Disease management: panacea, another false hope, or something in between?

The Relationship Between Health Literacy and Diabetes Self-Efficacy and Foot Self-Care in Type II Diabetics

This study was conducted to determine the effect of health literacy on diabetes self-efficacy and foot self-care in type II diabetics. This descriptive correlational study was conducted with 187 people. The research was conducted between 01 June 2021 and 31 December 2021 in a province located in the southeastern region of Turkey. Non-probability purposive sampling was used as the sampling method. An introductory information form, and the Turkish Health Literacy Scale-32 (THLS-32), Diabetes Self-Efficacy Scale and Diabetes Foot Self-Care Behavior Scale (DFSBS) were used in the study. Data were evaluated with frequency, percentage, mean, and correlation analyses using SPSS 25 software. It was determined that the participants had a low education level and were of advanced age, and that the feet of most of the patients were not examined and there were no wounds on their feet. The health literacy level of 57.8% of the participants was found to be insufficient. The mean THLS-32 score was 22.50 ± 10.65, the Diabetes Self-Efficacy Scale mean score was 72.83 ± 11.84, and the Diabetes Foot Self-Care Behavior Scale mean score was 22.60 ± 5.44. It was determined that there was a relationship between the THLS-32 and Diabetes Self-Efficacy score of those with type II diabetes, and that as health literacy increased, diabetes self-efficacy increased (p < 0.05). It was determined that the health literacy level was insufficient, whereas diabetes self-efficacy and foot self-care were at a good level. It was found that as health literacy increased, self-efficacy increased. Information on health literacy is effective in coping with the disease. For this reason, information on health literacy should be given from an early age.

The association between Patient Assessment of Chronic Illness Care Scores and quality of life in type 2 diabetes patients

Background

Chronic illness care is an important factor for health promotion in diabetes since it affects health outcomes such as quality of life.

Aims

The aim of this study was to investigate the relationship between the Patient Assessment of Chronic Illness Care and the quality of life in type 2 diabetes patients.

Methods

The study used a cross-sectional and correlational design. The sample included 317 patients with type 2 diabetes. A socio-demographic and disease-related questionnaire form, the Patient Assessment of Chronic Illness Care (PACIC) scale and the WHOQOL-BREF Quality of Life Scale were used to collect data.

Results

According to the regression analysis, the stronger predictor affecting all domains of quality of life was the overall PACIC. This study demonstrated the importance of satisfaction level of chronic illness care in the improvement of quality of life. Therefore, the factors affecting the satisfaction level with chronic care services should be determined to improve the quality of life of patients. In addition, healthcare based on the chronic-care model should be provided in the care of the patients.

Conclusions

PACIC had an important effect on quality of life of the patients. This study demonstrated the importance of satisfaction level on chronic illness care in the improvement of quality of life.

Serial multiple mediation of treatment adherence and disease activity in the relationship between continuity of care and health outcomes among rheumatoid arthritis patients

OBJECTIVE

To evaluate the effect of continuity of care on health outcomes (quality of life and functionality) in patients with rheumatoid arthritis and to reveal whether treatment adherence and disease activity have a serial multiple mediator role on this relationship.

METHODS

The study was cross-sectional on 440 rheumatoid arthritis patients who applied to a university hospital rheumatology outpatient clinic. Research data were obtained from both the questionnaire method, which is the primary data source, and the patient files, which are the secondary data source. Process analysis was used in the analysis of the data.

RESULTS

It was found that the continuity of care has a direct effect on the quality of life and the functionality. In addition, it is seen that treatment adherence has a single partial mediator role on the relationship between continuity of care and quality of life; It has been determined that treatment adherence and disease activity have both partial single mediation and serial multiple mediation roles on the relationship between continuity of care and functionality.

CONCLUSION

It is thought that these findings will provide clinicians with important data and information in the management of rheumatoid arthritis.

Born in the USA? A Comparison of "Inspired" Health Care Reforms in Germany and France

CONTEXT

Despite numerous examples of health policy transfer in Western health systems, the nature of such "inspired" reforms has received little detailed attention. The aim of this article is to apply and refine a specific theoretical angle for the analysis of these reforms using the theoretical frameworks of transfer and translation.

METHODS

The design is based on a comparative case study: the introduction of disease management programs (DMPs) for diabetes in Germany in 2002 and in France in 2008, drawing on a literature review and semistructured interviews.

