1
|
Shen H, van der Kleij R, van der Boog PJM, Chavannes NH. Developing a Tailored eHealth Self-Management Intervention for Patients With Chronic Kidney Disease in China: Intervention Mapping Approach. JMIR Form Res 2024; 8:e48605. [PMID: 38869943 PMCID: PMC11211709 DOI: 10.2196/48605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 09/24/2023] [Accepted: 04/03/2024] [Indexed: 06/14/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a major public health concern. Adequate self-management skills are vital to reduce CKD burden, optimize patient health outcomes, and control health care expenditures. Using eHealth to support CKD self-management has the potential to promote healthy behaviors and improve health outcomes of patients with CKD. However, knowledge of the implementation of such interventions in general, and in China specifically, is still limited. OBJECTIVE This study aims to develop a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) eHealth self-management intervention. METHODS We used an intervention mapping approach. In phase 1, a systematic review and 2 qualitative studies were conducted to examine the needs, beliefs, and perceptions of patients with CKD and health care professionals regarding CKD self-management and eHealth interventions. Afterward, key factors gathered from the aforementioned studies were categorized following the 5 domains of the Consolidated Framework for Implementation Research (CFIR). In phase 2, we specified program outcomes, performance objectives, determinants, theory-based methods, and practical strategies. Knowledge obtained from previous results was combined to complement core components of the MD self-management intervention and adapt them for Chinese patients with CKD. Additionally, the CFIR-Expert Recommendations for Implementing Change Matching Tool was pragmatically used to generate a list of potential implementation strategies to address the key factors influencing the implementation of eHealth CKD self-management interventions, and implementation strategies were discussed and finalized with the intervention monitoring group. RESULTS An overview of the CFIR domains showed the essential factors influencing the implementation of eHealth CKD self-management interventions in Chinese settings, including "knowledge and beliefs" in the domain "individual characteristics," "quality and advantage of eHealth intervention" in the domain "intervention characteristics," "compatibility" in the domain "inner setting," and "cultural context" in the domain "outer setting." To ensure the effectiveness of the Dutch MD-based self-management intervention, we did not change the core self-management intervention components of MD that underlie its effectiveness, such as self-monitoring. We identified surface-level cultural adaptations involving customizing intervention content, messages, and approaches to the observable cultural characteristics of the local population to enhance the intervention's appeal, receptivity, and feasibility, such as providing video or voice call options to support interactions with health care professionals. Furthermore, the adapted modules such as Knowledge Center and My Self-Monitoring were developed in a mobile health app. CONCLUSIONS Our study resulted in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China that has the potential to optimize patients' self-management skills and improve health status and quality of life. Moreover, our study's research approach and results can inform future research on the tailoring and translation of evidence-based, eHealth self-management interventions to various contexts. TRIAL REGISTRATION ClinicalTrials.gov NCT04212923; https://classic.clinicaltrials.gov/ct2/show/NCT04212923.
Collapse
Affiliation(s)
- Hongxia Shen
- School of Nursing, Guangzhou Medical University, Guangzhou, China
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| | | | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
- National eHealth Living Lab, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
2
|
Chen X, Hu Y, Peng L, Wu H, Ren J, Liu G, Cao L, Yang M, Hao Q. Comprehensive geriatric assessment of older patients with renal disease: a cross-sectional survey. Sci Rep 2024; 14:8758. [PMID: 38627582 PMCID: PMC11021503 DOI: 10.1038/s41598-024-59370-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Accepted: 04/09/2024] [Indexed: 04/19/2024] Open
Abstract
Multidimensional health function impairments are common in older patients with chronic kidney disease (CKD). The purpose of this study was to explore whether the risk or severity of geriatric syndrome increased with a decline in renal function. This survey was conducted for CKD patients aged ≥ 60 years and hospitalized at West China Hospital of Sichuan University (Center of Gerontology and Geriatrics, Nephrology, and Endocrinology) and Chengdu Kangfu Kidney Disease Hospital from September 01, 2013 to June 30, 2014. Patients underwent multidimensional individualized assessments by trained doctors. Logistic regression analysis found that the risk of assisted walking (P = 0.001) and urinary incontinence (P = 0.039) increased with a decline in renal function. Regression analysis revealed that the scores of activities of daily living (P = 0.024), nutritional status (P = 0.000), total social support (P = 0.014), and objective support (P = 0.000) decreased with a decline in renal function.
Collapse
Affiliation(s)
- Xiaoyu Chen
- Department of Nephropathy and Rheumatology Immunology, Jiulongpo People's Hospital, Chongqing, China
| | - Yingchun Hu
- Department of Cardiovascular, Nanfang Hospital, Southern Medical University, Guangzhou, China.
| | - Lei Peng
- Department of Medical Clinical Laboratory, People's Hospital of Shapingba District, Chongqing, China
| | - Hongmei Wu
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Jiangwen Ren
- Department of Nephropathy and Rheumatology Immunology, Jiulongpo People's Hospital, Chongqing, China
| | - Guanjian Liu
- Center for Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, China
| | - Li Cao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Ming Yang
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| | - Qiukui Hao
- The Center of Gerontology and Geriatrics, West China Hospital, Sichuan University, Chengdu, China
| |
Collapse
|
3
|
Hui M, Zhang D, Ye L, Lv J, Yang L. Digital Health Interventions for Quality Improvements in Chronic Kidney Disease Primary Care: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med 2024; 13:364. [PMID: 38256498 PMCID: PMC10816029 DOI: 10.3390/jcm13020364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Revised: 12/10/2023] [Accepted: 01/04/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a significant public health issue globally. The importance of its timely identification and early intervention is paramount. However, a systematic approach for early CKD management in the primary care setting is currently lacking, receiving less attention compared to upstream risk factors such as diabetes and hypertension. This oversight may lead to a failure in meeting quality-of-care indicators. Digital health interventions (DHIs), which leverage digital tools to enhance healthcare delivery, have shown effectiveness in managing chronic diseases and improving the quality, safety, and efficiency of primary care. Our research aimed to evaluate the effectiveness of DHIs in the care process, focusing on their reach, uptake, and feasibility. METHODS In this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane Central Register of Controlled Trials, Web of Science, and ClinicalTrials.gov for randomized controlled trials (RCTs) assessing DHIs' effectiveness in CKD patient care among adults in primary care settings. The search, conducted on 30 June 2023, included studies published in English from 1 January 2009. Screening was conducted using Covidence, adhering to Cochrane's guidelines for data extraction. We primarily evaluated changes in care processes (testing, documentation, medication use, etc.) and the use of renin-angiotensin-aldosterone system inhibitors (RAASi), referrals, among others. Multilevel meta-analysis was employed to address within-study clustering, and meta-regression analyzed the impact of study characteristics on heterogeneity in effect sizes. Clinical endpoints were recorded where available. Bias risk was assessed using the Cochrane Risk of Bias 2 tool. Data on reach, uptake, and feasibility were narratively summarized. The study is registered with PROSPERO (CRD42023449098). RESULTS From 679 records, 12 RCTs were included in the narrative synthesis, and 6 studies (encompassing 7 trials) in the meta-analysis. The trials indicated a -0.85% change (95%CI, -5.82% to 4.11%) in the proportion of patients receiving desired care. This result showed considerable heterogeneity (I2 = 91.9%). One study characteristic (co-intervention, education) correlated with larger effects. Although including co-intervention in multivariable meta-regression was significant, it did not diminish heterogeneity. The reported reach varied and was not high, while the uptake was relatively high. Most studies did not explicitly address feasibility, though some statements implied its evaluation. CONCLUSIONS The current literature on the impact of DHIs in community-based CKD care is limited. The studies suggest a non-significant effect of DHIs on enhancing CKD management in community settings, marked by significant heterogeneity. Future research should focus on rigorous, methodologically sound implementations to better assess the effectiveness of DHIs in the primary care management of CKD.
Collapse
Affiliation(s)
- Miao Hui
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China (J.L.); (L.Y.)
- Department of Cell Biology and Stem Cell Research Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing 100191, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, China
| | - Duoduo Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China (J.L.); (L.Y.)
- Department of Cell Biology and Stem Cell Research Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing 100191, China
| | - Lili Ye
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China (J.L.); (L.Y.)
- Department of Cell Biology and Stem Cell Research Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing 100191, China
| | - Jicheng Lv
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China (J.L.); (L.Y.)
- Department of Cell Biology and Stem Cell Research Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing 100191, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, China
| | - Li Yang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing 100034, China (J.L.); (L.Y.)
- Department of Cell Biology and Stem Cell Research Center, School of Basic Medical Sciences, Peking University Health Science Center, Beijing 100191, China
- Key Laboratory of Renal Disease, National Health Commission of China, Beijing 100191, China
- Key Laboratory of Chronic Kidney Disease Prevention and Treatment (Peking University), Ministry of Education, Beijing 100034, China
| |
Collapse
|
4
|
Gazaway S, Gutierrez O, Wells R, Nix‐Parker T, Lyas C, Daniel S, Lang‐Lindsey K, Bryant T, Knight R, Odom JN. Exploring the health-related decision-making experiences of people with chronic kidney disease and their caregivers: A qualitative study. Health Expect 2023; 27:e13907. [PMID: 37926914 PMCID: PMC10757106 DOI: 10.1111/hex.13907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 10/21/2023] [Accepted: 10/24/2023] [Indexed: 11/07/2023] Open
Abstract
BACKGROUND This study aimed to explore the decision-making experience of patients with chronic kidney disease (CKD) and their caregivers. METHODS This was a qualitative descriptive study of the decision-making experiences of individuals with stage 3-end-stage CKD and their family caregivers. One-on-one, semistructured interviews were conducted using a guide developed and approved by a community advisory group. Data were analyzed using thematic analysis. RESULTS Three themes were identified: (1) decisions triggered by declining health and broad in scope, (2) challenges to decision-making and (3) factors influencing decision-making. Participants' experiences with health-related decision-making demonstrated that decisions were triggered when health declined. Yet, decisions that impact disease progression were being made in stage 3. Decision-making was made difficult due to lack of information, complex co-morbidities, and poor resource utilization. However, the structure and nature of the medical appointment, supportive caregivers, and resources served to remove challenges. CONCLUSION Decision-support interventions must train patients and caregivers to be empowered participants in answer-seeking behaviours upstream of advanced illness. PUBLIC CONTRIBUTIONS This work was conducted in full collaboration with a community advisory board consisting of patients with CKD, caregivers and clinicians. These members are noted in the acknowledgement section, and those who worked with the team to develop the interview guide, study protocols, and manuscript preparation are included as authors. As part of their role, advisory members met monthly, providing input on recruitment, study progress, inclusion of diverse voices and added relevance to study findings.
