of British Columbia, Vancouver, BC
| | - Sharon Johnston
- Associate Professor, Department of Family Medicine, University of Ottawa & Bruyere Research Institute, Ottawa, ON
| | - Julia Abelson
- Professor, Department of Clinical Epidemiology & Biostatistics, Centre for Health Economics and Policy Analysis, McMaster University, Hamilton, ON
| | - Mehdi Ammi
- Assistant Professor, School of Public Policy & Administration, Carleton University, Ottawa, ON
| | - Fred Burge
- Professor, Faculty of Medicine, Dalhousie University, Halifax, NS
| | - John Campbell
- Professor, Primary Care Research Group, University of Exeter Medical School, Exeter, UK
| | | | - William Hogg
- Professor, Department of Family Medicine, University of Ottawa & Bruyere Research Institute, Ottawa, ON
| | - Walter P. Wodchis
- Associate Professor, Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Kimberlyn McGrail
- Associate Professor, Centre for Health Services and Policy Research, University of British Columbia, Vancouver, BC
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Stange KC. In This Issue: Multilevel Effects. Ann Fam Med 2015; 13:510-1. [PMID: 26863691 PMCID: PMC4639373 DOI: 10.1370/afm.1876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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