FINDINGS

In introducing its DMP, Germany chose and combined several components in a process of selective borrowing, while France opted for copying a specific foreign program and adapting it. Such differences in process are linked to distinct system structures, in particular the setup of health insurance and the representation of physicians. Furthermore, the displayed versus actual degree of inspiration varied significantly, with a branding strategy in Germany (high display of foreign influence) and the inverse picture in France (high degree of actual inspiration).

CONCLUSIONS

This analysis has applied the dual perspective of transfer and translation. Both perspectives proved complementary and necessary, and translation appeared as a main determinant of implementation success.

Factors Affecting Primary Care Implementation for Older Veterans with multimorbidity in VA

OBJECTIVE

To identify factors affecting implementation of Geriatric Patient Aligned Care Teams (GeriPACT), a patient-centered medical home model for older adults with complex care needs including multiple chronic conditions (MCC), designed to provide them with comprehensive, managed and coordinated primary care.

DATA SOURCES

Qualitative data was collected from key informants at eight VA Medical Centers (VAMCs) geographically spread across the US.

STUDY DESIGN

Guided by the Consolidated Framework for Implementation Research (CFIR), we collected prospective primary data through semi-structured interviews with GeriPACT team members (e.g. physicians, nurses, social workers, pharmacists), leaders (e.g., executive leaders and middle managers), and other staff referring to the program.

DATA COLLECTION

We conducted in-person, semi-structured interviews with 134 key informants. Interviews were recorded with permission and professionally transcribed. Transcripts were coded in NVIVO 11. We used directed content analysis to identify key factors affecting GeriPACT implementation across sites.

PRINCIPAL FINDINGS

Five key factors affected GeriPACT implementation-5 CFIR constructs within two CFIR domains. Within the intervention characteristics domain, two constructs emerged: 1) the structure of the GeriPACT model, and 2) design, quality and packaging. In the inner setting domain, we identified three constructs: 1) available resources (e.g., staffing and space, and infrastructure and information technology; 2) leadership support and engagement, and 3) networks and communications including teamwork, communication and coordination.

CONCLUSIONS

Older Veterans with MCC have complex primary care needs requiring high levels of care management and coordination. Knowing what key factors affect GeriPACT implementation is critical. Study findings also contribute to the growing implementation science literature on applying CFIR to evaluate factors that affect program implementation, especially to aging research. Further studies on MCC-focused specialty primary care will help facilitate patient-centered care provision for older adults' complex health needs while also leveraging synergistic work across factors affecting implementation. This article is protected by copyright. All rights reserved.

Helping persons with multiple chronic conditions overcome barriers to self-management

ABSTRACT

The prevalence of multiple chronic conditions is growing dramatically, which complicates day-to-day self-management for patients. This article describes the features of multiple chronic conditions, an updated chronic care model, barriers to self-management, and strategies NPs can use to reduce or eliminate barriers to self-management in adults with multiple chronic conditions.

Consequences of the presence and absence of empathy during consultations in primary care: A focus group study with patients

OBJECTIVE

There is general consensus that explicit expression of empathy in patient-GP communication is highly valued. Yet, little is known so far about patients' personal experiences with and expectations of empathy. Insight into these experiences and expectations can help to achieve more person-centeredness in GP practice care.

METHODS

Participants were recruited by a press report in local newspapers.

INCLUSION CRITERIA

adults, a visit to the GP in the previous year. Exclusion criterion: a formal complaint procedure. Five focus groups were conducted. The discussions were analyzed using constant comparative analysis.

RESULTS

In total 28 participants took part in the focus group interviews. Three themes were identified: (1) Personalized care and enablement when empathy is present; (2) Frustrations when empathy is absent; (3) Potential pitfalls of empathy. Participants indicated that empathy helps build a more personal relationship and makes them feel welcome and at ease. Furthermore, empathy makes them feel supported and enabled. A lack of empathy can result in avoiding a visit to the GP.

CONCLUSION

Empathy is perceived as an important attribute of patient-GP communication. Its presence results in feelings of satisfaction, relief and trust. Furthermore, it supports patients, resulting in new coping strategies. A lack of empathy causes feelings of frustration and disappointment and can lead to patients avoiding visiting their GP.