Collapse
Affiliation(s)
- Shena Gazaway
- Division Family, Commuity, & Health Systems, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Nephrology Training and Research CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Orlando Gutierrez
- Nephrology Training and Research CenterUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division of Nephrology, Heersink School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Rachel Wells
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Tamara Nix‐Parker
- School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Claretha Lyas
- Division of Nephrology, Heersink School of MedicineUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Shawona Daniel
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| | - Katina Lang‐Lindsey
- Department of Social Work, Psychology and CounselingAlabama A&M UniversityHuntsvilleAlabamaUSA
| | | | | | - James N. Odom
- Center for Palliative and Supportive CareUniversity of Alabama at BirminghamBirminghamAlabamaUSA
- Division‐Acute, Chronic & Continuing Care, School of NursingUniversity of Alabama at BirminghamBirminghamAlabamaUSA
| |
Collapse
|
5
|
Lunardi LE, Hill K, Xu Q, Le Leu R, Bennett PN. The effectiveness of patient activation interventions in adults with chronic kidney disease: A systematic review and meta-analysis. Worldviews Evid Based Nurs 2023. [PMID: 36906914 DOI: 10.1111/wvn.12634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2022] [Revised: 12/14/2022] [Accepted: 12/28/2022] [Indexed: 03/13/2023]
Abstract
BACKGROUND Chronic kidney disease (CKD) is a complex health condition that profoundly impacts an individual's general health and well-being throughout their entire lifetime. People with CKD require the knowledge, confidence, and skills to actively self-manage their health. This is referred to as patient activation. The efficacy of interventions to increase patient activation in the CKD population is unclear. AIM This study aimed to examine the effectiveness of patient activation interventions on behavioral health-related outcomes among people with CKD stages 3-5. METHODS A systematic review and meta-analysis of randomized controlled trials (RCTs) of patients with CKD stages 3-5 was performed. MEDLINE, EMCARE, EMBASE, and PsychINFO databases were searched between 2005 and February 2021. Risk of bias was assessed using the Joanna Bridge Institute critical appraisal tool. RESULTS Nineteen RCTs that enrolled 4414 participants were included for synthesis. Only one RCT reported patient activation using the validated 13-item patient activation measure (PAM-13). Four studies demonstrated strong evidence that the intervention group developed a higher level of self-management compared to the control group (standardized mean differences [SMD] = 1.12, 95% CI [0.36, 1.87], p = .004). Eight RCTs led to a significant improvement in self-efficacy (SMD = 0.73, 95% CI [0.39, 1.06], p < .0001). There was weak to no evidence on the effect of the strategies shown on the physical component and mental components of health-related quality of life, and medication adherence. LINKING EVIDENCE TO ACTION This meta-analysis highlights the importance of including tailored interventions using a cluster approach including patient education, goal setting with individualized action plan, and problem-solving to engage patients to be more actively involved in the self-management of their CKD.
Collapse
Affiliation(s)
- Laura E Lunardi
- Central Northern Adelaide Renal & Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Clinical Health Sciences, Rosemary Byrant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Kathy Hill
- Clinical Health Sciences, Rosemary Byrant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Qunyan Xu
- Clinical Health Sciences, Rosemary Byrant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| | - Richard Le Leu
- Central Northern Adelaide Renal & Transplantation Service, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Paul N Bennett
- Clinical Health Sciences, Rosemary Byrant AO Research Centre, University of South Australia, Adelaide, South Australia, Australia
| |
Collapse
|
6
|
Wright PJ, Raynor PA, Bowers D, Combs EM, Corbett CF, Hardy H, Patel K. Leveraging digital technology for social connectedness among adults with chronic conditions: A systematic review. Digit Health 2023; 9:20552076231204746. [PMID: 37799504 PMCID: PMC10548813 DOI: 10.1177/20552076231204746] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 09/14/2023] [Indexed: 10/07/2023] Open
Abstract
Purpose To review the evidence about the impact of digital technology on social connectedness among adults with one or more chronic health conditions. Methods PubMed, Embase, Social Sciences, CINAHL, and Compendex were systematically searched for full-text, peer-reviewed empirical evidence published between 2012 and 2023 and reported using the PRISMA flow diagram. Articles were critically appraised applying the Joanna Briggs Institute checklists. Specific data were extracted based on the framework for social identity and technology approaches for health outcomes and then analyzed and synthesized. Results Thirty-four studies met study criteria. Evidence showed heterogeneity among research methodology, chronic health conditions, digital technology, and health outcomes. Technology use was influenced by factors such as usability, anonymity, availability, and control. More advanced digital technologies require higher digital literacy and improved accessibility features/modifications. Social support was the most measured aspect of social connectedness. The emotional and informational forms of social support were most reported; instrumental support was the least likely to be delivered. Self-efficacy for using technology was considered in seven articles. Sixteen articles reported health outcomes: 31.2% (n = 5) described mental health outcomes only, 18.8% (n = 3) reported physical health outcomes only, 31.2% (n = 5) detailed both physical and mental health outcomes, whereas 18.8% (n = 3) denoted well-being or quality-of-life outcomes. Most often, health outcomes were positive, with negative outcomes for selected groups also noted. Conclusion Leveraging digital technology to promote social connectedness has the potential to affect positive health outcomes. Further research is needed to better understand the social integration of technology among populations with different contexts and chronic health conditions to enhance and tailor digital interventions.
Collapse
Affiliation(s)
- Pamela J Wright
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Phyllis A Raynor
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Dana Bowers
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Elizabeth M Combs
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Cynthia F Corbett
- Department of Biobehavioral Health and Nursing Science, College of Nursing, University of South Carolina, Columbia, SC, USA
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Hannah Hardy
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
- Department of Public Health, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Khushi Patel
- Advancing Chronic Care Outcomes through Research and iNnovation (ACORN) Center, College of Nursing, University of South Carolina, Columbia, SC, USA
- Department of Public Health, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
7
|
Campbell ZC, Dawson JK, Kirkendall SM, McCaffery KJ, Jansen J, Campbell KL, Lee VW, Webster AC. Interventions for improving health literacy in people with chronic kidney disease. Cochrane Database Syst Rev 2022; 12:CD012026. [PMID: 36472416 PMCID: PMC9724196 DOI: 10.1002/14651858.cd012026.pub2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Low health literacy affects 25% of people with chronic kidney disease (CKD) and is associated with increased morbidity and death. Improving health literacy is a recognised priority, but effective interventions are not clear. OBJECTIVES This review looked the benefits and harms of interventions for improving health literacy in people with CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 12 July 2022 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. We also searched MEDLINE (OVID) and EMBASE (OVID) for non-randomised studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and non-randomised studies that assessed interventions aimed at improving health literacy in people with CKD. DATA COLLECTION AND ANALYSIS Two authors independently assessed studies for eligibility and performed risk of bias analysis. We classified studies as either interventions aimed at improving aspects of health literacy or interventions targeting a population of people with poor health literacy. The interventions were further sub-classified in terms of the type of intervention (educational, self-management training, or educational with self-management training). Results were expressed as mean difference (MD) or standardised mean difference (SMD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% CI for dichotomous outcomes. MAIN RESULTS We identified 120 studies (21,149 participants) which aimed to improve health literacy. There were 107 RCTs and 13 non-randomised studies. No studies targeted low literacy populations. For the RCTs, selection bias was low or unclear in 94% of studies, performance bias was high in 86% of studies, detection bias was high in 86% of studies reporting subjective outcomes and low in 93% of studies reporting objective outcomes. Attrition and other biases were low or unclear in 86% and 78% of studies, respectively. Compared to usual care, low certainty evidence showed educational interventions may increase kidney-related knowledge (14 RCTs, 2632 participants: SMD 0.99, 95% CI 0.69 to 1.32; I² = 94%). Data for self-care, self-efficacy, quality of life (QoL), death, estimated glomerular filtration rate (eGFR) and hospitalisations could not be pooled or was not reported. Compared to usual care, low-certainty evidence showed self-management interventions may improve self-efficacy (5 RCTs, 417 participants: SMD 0.58, 95% CI 0.13 to 1.03; I² = 74%) and QoL physical component score (3 RCTs, 131 participants: MD 4.02, 95% CI 1.09 to 6.94; I² = 0%). There was moderate-certainty evidence that self-management interventions probably did not slow the decline in eGFR after one year (3 RCTs, 855 participants: MD 1.53 mL/min/1.73 m², 95% CI -1.41 to 4.46; I² = 33%). Data for knowledge, self-care behaviour, death and hospitalisations could not be pooled or was not reported. Compared to usual care, low-certainty evidence showed educational with self-management interventions may increase knowledge (15 RCTs, 2185 participants: SMD 0.65, 95% CI 0.36 to 0.93; I² = 90%), improve self-care behaviour scores (4 RCTs, 913 participants: SMD 0.91, 95% CI 0.00 to 1.82; I² =97%), self-efficacy (8 RCTs, 687 participants: SMD 0.50, 95% CI 0.10 to 0.89; I² = 82%), improve QoL physical component score (3 RCTs, 2771 participants: MD 2.56, 95% CI 1.73 to 3.38; I² = 0%) and may make little or no difference to slowing the decline of eGFR (4 RCTs, 618 participants: MD 4.28 mL/min/1.73 m², 95% CI -0.03 to 8.85; I² = 43%). Moderate-certainty evidence shows educational with self-management interventions probably decreases the risk of death (any cause) (4 RCTs, 2801 participants: RR 0.73, 95% CI 0.53 to 1.02; I² = 0%). Data for hospitalisation could not be pooled. AUTHORS' CONCLUSIONS Interventions to improve aspects of health literacy are a very broad category, including educational interventions, self-management interventions and educational with self-management interventions. Overall, this type of health literacy intervention is probably beneficial in this cohort however, due to methodological limitations and high heterogeneity in interventions and outcomes, the evidence is of low certainty.
Collapse
Affiliation(s)
- Zoe C Campbell
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jessica K Dawson
- Westmead Clinical School, The University of Sydney at Westmead, Westmead, Australia
- Department of Nutrition and Dietetics, St George Hospital, Kogarah, Australia
| | | | - Kirsten J McCaffery
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - Jesse Jansen
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Department of Family Medicine, School Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, Netherlands
- Faculty of Health Medicine and Life Sciences (FHML), Maastricht University, Maastricht, Netherlands
| | - Katrina L Campbell
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Vincent Ws Lee
- Westmead Clinical School, The University of Sydney at Westmead, Westmead, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia
| | - Angela C Webster
- Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- NHMRC Clinical Trials Centre, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
- Westmead Applied Research Centre, The University of Sydney at Westmead, Westmead, Australia
- Department of Transplant and Renal Medicine, Westmead Hospital, Westmead, Australia
| |
Collapse
|
8
|
Yang Y, Hoo J, Tan J, Lim L. Multicomponent integrated care for patients with chronic heart failure: systematic review and meta‐analysis. ESC Heart Fail 2022; 10:791-807. [PMID: 36377317 PMCID: PMC10053198 DOI: 10.1002/ehf2.14207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Revised: 09/13/2022] [Accepted: 10/02/2022] [Indexed: 11/16/2022] Open
Abstract
To investigate the effectiveness of multicomponent integrated care on clinical outcomes among patients with chronic heart failure. We conducted a meta-analysis of randomized clinical trials, published in English language from inception to 20 April 2022, with at least 3-month implementation of multicomponent integrated care (defined as two or more quality improvement strategies from different domains, viz. the healthcare system, healthcare providers, and patients). The study outcomes were mortality (all-cause or cardiovascular) and healthcare utilization (hospital readmission or emergency department visits). We pooled the risk ratio (RR) using Mantel-Haenszel test. A total of 105 trials (n = 37 607 patients with chronic heart failure; mean age 67.9 ± 7.3 years; median duration of intervention 12 months [interquartile range 6-12 months]) were analysed. Compared with usual care, multicomponent integrated care was associated with reduced risk for all-cause mortality [RR 0.90, 95% confidence interval (CI) 0.86-0.95], cardiovascular mortality (RR 0.73, 95% CI 0.60-0.88), all-cause hospital readmission (RR 0.95, 95% CI 0.91-1.00), heart failure-related hospital readmission (RR 0.84, 95% CI 0.79-0.89), and all-cause emergency department visits (RR 0.91, 95% CI 0.84-0.98). Heart failure-related mortality (RR 0.94, 95% CI 0.74-1.18) and cardiovascular-related hospital readmission (RR 0.90, 95% CI 0.79-1.03) were not significant. The top three quality improvement strategies for all-cause mortality were promotion of self-management (RR 0.86, 95% CI 0.79-0.93), facilitated patient-provider communication (RR 0.87, 95% CI 0.81-0.93), and e-health (RR 0.88, 95% CI 0.81-0.96). Multicomponent integrated care reduced risks for mortality (all-cause and cardiovascular related), hospital readmission (all-cause and heart failure related), and all-cause emergency department visits among patients with chronic heart failure.
Collapse
Affiliation(s)
- Ya‐Feng Yang
- Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia
| | - Jia‐Xin Hoo
- Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia
| | - Jia‐Yin Tan
- Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia
| | - Lee‐Ling Lim
- Department of Medicine, Faculty of Medicine Universiti Malaya Kuala Lumpur Malaysia
- Department of Medicine and Therapeutics The Chinese University of Hong Kong Hong Kong SAR China
- Asia Diabetes Foundation Hong Kong SAR China
| |
Collapse
|
9
|
Patel Y, Vassilev I, du Toit SHJ. Implementing a digital tool to support meaningful engagement with socially isolated or lonely older adults. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e6456-e6466. [PMID: 36308765 PMCID: PMC10092141 DOI: 10.1111/hsc.14090] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 07/18/2022] [Accepted: 10/01/2022] [Indexed: 06/16/2023]
Abstract
Social isolation and loneliness are significant concerns in community dwelling older adults due to associated poorer health outcomes, inadequate crises responsiveness and increased societal burdens of care and cost. Generating Engagement in Networks Involvement (GENIE) is an online evidence-based, client-centred social network tool piloted by community-aged care services in Sydney, Australia. GENIE facilitates access to community resources, activities and people to extend or re-establish a client's social connections. This study aimed to identify GENIE's potential to maintain and promote social connections in older adults from the perspective of allied health professionals who could deliver GENIE. This qualitative exploratory study involved 33 participants on an emerging placement across two organisations who piloted GENIE. Data included consensus and priority statements produced from six nominal group technique-facilitated discussions, and an inductive thematic analysis of student documentation and all consensus statements. The main findings indicated that participants prioritised GENIE's clinical advantages, implementation barriers and recommendations for future implementation. The inductive thematic analysis revealed the two themes of practice applications, and client and professional experiences when using GENIE. As a time-efficient and personalised intervention, the research team concluded that GENIE could empower service providers to address the overarching needs of clients through rapidly connecting older adults to resources of their interests within the overburdened Australian-aged care system.
Collapse
Affiliation(s)
- Yasheeka Patel
- Discipline of Occupational Therapy, Faculty of Medicine and HealthThe University of SydneySydneyNew South WalesAustralia
| | | | | |
Collapse
|
10
|
Rossing P, Caramori ML, Chan JC, Heerspink HJ, Hurst C, Khunti K, Liew A, Michos ED, Navaneethan SD, Olowu WA, Sadusky T, Tandon N, Tuttle KR, Wanner C, Wilkens KG, Zoungas S, de Boer IH. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int 2022; 102:S1-S127. [PMID: 36272764 DOI: 10.1016/j.kint.2022.06.008] [Citation(s) in RCA: 280] [Impact Index Per Article: 140.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 06/21/2022] [Indexed: 02/07/2023]
|
11
|
Brooks H, Devereux-Fitzgerald A, Richmond L, Caton N, Newton A, Downs J, Lovell K, Bee P, Cherry MG, Young B, Vassilev I, Rotheram C, Rogers A. Adapting a social network intervention for use in secondary mental health services using a collaborative approach with service users, carers/supporters and health professionals in the United Kingdom. BMC Health Serv Res 2022; 22:1140. [PMID: 36085063 PMCID: PMC9461266 DOI: 10.1186/s12913-022-08521-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 08/30/2022] [Indexed: 12/03/2022] Open
Abstract
Background Social integration, shared decision-making and personalised care are key elements of mental health and social care policy. Although these elements have been shown to improve service user and service-level outcomes, their translation into practice has been inconsistent and social isolation amongst service users persists. Aim To co-adapt, with service users, carers/supporters and health professionals, a web-based social network intervention, GENIE™, for use in secondary mental health services. The intervention is designed to support social activity and preference discussions between mental healthcare professionals and service users as a means of connecting individuals to local resources. Methods In Phase 1 (LEARN), we completed two systematic reviews to synthesise the existing evidence relating to the i) effectiveness and ii) the implementation of social network interventions for people with mental health difficulties. We undertook semi-structured interviews with a convenience sample of 15 stakeholders previously involved in the implementation of the intervention in physical healthcare settings. Interviews were also conducted with 5 national key stakeholders in mental health (e.g., policy makers, commissioners, third sector leads) to explore wider implementation issues. In Phase 2 (ADAPT), we worked iteratively with eight service users, nine carers, six professionals/volunteers and our patient and public advisory group. We drew on a framework for experience-based co-design, consisting of a series of stakeholder consultation events, to discuss the use of the social network intervention, in mental health services. Participants also considered factors that could serve as enablers, barriers, and challenges to local implementation. Results Across the stakeholder groups there was broad agreement that the social network intervention had potential to be useful within mental health services. In terms of appropriate and effective implementation, such an intervention was predicted to work best within the care planning process, on discharge from hospital and within early intervention services. There were indications that the social connection mapping and needs assessment components were of most value and feasible to implement which points to the potential utility of a simplified version compared to the one used in this study. The training provided to facilitators was considered to be more important than their profession and there were indications that service users should be offered the opportunity to invite a carer, friend, or family member to join them in the intervention. Conclusion The GENIE™ intervention has been co-adapted for use in mental health services and a plan for optimal implementation has been co-produced. The next phase of the programme of work is to design and implement a randomised controlled trial to evaluate clinical and cost effectiveness of a simplified version of the intervention. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08521-1.