PRACTICE IMPLICATIONS

More explicit attention should be given to empathy during medical education in general and during vocational GP-training.

A metasynthesis of factors affecting self-management of chronic illness

AIM

To identify factors that may serve as facilitators and barriers to self-management described by adults living with chronic illness by conducting a qualitative metasynthesis.

BACKGROUND

Self-management is an individuals' active management of a chronic illness in collaboration with their family members and clinicians.

DESIGN

Qualitative metasynthesis.

DATA SOURCES

We analysed studies (N = 53) published between January 2000-May 2013 that described factors affecting self-management in chronic illness as reported by adults aged over 18 years with chronic illness.

REVIEW METHODS

Sandelowsi and Barroso approach to qualitative metasynthesis: literature search; quality appraisal; analysis and synthesis of findings.

RESULTS

Collectively, article authors reported on sixteen chronic illnesses, most commonly diabetes (N = 28) and cardiovascular disease (N = 20). Participants included men and women (mean age = 57, range 18-94) from 20 countries representing diverse races and ethnicities. We identified five categories of factors affecting self-management: Personal/Lifestyle Characteristics; Health Status; Resources; Environmental Characteristics; and Health Care System. Factors may interact to affect self-management and may exist on a continuum of positive (facilitator) to negative (barrier).

CONCLUSION

Understanding factors that influence self-management may improve assessment of self-management among adults with chronic illness and may inform interventions tailored to meet individuals' needs and improve health outcomes.

[Restructuring the healthcare system: redesigning based on needs]

The main task of a healthcare system is the provision of the healthcare services demanded by the population. These needs are mostly defined by the epidemiological status, which has been significantly changed during the last century. Due to development of medical science and technology, the main health problems in modern industrial societies are related to chronic diseases rather than infectious diseases occurring at the beginning of the 20th century. However, healthcare services provided by health institutions are still reactive, formed as reactions to current conditions, and they are hardly suited to requirements related to chronic diseases. This paper outlines international and national healthcare models and their shortcomings, and it traces novel paths of a future solution. The structure of the optimal model is suited to systematically produce the services which are needed by the population, decisively in the case of chronic, non communicable diseases. This can significantly relieve the expensive, technology-based reactive care system, nevertheless, it can provide efficient services in case of tertiary prevention. The configuration of this system is cheap, there is no need of significant infrastructure, but needs massive human resource, so that it can be rationally designed in parallel with the constriction of the reactive care system.

Gerenciamento de doença crônica: equívoco para o grupo etário dos idosos

Alterações nos estilos de vida (mudanças dos hábitos alimentares, aumento do sedentarismo e estresse) e maior expectativa de vida aumentam a incidência das doenças crônicas não transmissíveis, principais causas de óbito e incapacidade no Brasil. Sua gestão passou a ser considerada importante pelos gestores na busca de intervenções e estratégias para reduzir custos, diminuir hospitalizações e combater agravos. Mas a maior parte dos programas de atendimento foca exclusivamente na doença, e isso é um erro. Modelos que funcionem de modo integrado e deem conta das necessidades dos pacientes serão mais efetivos. O objetivo deste artigo foi contribuir para a discussão de políticas e estratégias que permitam a indução de modelos de atenção ao idoso com ênfase em projetos preventivos e resolutivos.

Managing multiple chronic conditions: a strategic framework for improving health outcomes and quality of life

The escalating problem of multiple chronic conditions (MCC) among Americans is now a major public health and medical challenge, associated with suboptimal health outcomes and rising health-care expenses. Despite this problem's growth, the delivery of health services has continued to employ outmoded "siloed" approaches that focus on individual chronic diseases. We describe an action-oriented framework--developed by the U.S. Department of Health and Human Services with additional input provided by stakeholder organizations--that outlines national strategies for maximizing care coordination and for improving health and quality of life for individuals with MCC. We note how the framework's potential can be optimized through some of the provisions of the new Patient Protection and Affordable Care Act, and through public-private partnerships.

When information is insufficient: inspiring patients for medication adherence and the role of social support networking

BACKGROUND

A report presented by the RAND Corporation for the Agency for Healthcare Research and Quality recommends that patient self-management programs should include supportive coaching, and the World Health Organization has suggested that the enhancement of patient motivation and behavioral skills is crucial to increasing patient care adherence. The US healthcare reform legislation also provides incentives for evidence-based activities (eg, coaching) that promote healthy behaviors.