Collapse
|
12
|
Shen H, van der Kleij R, van der Boog PJM, Wang W, Song X, Li Z, Brakema E, Lou X, Chavannes N. Digital tools/eHealth to support CKD self-management: A qualitative study of perceptions, attitudes and needs of patients and health care professionals in China. Int J Med Inform 2022; 165:104811. [PMID: 35753175 DOI: 10.1016/j.ijmedinf.2022.104811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 05/05/2022] [Accepted: 06/05/2022] [Indexed: 10/18/2022]
Abstract
BACKGROUND A growing body of evidence supports the potential effectiveness of electronic health (eHealth) self-management interventions in improving disease self-management skills and health outcomes of patients suffering from chronic kidney disease (CKD). However, current research on CKD eHealth self-management interventions has almost exclusively focused on high-income, western countries. OBJECTIVE To inform the adaptation of a tailored eHealth self-management intervention for patients with CKD in China based on the Dutch Medical Dashboard (MD) intervention, we examined the perceptions, attitudes and needs of Chinese patients with CKD and health care professionals (HCPs) towards eHealth based (self-management) interventions in general and the Dutch MD intervention in specific. METHODS We conducted a basic interpretive, cross-sectional qualitative study comprising semi-structured interviews with 11 patients with CKD and 10 HCPs, and 2 focus group discussions with 9 patients with CKD. This study was conducted in the First Affiliated Hospital of Zhengzhou University in China. Data collection continued until data saturation was reached. All data were transcribed verbatim and analyzed using a framework approach. RESULTS Three themes emerged: (1) experience with eHealth in CKD (self-management), (2) needs for supporting CKD self-management with the use of eHealth, and (3) adaptation and implementation of the Dutch MD intervention in China. Both patients and HCPs had experience with and solely mentioned eHealth to 'inform, monitor and track' as potentially relevant interventions to support CKD self-management, not those to support 'interaction' and 'data utilization'. Factors reported to influence the implementation of CKD eHealth self-management interventions included information barriers (i.e. quality and consistency of the disease-related information obtained via eHealth), perceived trustworthiness and safety of eHealth sources, clinical compatibility and complexity of eHealth, time constraints and eHealth literacy. Moreover, patients and HCPs expressed that eHealth interventions should support CKD self-management by improving the access to reliable and relevant disease related knowledge and optimizing the timeliness and quality of patient and HCPs interactions. Finally, suggestions to adaptation and implementation of the Dutch MD intervention in China were mainly related to improving the intervention functionalities and content of MD such as addressing the complexity of the platform and compatibility with HCPs' workflows. CONCLUSIONS The identified perceptions, attitudes and needs towards eHealth self-management interventions in Chinese settings should be considered by researchers and intervention developers to adapt a tailored eHealth self-management intervention for patients with CKD in China. In more detail, future research needs to engage in co-creation processes with vulnerable groups during eHealth development and implementation, increase eHealth literacy and credibility of eHealth (information resource), ensure eHealth to be easy to use and well-integrated into HCPs' workflows.
Collapse
Affiliation(s)
- Hongxia Shen
- School of Nursing, Guangzhou Medical University, Guangzhou, China; Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands; Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Wenjiao Wang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Evelyn Brakema
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Xiaoping Lou
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
13
|
Donison V, Chesney TR, Wills A, Santos B, McLean B, Alqurini N, Hossain N, Durbano S, Lemonde M, Alibhai SMH, Puts M. Self-management interventions for issues identified in a geriatric assessment: A systematic review. J Am Geriatr Soc 2021; 70:1268-1279. [PMID: 34902156 DOI: 10.1111/jgs.17601] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 11/18/2021] [Accepted: 11/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND With the development of electronic geriatric assessment (GA), recommendations for self-management can be provided to patients without the presence of health care providers. Our research question was to identify what self-management interventions can be used by patients to address issues identified in GA and to determine their effect on patient-centered outcomes such as quality of life, health, mood, cognition, and functional status. METHODS Searches were conducted on July 13, 2021, by a health sciences librarian in Medline, Embase, CINAHL, PsycInfo, and the Cochrane Library. A combination of database-specific subject headings and text word searches was used such as self-management, a key word for each of the geriatric assessment domains and older adults. Two independent reviewers reviewed abstracts and full texts for inclusion and abstracted data. Narrative synthesis was used to summarize findings. RESULTS Among 28,520 abstracts reviewed, 34 randomized controlled trials were included. The most frequently studied geriatric domains were mood (n = 13 studies), mobility/falls (n = 12), quality of life (n = 11), and functional status (n = 7). The majority of studies demonstrated positive effects on mobility/falls (9 of 12), pain (3 of 5), comorbidity (4 of 4), and medication management (4 of 4). Most studies were of low to moderate quality. All geriatric domains were targeted in at least one study. CONCLUSIONS Low- to moderate-quality studies show a variety of effective self-efficacy-targeted interventions exist for older adults to improve several important geriatric domains and related outcomes. However, long-term effects, validation, and scalability of these interventions remain largely unknown.
Collapse
Affiliation(s)
- Valentina Donison
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Tyler R Chesney
- Department of Surgery, St. Michael's Hospital, Toronto, Canada.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada.,Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada
| | - Aria Wills
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Brenda Santos
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| | - Bianca McLean
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Canada
| | - Naser Alqurini
- Central Department of Primary Health Care, Ministry of Health, Kuwait City, Kuwait
| | - Nazia Hossain
- Postgraduate Medical Education, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Sara Durbano
- Department of Medicine, University Health Network, Toronto, Canada
| | - Manon Lemonde
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada
| | - Shabbir M H Alibhai
- Department of Medicine, University Health Network, Toronto, Canada.,Department of Medicine, Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Martine Puts
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada
| |
Collapse
|
14
|
Valaitis R, Cleghorn L, Vassilev I, Rogers A, Ploeg J, Kothari A, Risdon C, Gillett J, Guenter D, Dolovich L. A Web-Based Social Network Tool (GENIE) for Supporting Self-management Among High Users of the Health Care System: Feasibility and Usability Study. JMIR Form Res 2021; 5:e25285. [PMID: 34255654 PMCID: PMC8315309 DOI: 10.2196/25285] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 04/01/2021] [Accepted: 05/31/2021] [Indexed: 01/23/2023] Open
Abstract
Background Primary care providers are well positioned to foster self-management through linking patients to community-based health and social services (HSSs). This study evaluated a web-based tool—GENIE (Generating Engagement in Network Involvement)—to support the self-management of adults. GENIE empowers patients to leverage their personal social networks and increase their access to HSSs. GENIE maps patients’ personal social networks, elicits preferences, and filters local HSSs from a community service directory based on patient’s interests. Trained volunteers (an extension of the primary care team) conducted home visits and conducted surveys related to life and health goals in the context of the Health TAPESTRY (Teams Advancing Patient Experience: Strengthening Quality) program, in which the GENIE tool was implemented. GENIE reports were uploaded to an electronic medical record for care planning by the team. Objective This study aims to explore patients’, volunteers’, and clinicians’ perceptions of the feasibility, usability, and perceived outcomes of GENIE—a tool for community-dwelling adults who are high users of the health care system. Methods This study involved 2 primary care clinician focus groups and 1 clinician interview (n=15), 1 volunteer focus group (n=3), patient telephone interviews (n=8), field observations that captured goal-action sequences to complete GENIE, and GENIE utilization statistics. The patients were enrolled in a primary care program—Health TAPESTRY—and Ontario’s Health Links Program, which coordinates care for the highest users of the health care system. NVivo 11 (QSR International) was used to support qualitative data analyses related to feasibility and perceived outcomes, and descriptive statistics were used for quantitative data. Results Most participants reported positive overall perceptions of GENIE. However, feasibility testing showed that participants had a partial understanding of the tool; volunteer facilitation was critical to support the implementation of GENIE; clinicians perceived their navigation ability as superior to that of GENIE supported by volunteers; and tool completion took 39 minutes, which made the home visit too long for some. Usability challenges included difficulties completing some sections of the tool related to medical terminology and unclear instructions, limitations in the quality and quantity of HSSs results, and minor technological challenges. Almost all patients identified a community program or activity of interest. Half of the patients (4/8, 50%) followed up on HSSs and added new members to their network, whereas 1 participant lost a member. Clinicians’ strengthened their understanding of patients’ personal social networks and needs, and patients felt less social isolation. Conclusions This study demonstrated the potential of GENIE, when supported by volunteers, to expand patients’ social networks and link them to relevant HSSs. Volunteers require training to implement GENIE for self-management support, which may help overcome the time limitations faced by primary care clinicians. Refining the filtering capability of GENIE to address adults’ needs may improve primary care providers’ confidence in using such tools.
Collapse
Affiliation(s)
- Ruta Valaitis
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Laura Cleghorn
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Ivaylo Vassilev
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Anne Rogers
- School of Health Sciences, University of Southampton, Southampton, United Kingdom
| | - Jenny Ploeg
- School of Nursing, McMaster University, Hamilton, ON, Canada
| | - Anita Kothari
- School of Health Studies, Western University, London, ON, Canada
| | - Cathy Risdon
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - James Gillett
- Health Aging and Society, McMaster University, Hamilton, ON, Canada
| | - Dale Guenter
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Lisa Dolovich
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| |
Collapse
|
15
|
Li WY, Chiu FC, Zeng JK, Li YW, Huang SH, Yeh HC, Cheng BW, Yang FJ. Mobile Health App With Social Media to Support Self-Management for Patients With Chronic Kidney Disease: Prospective Randomized Controlled Study. J Med Internet Res 2020; 22:e19452. [PMID: 33320101 PMCID: PMC7772070 DOI: 10.2196/19452] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 09/12/2020] [Accepted: 11/11/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is a global health burden. Self-management plays a key role in improving modifiable risk factors. OBJECTIVE The aim of this study was to evaluate the effectiveness of wearable devices, a health management platform, and social media at improving the self-management of CKD, with the goal of establishing a new self-management intervention model. METHODS In a 90-day prospective experimental study, a total of 60 people with CKD at stages 1-4 were enrolled in the intervention group (n=30) and control group (n=30). All participants were provided with wearable devices that collected exercise-related data. All participants maintained dietary diaries using a smartphone app. All dietary and exercise information was then uploaded to a health management platform. Suggestions about diet and exercise were provided to the intervention group only, and a social media group was created to inspire the participants in the intervention group. Participants' self-efficacy and self-management questionnaire scores, Kidney Disease Quality of Life scores, body composition, and laboratory examinations before and after the intervention were compared between the intervention and control groups. RESULTS A total of 49 participants completed the study (25 in the intervention group and 24 in the control group); 74% of the participants were men and the mean age was 51.22 years. There were no differences in measured baseline characteristics between the groups except for educational background. After the intervention, the intervention group showed significantly higher scores for self-efficacy (mean 171.28, SD 22.92 vs mean 142.21, SD 26.36; P<.001) and self-management (mean 54.16, SD 6.71 vs mean 47.58, SD 6.42; P=.001). Kidney Disease Quality of Life scores were also higher in the intervention group (mean 293.16, SD 34.21 vs mean 276.37, SD 32.21; P=.02). The number of steps per day increased in the intervention group (9768.56 in week 1 and 11,389.12 in week 12). The estimated glomerular filtration rate (eGFR) of the intervention group was higher than that of the control group (mean 72.47, SD 24.28 vs mean 59.69, SD 22.25 mL/min/1.73m2; P=.03) and the decline in eGFR was significantly slower in the intervention group (-0.56 vs -4.58 mL/min/1.73m2). There were no differences in body composition between groups postintervention. CONCLUSIONS The use of wearable devices, a health management platform, and social media support not only strengthened self-efficacy and self-management but also improved quality of life and a slower eGFR decline in people with CKD at stages 1-4. These results outline a new self-management model to promote healthy lifestyle behaviors for patients with CKD. TRIAL REGISTRATION ClinicalTrials.gov NCT04617431; https://www.clinicaltrials.gov/ct2/show/NCT04617431.
Collapse
Affiliation(s)
- Wen-Yi Li
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Fu-Chun Chiu
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
- Cardiovascular Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
| | - Jyun-Kai Zeng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Yao-Wei Li
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Su-Hua Huang
- Department of Dietetics, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
| | - Hui-Chin Yeh
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
- Department of Applied Foreign Languages, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Bor-Wen Cheng
- Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Douliu, Taiwan
| | - Feng-Jung Yang
- Renal Division, Department of Internal Medicine, National Taiwan University Hospital Yun Lin Branch, Douliu, Taiwan
- School of Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
| |
Collapse
|
16
|
Shen H, van der Kleij R, van der Boog PJM, Song X, Wang W, Zhang T, Li Z, Lou X, Chavannes N. Development and evaluation of an eHealth self-management intervention for patients with chronic kidney disease in China: protocol for a mixed-method hybrid type 2 trial. BMC Nephrol 2020; 21:495. [PMID: 33213398 PMCID: PMC7678219 DOI: 10.1186/s12882-020-02160-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 11/10/2020] [Indexed: 12/13/2022] Open
Abstract
Background Chronic kidney disease (CKD) is a significant public health concern. In patients with CKD, interventions that support disease self-management have shown to improve health status and quality of life. At the moment, the use of electronic health (eHealth) technology in self-management interventions is becoming more and more popular. Evidence suggests that eHealth-based self-management interventions can improve health-related outcomes of patients with CKD. However, knowledge of the implementation and effectiveness of such interventions in general, and in China in specific, is still limited. This study protocol aims to develop and tailor the evidence-based Dutch ‘Medical Dashboard’ eHealth self-management intervention for patients suffering from CKD in China and evaluate its implementation process and effectiveness. Methods To develop and tailor a Medical Dashboard intervention for the Chinese context, we will use an Intervention Mapping (IM) approach. A literature review and mixed-method study will first be conducted to examine the needs, beliefs, perceptions of patients with CKD and care providers towards disease (self-management) and eHealth (self-management) interventions (IM step 1). Based on the results of step 1, we will specify outcomes, performance objectives, and determinants, select theory-based methods and practical strategies. Knowledge obtained from prior results and insights from stakeholders will be combined to tailor the core interventions components of the ‘Medical Dashboard’ self-management intervention to the Chinese context (IM step 2–5). Then, an intervention and implementation plan will be developed. Finally, a 9-month hybrid type 2 trial design will be employed to investigate the effectiveness of the intervention using a cluster randomized controlled trial with two parallel arms, and the implementation integrity (fidelity) and determinants of implementation (IM step 6). Discussion Our study will result in the delivery of a culturally tailored, standardized eHealth self-management intervention for patients with CKD in China, which has the potential to optimize patients’ self-management skills and improve health status and quality of life. Moreover, it will inform future research on the tailoring and translation of evidence-based eHealth self-management interventions in various contexts. Trial registration Clinicaltrials.gov NCT04212923; Registered December 30, 2019. Supplementary Information The online version contains supplementary material available at 10.1186/s12882-020-02160-6.
Collapse
Affiliation(s)
- Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands. .,Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China.
| | - Rianne van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Xiaoyue Song
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Wenjiao Wang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Tongtong Zhang
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Zhengyan Li
- Department of Nephrology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Xiaoping Lou
- Department of Nursing, The First Affiliated Hospital of Zhengzhou University, Zhengzhou University, Zhengzhou, China
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
17
|
Cooper JT, Lloyd A, Sanchez JJG, Sörstadius E, Briggs A, McFarlane P. Health related quality of life utility weights for economic evaluation through different stages of chronic kidney disease: a systematic literature review. Health Qual Life Outcomes 2020; 18:310. [PMID: 32957990 PMCID: PMC7507735 DOI: 10.1186/s12955-020-01559-x] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 09/09/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND A Task Force from the International Society of Pharmacoeconomics and Outcomes Research (ISPOR) provides recommendations on how to systematically identify and appraise health state utility (HSU) weights for cost-effectiveness analyses. We applied these recommendations to conduct a systematic review (SR) to identify HSU weights for different stages of chronic kidney disease (CKD), renal replacement therapy (RRT) and complications. METHODS MEDLINE® and Embase were searched for interventional and non-interventional studies reporting HSU weights for patients with CKD stages 1-5 or RRT. As per ISPOR Task Force Guidance, study quality criteria, applicability for Health Technology Assessment (HTA) and generalisability to a broad CKD population were used to grade studies as either 1 (recommended), 2 (to be considered if there are no data from grade 1 studies) or 3 (not recommended). RESULTS A total of 17 grade 1 studies were included in this SR with 51 to 1767 participants, conducted in the UK, USA, Canada, China, Spain, and multiple-countries. Health related quality of life (HRQL) instruments used in the studies included were EQ-5D-3L (10 studies), SF-6D (4 studies), HUI2/HUI3 (1 study), and combinations (2 studies). Although absolute values for HSU weights varied among instruments, HSU weights decreased with CKD severity in a consistent manner across all instruments. CONCLUSIONS This SR identified HSU weights for a range of CKD states and showed that HRQL decreases with CKD progression. Data were available to inform cost-effectiveness analysis in CKD in a number of geographies using instruments acceptable by HTA agencies.
Collapse
Affiliation(s)
| | | | - Juan Jose Garcia Sanchez
- Health Economics and Payer Evidence Lead, Global Market Access & Pricing, AstraZeneca, Academy House, 136 Hills Road, Cambridge, CB2 8PA, UK.
| | - Elisabeth Sörstadius
- Price and Market Access Director, Global Market Access & Pricing. AstraZeneca, Mölndal, Sweden
| | - Andrew Briggs
- Avalon Health Economics, Morristown, NJ, USA.,Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | |
Collapse
|
18
|
Tsang JY, Murray J, Kingdon E, Tomson C, Hallas K, Campbell S, Blakeman T. Guidance for post-discharge care following acute kidney injury: an appropriateness ratings evaluation. BJGP Open 2020; 4:bjgpopen20X101054. [PMID: 32546580 PMCID: PMC7465579 DOI: 10.3399/bjgpopen20x101054] [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: 02/06/2020] [Accepted: 02/10/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is associated with poor health outcomes, including increased mortality and rehospitalisation. National policy and patient safety drivers have targeted AKI as an example to ensure safer transitions of care. AIM To establish guidance to promote high-quality transitions of care for adults following episodes of illness complicated by AKI. DESIGN & SETTING An appropriateness ratings evaluation was undertaken using the RAND/UCLA Appropriateness Method (RAM). The Royal College of General Practitioners (RCGP) AKI working group developed a range of clinical scenarios to help identify the necessary steps to be taken following discharge of a patient from secondary care into primary care in the UK. METHOD A 10-person expert panel was convened to rate 819 clinical scenarios, testing the most appropriate time and action following hospital discharge. Specifically, the scenarios focused on determining the appropriateness and urgency for planning: an initial medication review; monitoring of kidney function; and assessment for albuminuria. RESULTS Taking no action (that is, no medication review; no kidney monitoring; or no albuminuria testing) was rated inappropriate in all cases. In most scenarios, there was consensus that both the initial medication review and kidney function monitoring should take place within 1-2 weeks or 1 month, depending on clinical context. However, patients with heart failure and poor kidney recovery were rated to require expedited review. There was consensus that assessment for albuminuria should take place at 3 months after discharge following AKI. CONCLUSION Systems to support tailored and timely post-AKI discharge care are required, especially in high-risk populations, such as people with heart failure.