OBJECTIVES

To review the current research on evidence-based coaching methods and their impact on medication adherence, as well as offer practical applications for such coaching interventions.

DISCUSSION

The authors review the role of medication adherence in reducing the burden of chronic diseases, using the definitions of coaching and Network Coaching as a starting point for interventions that can enhance providers' skills in motivating patients to improve their treatment adherence. Practical examples are included throughout the article to illustrate the benefits of these coaching methods for patients and providers. The mnemonic COPE is used to assist providers in the recall of 4 significant coaching and Network Coaching concepts-connectedness and collaboration, open-ended questions, positive attitude, and encourage support. Following COPE can reinforce physicians and pharmacists in their attempt to improve patient medication adherence.

CONCLUSION

The article presents healthcare providers, including physicians and pharmacists, with a rationale for developing evidence-based coaching skills and offers suggestions for the application of key coaching concepts.

The potential impact of the World Trade Organization's general agreement on trade in services on health system reform and regulation in the United States

The collapse of the World Trade Organization's (WTO) Doha Round of talks without achieving new health services liberalization presents an important opportunity to evaluate the wisdom of granting further concessions to international investors in the health sector. The continuing deterioration of the U.S. health system and the primacy of reform as an issue in the 2008 presidential campaign make clear the need for a full range of policy options for addressing the national health crisis. Yet few commentators or policymakers realize that existing WTO health care commitments may already significantly constrain domestic policy options. This article illustrates these constraints through an evaluation of the potential effects of current WTO law and jurisprudence on the implementation of a single-payer national health insurance system in the United States, proposed incremental national and state health system reforms, the privatization of Medicare, and other prominent health system issues. The author concludes with some recommendations to the U.S. Trade Representative to suspend existing liberalization commitments in the health sector and to interpret current and future international trade treaties in a manner consistent with civilized notions of health care as a universal human right.

Making the Case for a Nurse-Led Vascular Access Team Utilizing a Quality Assurance Conceptual Framework

The cost of complications of central venous access devices (CVADs) in today's health care setting is creating a financial burden, increasing the expenditures of resources, and consuming the time of health care providers to resolve. As the roles of nurses continue to evolve, nurses may be in a position to recognize and prevent many of these complications. This paper proposes a conceptual model to address the issues related to caring for and monitoring CVADs, while reducing complications and increasing quality of patient care.

Evidence on the Chronic Care Model in the new millennium

Developed more than a decade ago, the Chronic Care Model (CCM) is a widely adopted approach to improving ambulatory care that has guided clinical quality initiatives in the United States and around the world. We examine the evidence of the CCM's effectiveness by reviewing articles published since 2000 that used one of five key CCM papers as a reference. Accumulated evidence appears to support the CCM as an integrated framework to guide practice redesign. Although work remains to be done in areas such as cost-effectiveness, these studies suggest that redesigning care using the CCM leads to improved patient care and better health outcomes.

Medicare disease management in policy context

Interim results of the Medicare health support (MHS) demonstration projects suggest that commercial disease management (DM) is unable to deliver short-term medical cost savings. This is not surprising given the current DM program focus on compliance with process measures that may only lead to cost savings in the long-term. A program focused on reducing near-term hospitalizations is more likely to deliver savings during the initial 3-year phase of MHS. If the early trends in MHS are indicative of the final results, CMS will face the decision of whether to abandon commercial DM in favor of other chronic care management strategies. This article supports the upcoming assessment by describing the characteristics of the current commercial DM model that limit its ability to deliver short-term medical cost savings and the changes required to overcome these limitations.

15-site randomized trial of coordinated care in Medicare FFS

Medicare beneficiaries in fee-for-service (FFS) who had chronic illnesses and volunteered to participate in 15 care coordination programs were randomized to treatment or control status. Nurses provided patient education (mostly by telephone) to improve adherence and ability to communicate with physicians. Patients were contacted an average of two times per month. The findings after 2 years are not encouraging. Few programs improved patient behaviors, health, or quality of care. The treatment group had significantly fewer hospitalizations in only one program; no program reduced gross or net expenditures. However, effects may be observed when 4 years of followup are available and sample sizes increase.