Collapse
Affiliation(s)
- Jung Yin Tsang
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care and Health Services Research, Institute of Population Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PTSRC), University of Manchester, Manchester, UK
| | - Jonathan Murray
- Renal Unit, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Academic Health Science Network for the North East and North Cumbria (AHSN NENC), Newcastle upon Tyne, UK
| | - Edward Kingdon
- Brighton & Sussex University Hospitals NHS Trust, Brighton, UK
- Kent Surrey Sussex Academic Health Science Network (KSS AHSN), Crawley, UK
| | - Charlie Tomson
- Department of Renal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Kyle Hallas
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care and Health Services Research, Institute of Population Health, University of Manchester, Manchester, UK
| | - Stephen Campbell
- NIHR Greater Manchester Patient Safety Translational Research Centre (PTSRC), University of Manchester, Manchester, UK
| | - Tom Blakeman
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care and Health Services Research, Institute of Population Health, University of Manchester, Manchester, UK
- NIHR Greater Manchester Patient Safety Translational Research Centre (PTSRC), University of Manchester, Manchester, UK
- RCGP Clinical Champion for Kidney Care, Royal College of General Practitioners, London, UK
| |
Collapse
|
19
|
Welch L, Orlando R, Lin SX, Vassilev I, Rogers A. Findings from a pilot randomised trial of a social network self-management intervention in COPD. BMC Pulm Med 2020; 20:162. [PMID: 32513163 PMCID: PMC7278059 DOI: 10.1186/s12890-020-1130-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 04/02/2020] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Self-Management Support (SMS), refers to the actions taken by individuals to recognise and manage their own health. It is increasingly recognised that individuals with chronic obstructive pulmonary disease (COPD) require additional support with their Self-management. Emerging evidence suggests that the use of a social network intervention can improve health outcomes and increase quality of life. In order to understand the potential benefits of SMS in COPD, the GENIE (Generating Engagement in Network Support) SMS tool was implemented and evaluated in a COPD primary care context. The GENIE intervention is a social networking tool that consists of 3 parts; a concentric circle modelling to map existing social networks; a questions sections to elicit preferences for activities; a map of selected resources is then produced, aligned with the user's interests and suggestions for connections to existing network members and to new resources. METHODS A pilot, parallel, single blind, block randomised controlled trial. Patients with COPD ranging from mild-very severe were recruited. Participants provided written consent and were then randomised to either the intervention or usual care. The primary aim was to understand the clinical benefit through the analysis of health status, symptom burden and quality of life. The secondary outcome measure was health utilisation. NHS cost differences were reported between groups using the GENIE intervention over usual care. RESULTS The GENIE pilot results demonstrate maintenance in health status and clinical symptoms with a decrease in anxiety. An overall increase in quality of life was observed, these findings did not reach significance. A cost reduction was demonstrated in inpatient stay with no difference in primary care costs. Overall a cost reduction in NHS service utilisation was indicated in the intervention group. CONCLUSION This pilot study indicated that using a social network intervention can encourage the development of new social connections and extend existing support networks for COPD patients. Increasing network support in this population is of benefit to both patients and NHS providers in terms of cost reductions and enhancing wellbeing. This broadens the understanding of possible new approaches to SMS in community COPD patients, which could now be investigated in a larger population over a longer period. TRIAL REGISTRATION Clinical Trials.gov PRS National Library of Medicine. Protocol ID number: 19175, Clinical Trial ID: NCT02935452.
Collapse
Affiliation(s)
- Lindsay Welch
- NIHR Wessex CLARHC, Southampton, UK
- University of Southampton, Faculty of Environmental and Life Sciences, School of Health Sciences, Building 67, University Road, Southampton, SO17 1BJ UK
- Solent University, School of Sport, Health and Social Sciences, RM 126, East Park Terrace, Southampton, SO14 0YN UK
| | - Rosanna Orlando
- NIHR Wessex CLARHC, Southampton, UK
- University of Southampton, Faculty of Environmental and Life Sciences, School of Health Sciences, Building 67, University Road, Southampton, SO17 1BJ UK
| | - Sharon X. Lin
- NIHR Wessex CLARHC, Southampton, UK
- University of Southampton, Faculty of Environmental and Life Sciences, School of Health Sciences, Building 67, University Road, Southampton, SO17 1BJ UK
| | - Ivaylo Vassilev
- NIHR Wessex CLARHC, Southampton, UK
- University of Southampton, Faculty of Environmental and Life Sciences, School of Health Sciences, Building 67, University Road, Southampton, SO17 1BJ UK
| | - Anne Rogers
- NIHR Wessex CLARHC, Southampton, UK
- University of Southampton, Faculty of Environmental and Life Sciences, School of Health Sciences, Building 67, University Road, Southampton, SO17 1BJ UK
| |
Collapse
|
20
|
Ellis J, Band R, Kinsella K, Cheetham-Blake T, James E, Ewings S, Rogers A. Optimising and profiling pre-implementation contexts to create and implement a public health network intervention for tackling loneliness. Implement Sci 2020; 15:35. [PMID: 32429961 PMCID: PMC7238736 DOI: 10.1186/s13012-020-00997-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2019] [Accepted: 05/03/2020] [Indexed: 01/14/2023] Open
Abstract
Background The implementation of complex interventions experiences challenges that affect the extent to which they become embedded and scaled-up. Implementation at scale in complex environments like community settings defies universal replication. Planning for implementation in such environments requires knowledge of organisational capacity and structure. Pre-implementation work is an important element of the early phase of preparing the setting for the introduction of an intervention, and the factors contributing towards the creation of an optimal pre-implementation community context are under-acknowledged. Methods To explore the factors contributing towards the creation of an optimal pre-implementation context, a quasi-ethnographic approach was taken. The implementation of a social network intervention designed to tackle loneliness in a community setting acts as the case in example. Observations (of meetings), interviews (with community partners) and documentary analysis (national and local policy documents and intervention resources) were conducted. Layder’s adaptive theory approach was taken to data analysis, with the Consolidated Framework for Implementation Research (CFIR) and a typology of third-sector organisations used to interpret the findings. Results Community settings were found to sit along a continuum with three broad categories defined as Fully Professionalised Organisations; Aspirational Community, Voluntary and Social Enterprises; and Non-Professionalised Community-Based Groups. The nature of an optimal pre-implementation context varied across these settings. Using the CFIR, the results illustrate that some settings were more influenced by political landscape (Fully professional and Aspirational setting) and others more influenced by their founding values and ethos (Non-Professionalised Community-Based settings). Readiness was achieved at different speeds across the categories with those settings with more resource availability more able to achieve readiness (Fully Professional settings), and others requiring flexibility in the intervention to help overcome limited resource availability (Aspirational and Non-Professionalised Community-Based settings). Conclusions The CFIR is useful in highlighting the multiple facets at play in creating the optimal pre-implementation context, and where flex is required to achieve this. The CFIR illuminates the similarities and differences between and across settings, highlighting the complexity of open system settings and the important need for pre-implementation work. Trial registration ISRCTN19193075
Collapse
Affiliation(s)
- J Ellis
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK.
| | - R Band
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - K Kinsella
- Public Health Institute, Liverpool John Moores University, 3rd Floor Exchange Station, Tithebarn Street, Liverpool, L2 2QP, UK
| | - T Cheetham-Blake
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - E James
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - S Ewings
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| | - A Rogers
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK
| |
Collapse
|
21
|
Reidy C, Foster C, Rogers A. A Facilitated Web-Based Self-Management Tool for People With Type 1 Diabetes Using an Insulin Pump: Intervention Development Using the Behavior Change Wheel and Theoretical Domains Framework. J Med Internet Res 2020; 22:e13980. [PMID: 32356776 PMCID: PMC7229530 DOI: 10.2196/13980] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 11/08/2019] [Accepted: 12/16/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Type 1 diabetes (T1D) requires intensive self-management (SM). An insulin pump is designed to better support personal T1D management, but at the same time, it exacerbates the complexity and requirements of SM. Research shows that people with diabetes are likely to benefit from navigating and connecting to local means of social support and resources through web-based interventions that offer flexible, innovative, and accessible SM. However, questions remain as to which behavior change mechanisms within such resources benefit patients most and how to foster engagement with and endorsement of SM interventions. OBJECTIVE The aim of this study was to evaluate the perspectives and experiences of people with T1D using an insulin pump and specialist health care professionals (HCPs) and determine what behavior change characteristics and strategies are required to inform the optimization of an existing web-based social network (SN) intervention to support SM. METHODS Focus groups with insulin pump users (n=19) and specialist HCPs (n=20) in 6 National Health Service (NHS) trusts across the south of England examined the barriers and enablers to incorporating and self-managing an insulin pump. An analysis was undertaken using the Behavior Change Wheel and Theoretical Domains Framework, followed by a taxonomy of behavior change techniques (BCTs) to identify the contents of and strategies for the implementation of a complex health intervention. RESULTS A total of 4 themes represent the SM perspectives and experiences of stakeholders: (1) a desire for access to tailored and appropriate resources and information-the support and information required for successful SM are situational and contextual, and these vary according to time and life circumstances, and therefore, these need to be tailored and appropriate; (2) specific social support preferences-taking away isolation as well as providing shared learnings and practical tips, but limitations included the fear of judgment from others and self-pity from peers; (3) the environmental context, that is, capacity and knowledge of pump clinic HCPs-HCPs acknowledge the patient's need for holistic support but lack confidence in providing it; and (4) professional responsibility and associated risks and dangers, whereas HCPs are fearful of the consequences of promoting non-NHSSM support, and they question whether SM support fits into their role. BCTs were identified to address these issues. CONCLUSIONS The use of behavioral theory and a validated implementation framework provided a comprehensive approach for systematically identifying barriers and enablers of self-managing T1D with an insulin pump. A web-based SN intervention appears to offer additional forms of SM support while complementing NHS services. However, for intervention implementation, HCPs' apprehensions about responsibility when signposting to non-NHS SM support would need to be addressed, and opportunistic features would need to be added, through which pump users could actively engage with other people living with T1D.
Collapse
Affiliation(s)
- Claire Reidy
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, United Kingdom.,School of Primary Care, Population Health & Medical Education, Faculty of Medicine, University of Southampton, Southampton, United Kingdom
| | - Claire Foster
- Macmillan Survivorship Research Group, School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, United Kingdom
| | - Anne Rogers
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care, School of Health Sciences, Faculty of Environmental & Life Sciences, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
22
|
James E, Kennedy A, Vassilev I, Ellis J, Rogers A. Mediating engagement in a social network intervention for people living with a long-term condition: A qualitative study of the role of facilitation. Health Expect 2020; 23:681-690. [PMID: 32162435 PMCID: PMC7321728 DOI: 10.1111/hex.13048] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 02/18/2020] [Accepted: 02/19/2020] [Indexed: 12/25/2022] Open
Abstract
Background Successful facilitation of patient‐centred interventions for self‐management support has traditionally focussed on individual behaviour change. A social network approach to self‐management support implicates the need for facilitation that includes an orientation to connecting to and mobilizing support and resources from other people and the local environment. Objective To identify the facilitation processes through which engagement with a social network approach to self‐management is achieved. Method Thematic analysis was used to analyse data from a longitudinal study design using quasi‐ethnographic methods comprising non‐participant observation, video and qualitative interviews involving 30 participants living with a long‐term condition recruited from a marginalized community. Results Findings centred on three themes about the social network approach facilitation processes: reversing the focus on the self by bringing others into view; visualization and reflection as a mediator of positive disruption and linking to new connections; personalized matching of valued activities as a means of realizing preference elicitation. Discussion and conclusions Engagement processes with a social network approach illuminated the relevance of cognizance of an individual's immediate social context and forefronting social participation with others as the bases of self‐management support of a long‐term condition. This differs from traditional guided facilitation of health behaviour interventions that frame health as a matter of personal choice and individual responsibility.
Collapse
Affiliation(s)
- Elizabeth James
- School of Health Sciences, University of Southampton, Southampton, UK.,NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Anne Kennedy
- School of Health Sciences, University of Southampton, Southampton, UK.,NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Ivaylo Vassilev
- School of Health Sciences, University of Southampton, Southampton, UK.,NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Jaimie Ellis
- School of Health Sciences, University of Southampton, Southampton, UK.,NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Anne Rogers
- School of Health Sciences, University of Southampton, Southampton, UK.,NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| |
Collapse
|
23
|
Bloom I, Welch L, Vassilev I, Rogers A, Jameson K, Cooper C, Robinson S, Baird J. Findings from an exploration of a social network intervention to promote diet quality and health behaviours in older adults with COPD: a feasibility study. Pilot Feasibility Stud 2020; 6:15. [PMID: 32042439 PMCID: PMC7003327 DOI: 10.1186/s40814-020-0553-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 01/22/2020] [Indexed: 02/01/2023] Open
Abstract
Background Diet quality in older people with chronic obstructive pulmonary disease (COPD) is associated with better health and lung function. Social factors, such as social support, social networks and participation in activities, have been linked with diet quality in older age. A social network tool—GENIE (Generating Engagement in Network Involvement)—was implemented in a COPD community care context. The study aimed to assess the feasibility of the GENIE intervention to promote diet quality and other health behaviours in COPD. Methods Twenty-two community-dwelling older adults with COPD were recruited from a local COPD service. Participants were offered usual care or the GENIE intervention. Process evaluation methods were used to assess intervention implementation, context and mechanisms of impact; these included observations of patient interactions with the intervention, documented in observational field notes and in films of a patient group discussion. Diet quality was assessed by food frequency questionnaire; ‘prudent’ diet scores were used to describe diet quality at baseline and at 3-month follow-up. Change in diet quality was expressed per month, from baseline to follow-up. Results Feasibility data showed that the GENIE intervention could be implemented in this sample of community-living older people. The intervention was acceptable to clinicians and older people with COPD, especially for those with less severe disease, when facilitated appropriately and considering the levels of literacy of participants. There was no significant change in diet quality in the intervention group over the follow-up period (median change in prudent diet score per month (interquartile range (IQR), 0.03 (− 0.24–0.07)), whereas an overall fall in diet quality was observed in the control group (− 0.15 (− 0.24–0.03)). Conclusion The process evaluation findings suggest that this intervention is feasible and acceptable to both patients and clinicians. Although the sample size achieved in this study was small, findings suggest that the intervention may have a protective effect against declines in diet quality, and other health behaviours, in an older COPD population. Findings from this feasibility study indicate that further evaluation of the GENIE intervention is warranted in a larger study, with a longer follow-up. Trial registration ClinicalTrials.gov, NCT02935452. NIH U.S. National Library of Medicine. Registered 17 October 2016.
Collapse
Affiliation(s)
- Ilse Bloom
- 1MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK.,2NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Lindsay Welch
- 3Solent NHS Trust, Bitterne Health Centre, Commercial Road, Bitterne, Southampton, UK.,4Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, UK
| | - Ivaylo Vassilev
- 4Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, UK
| | - Anne Rogers
- 4Faculty of Environmental and Life Sciences, School of Health Sciences, University of Southampton, Southampton, UK.,NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Southampton, UK
| | - Karen Jameson
- 1MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK
| | - Cyrus Cooper
- 1MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK.,2NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,6NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Sian Robinson
- 1MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK.,7AGE Research Group, Biomedical Research Building, Campus for Ageing and Vitality, Newcastle University, Newcastle upon Tyne, UK
| | - Janis Baird
- 1MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, SO16 6YD UK.,2NIHR Southampton Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK
| |
Collapse
|
24
|
Putri IRP, Nursalam N, Kurniawati ND. Information Technology-based Interventions for Health Care Support in Patients with Chronic Kidney Disease: A Systematic Review. JURNAL NERS 2020. [DOI: 10.20473/jn.v14i3.17030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Self-management and support in managing therapeutic regimens is very important for patients with CKD. Information technology-based interventions are increasingly being used to support the self-management of patients with CKD. This study aimed to conduct a systematic review to evaluate information technology-based interventions in relation to the support of the health management of patients with CKD.Method: We conducted a systematic review using electronic databases (Scopus, Science Direct, ProQuest) limited to the last 8 years from 2010 to 2018 with the relevant keywords. The studies included used RCT, pilot and case-control methods focusing on patients with CKD stage 1-5 and that reported on at least one outcome from the health management of patients with CKD.Result: Out of the 7.852 studies taken, 13 studies fulfilled the inclusion criteria. The interventions in this systematic review are multifaceted, including smartphone/PDA (6/13), telematics devices (2/13), internet/web (3/13) and a combination of several interventions (2 studies). In total, 12 (92%) out of the 13 studies showed a positive outcome from the intervention, 7 studies showed improved outcomes in the clinical points, 3 studies had improved adherence and 2 studies improved knowledge.Conclusion: This evidence indicates the potential of IT-based interventions (i.e. smartphone/PDA, computer, internet/web, telematic device) to support the health management of patients with CKD. The variety of interventions in this systematic review requires further research on which interventions are best applied.
Collapse
|
25
|
Shen H, van der Kleij RMJJ, van der Boog PJM, Chang X, Chavannes NH. Electronic Health Self-Management Interventions for Patients With Chronic Kidney Disease: Systematic Review of Quantitative and Qualitative Evidence. J Med Internet Res 2019; 21:e12384. [PMID: 31687937 PMCID: PMC6864489 DOI: 10.2196/12384] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 06/28/2019] [Accepted: 08/19/2019] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) poses a major challenge to public health. In CKD patients, adequate disease self-management has been shown to improve both proximal and distal outcomes. Currently, electronic health (eHealth) interventions are increasingly used to optimize patients' self-management skills. OBJECTIVE This study aimed to systematically review the existing evidence regarding the implementation and effectiveness of eHealth self-management interventions for patients with CKD. METHODS Following a search in 8 databases (up to November 2017), quantitative and qualitative data on process and effect outcomes were extracted from relevant studies. Quality was appraised using the Crowe Critical Appraisal Tool; narrative synthesis was performed to analyze the data extracted. RESULTS Of the 3307 articles retrieved, 24 (comprising 23 studies) were included in this review; of these, almost half were appraised to be of low to moderate quality. There was considerable heterogeneity in the types of interventions used and the outcomes measured. A total of 10 effect and 9 process outcome indicators were identified. The most frequently reported effect outcome indicators were specific laboratory tests and blood pressure (BP), whereas satisfaction was the most frequently reported process outcome indicator. Positive effects were found for proximal outcomes (eg, BP control and medication adherence), and mixed effects were found for more distal outcomes (eg, quality of life). High feasibility, usability, and acceptability of and satisfaction with eHealth self-management interventions were reported. The determinant ability of health care professionals to monitor and, if necessary, anticipate on patient measurements online was mostly cited to influence patients' adherence to interventions. CONCLUSIONS eHealth self-management interventions have the potential to improve disease management and health outcomes. To broaden the evidence base and facilitate intervention upscaling, more detailed descriptions and thorough analysis of the intervention components used are required. In addition, our review reveals that outcomes closely related to the scope and duration of the intervention implemented are most likely to be impacted. For instance, if a 4-week Web-based training to optimize disease management skills is implemented, the outcome perceived control would more likely be affected than kidney function. Although this seems obvious, most studies evaluate only distal outcomes and thereby fail to capture intervention effects that might contribute to long-term health improvement. We advise future researchers to carefully consider their choice of outcomes based on their sensitivity for change. In this way, we ensure that relevant effects are captured and legitimate conclusions are drawn.
Collapse
Affiliation(s)
- Hongxia Shen
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Rianne M J J van der Kleij
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,Department of Obstetrics and Gynaecology, Erasmus Medical Center, Rotterdam, Netherlands
| | | | - Xinwei Chang
- Department of Surgery, School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| |
Collapse
|
26
|
Band R, Ewings S, Cheetham-Blake T, Ellis J, Breheny K, Vassilev I, Portillo MC, Yardley L, Blickem C, Kandiyali R, Culliford D, Rogers A. Study protocol for 'The Project About Loneliness and Social networks (PALS)': a pragmatic, randomised trial comparing a facilitated social network intervention (Genie) with a wait-list control for lonely and socially isolated people. BMJ Open 2019; 9:e028718. [PMID: 31427326 PMCID: PMC6701612 DOI: 10.1136/bmjopen-2018-028718] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Revised: 03/13/2019] [Accepted: 06/17/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION Loneliness and social isolation have been identified as significant public health concerns, but improving relationships and increasing social participation may improve health outcomes and quality of life. The aim of the Project About Loneliness and Social networks (PALS) study is to assess the effectiveness and cost-effectiveness of a guided social network intervention within a community setting among individuals experiencing loneliness and isolation and to understand implementation of Generating Engagement in Network Involvement (Genie) in the context of different organisations. METHODS AND ANALYSIS The PALS trial will be a pragmatic, randomised controlled trial comparing participants receiving the Genie intervention to a wait-list control group. Eligible participants will be recruited from organisations working within a community setting: any adult identified as socially isolated or at-risk of loneliness and living in the community will be eligible. Genie will be delivered by trained facilitators recruited from community organisations. The primary outcome will be the difference in the SF-12 Mental Health composite scale score at 6-month follow-up between the intervention and control group using a mixed effects model (accounting for clustering within facilitators and organisation). Secondary outcomes will be loneliness, social isolation, well-being, physical health and engagement with new activities. The economic evaluation will use a cost-utility approach, and adopt a public sector perspective to include health-related resource use and costs incurred by other public services. Exploratory analysis will use a societal perspective, and explore broader measures of benefit (capability well-being). A qualitative process evaluation will explore organisational and environmental arrangements, as well as stakeholder and participant experiences of the study to understand the factors likely to influence future sustainability, implementation and scalability of using a social network intervention within this context. ETHICS AND DISSEMINATION This study has received NHS ethical approval (REC reference: 18/SC/0245). The findings from PALS will be disseminated widely through peer-reviewed publications, conferences and workshops in collaboration with our community partners. TRIAL REGISTRATION NUMBER ISRCTN19193075.
Collapse
Affiliation(s)
- Rebecca Band
- Psychology, University of Southampton, Southampton, UK
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| | - Sean Ewings
- Health Sciences, University of Southampton, Southampton, UK
| | - Tara Cheetham-Blake
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| | - Jaimie Ellis
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| | - Katie Breheny
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Ivaylo Vassilev
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| | - Mari Carmen Portillo
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| | - Lucy Yardley
- Academic Unit of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | | | - Rebecca Kandiyali
- Centre for Child and Adolescent Health, University of Bristol School of Social and Community Medicine, Bristol, UK
| | - David Culliford
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
- Faculty of Medicine, University of Southampton, Southampton, UK
| | - Anne Rogers
- Health Sciences, University of Southampton, Southampton, UK
- NIHR Collaboration for Leadership in Applied Health Research and Care Wessex, NIHR, Wessex, UK
| |
Collapse
|
27
|
Stevenson JK, Campbell ZC, Webster AC, Chow CK, Tong A, Craig JC, Campbell KL, Lee VWS. eHealth interventions for people with chronic kidney disease. Cochrane Database Syst Rev 2019; 8:CD012379. [PMID: 31425608 PMCID: PMC6699665 DOI: 10.1002/14651858.cd012379.pub2] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic kidney disease (CKD) is associated with high morbidity and death, which increases as CKD progresses to end-stage kidney disease (ESKD). There has been increasing interest in developing innovative, effective and cost-efficient methods to engage with patient populations and improve health behaviours and outcomes. Worldwide there has been a tremendous increase in the use of technologies, with increasing interest in using eHealth interventions to improve patient access to relevant health information, enhance the quality of healthcare and encourage the adoption of healthy behaviours. OBJECTIVES This review aims to evaluate the benefits and harms of using eHealth interventions to change health behaviours in people with CKD. SEARCH METHODS We searched the Cochrane Kidney and Transplant Register of Studies up to 14 January 2019 through contact with the Information Specialist using search terms relevant to this review. Studies in the Register are identified through searches of CENTRAL, MEDLINE, and EMBASE, conference proceedings, the International Clinical Trials Register (ICTRP) Search Portal and ClinicalTrials.gov. SELECTION CRITERIA Randomised controlled trials (RCTs) and quasi-RCTs using an eHealth intervention to promote behaviour change in people with CKD were included. There were no restrictions on outcomes, language or publication type. DATA COLLECTION AND ANALYSIS Two authors independently assessed trial eligibility, extracted data and assessed the risk of bias. The certainty of the evidence was assessed using GRADE. MAIN RESULTS We included 43 studies with 6617 participants that evaluated the impact of an eHealth intervention in people with CKD. Included studies were heterogeneous in terms of eHealth modalities employed, type of intervention, CKD population studied and outcomes assessed. The majority of studies (39 studies) were conducted in an adult population, with 16 studies (37%) conducted in those on dialysis, 11 studies (26%) in the pre-dialysis population, 15 studies (35%) in transplant recipients and 1 studies (2%) in transplant candidates We identified six different eHealth modalities including: Telehealth; mobile or tablet application; text or email messages; electronic monitors; internet/websites; and video or DVD. Three studies used a combination of eHealth interventions. Interventions were categorised into six types: educational; reminder systems; self-monitoring; behavioural counselling; clinical decision-aid; and mixed intervention types. We identified 98 outcomes, which were categorised into nine domains: blood pressure (9 studies); biochemical parameters (6 studies); clinical end-points (16 studies); dietary intake (3 studies); quality of life (9 studies); medication adherence (10 studies); behaviour (7 studies); physical activity (1 study); and cost-effectiveness (7 studies).Only three outcomes could be meta-analysed as there was substantial heterogeneity with respect to study population and eHealth modalities utilised. There was found to be a reduction in interdialytic weight gain of 0.13kg (4 studies, 335 participants: MD -0.13, 95% CI -0.28 to 0.01; I2 = 0%) and a reduction in dietary sodium intake of 197 mg/day (2 studies, 181 participants: MD -197, 95% CI -540.7 to 146.8; I2 = 0%). Both dietary sodium and fluid management outcomes were graded as being of low evidence due to high or unclear risk of bias and indirectness (interdialytic weight gain) and high or unclear risk of bias and imprecision (dietary sodium intake). Three studies reported death (2799 participants, 146 events), with 45 deaths/1000 cases compared to standard care of 61 deaths/1000 cases (RR 0.74, CI 0.53 to 1.03; P = 0.08). We are uncertain whether using eHealth interventions, in addition to usual care, impact on the number of deaths as the certainty of this evidence was graded as low due to high or unclear risk of bias, indirectness and imprecision. AUTHORS' CONCLUSIONS eHealth interventions may improve the management of dietary sodium intake and fluid management. However, overall these data suggest that current evidence for the use of eHealth interventions in the CKD population is of low quality, with uncertain effects due to methodological limitations and heterogeneity of eHealth modalities and intervention types. Our review has highlighted the need for robust, high quality research that reports a core (minimum) data set to enable meaningful evaluation of the literature.
Collapse
Affiliation(s)
- Jessica K Stevenson
- The University of SydneyWestmead Clinical SchoolCentre for Kidney ResearchCnr Darcy Rd and Hawksbury RdWestmead, SydneyNSWAustralia2145
| | - Zoe C Campbell
- The University of SydneyDepartment of MedicineSydneyNSWAustralia2006
| | - Angela C Webster
- The University of Sydney at WestmeadCentre for Transplant and Renal Research, Westmead Millennium InstituteWestmeadNSWAustralia2145
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- The University of SydneySydney School of Public HealthEdward Ford Building A27SydneyNSWAustralia2006
| | - Clara K Chow
- The George Institute for Global HealthCardiovascular DepartmentLevel 10, 83‐117 Missenden RoadCamperdownNSWAustralia2050
| | - Allison Tong
- The Children's Hospital at WestmeadCentre for Kidney ResearchLocked Bag 4001WestmeadNSWAustralia2145
| | - Jonathan C Craig
- The Children's Hospital at WestmeadCochrane Kidney and Transplant, Centre for Kidney ResearchWestmeadNSWAustralia2145
- Flinders UniversityCollege of Medicine and Public HealthAdelaideSAAustralia5001
| | - Katrina L Campbell
- Bond UniversityFaculty of Health Science and Medicine2 Promenthean WayRobinaQueenslandAustralia4226
| | - Vincent WS Lee
- Westmead & Blacktown HospitalsDepartment of Renal MedicineDarcy RdWestmeadNSWAustralia2145
| | | |
Collapse
|
28
|
Huang B, Li Z, Wang Y, Xia J, Shi T, Jiang J, Nolan MT, Li X, Nigwekar SU, Chen L. Effectiveness of self-management support in maintenance haemodialysis patients with hypertension: A pilot cluster randomized controlled trial. Nephrology (Carlton) 2019; 23:755-763. [PMID: 28666310 DOI: 10.1111/nep.13098] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2017] [Revised: 06/20/2017] [Accepted: 06/22/2017] [Indexed: 01/23/2023]
Abstract
AIM Uncontrolled hypertension is an independent risk factor for cardiovascular disease and is the leading cause of mortality in haemodialysis patients. The aim of this study was to examine the effectiveness of self-management support (SMS) for blood pressure (BP) control and health behaviours. METHODS We conducted a cluster randomized controlled trial (RCT) in which 90 adult haemodialysis patients were assigned to either an SMS or common intervention (CI) group. The SMS group received an intervention consisting of self-management education and motivational interviewing. The CI group received standard care and routine health education. The primary outcome was the BP monitored before each haemodialysis. Secondary outcomes included salt intake (measured using a balance formula), home BP monitoring (HBPM) (assessed using two self-administered questions), and medication adherence (measured using the Medication-taking Behavior Scale). Data were collected at baseline and at 1, 3 and 6 months post-intervention. RESULTS The SMS group showed continuous reductions in systolic BP from baseline: -9.2, -8.7, and -8.4 mmHg at 1, 3 and 6 months after the intervention, respectively (P < 0.01). Compared with the CI group, the SMS group had a greater decrease in systolic BP at 1 month: -5.9 mmHg (P = 0.0388), but no significant difference was found at 3 or 6 months (P > 0.05). SMS patients showed an improvement in health behaviours relative to baseline (less salt intake, more consistent HBPM, and greater medication adherence) (P < 0.05). CONCLUSIONS Self-management support obtained short-term success in improving salt restriction, regular performance of HBPM and medication adherence, which led to better BP control.
Collapse
Affiliation(s)
- Baoyan Huang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.,School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Zheng Li
- School of Nursing, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ying Wang
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jinghua Xia
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Tao Shi
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Jingmei Jiang
- Department of Epidemiology & Biostatistics, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Marie T Nolan
- School of Nursing, Johns Hopkins University, Baltimore, USA
| | - Xuemei Li
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Sagar U Nigwekar
- Division of Nephrology, Massachusetts General Hospital, Boston, MA, USA
| | - Limeng Chen
- Department of Nephrology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| |
Collapse
|
29
|
Hall PS, Mitchell ED, Smith AF, Cairns DA, Messenger M, Hutchinson M, Wright J, Vinall-Collier K, Corps C, Hamilton P, Meads D, Lewington A. The future for diagnostic tests of acute kidney injury in critical care: evidence synthesis, care pathway analysis and research prioritisation. Health Technol Assess 2019; 22:1-274. [PMID: 29862965 DOI: 10.3310/hta22320] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is highly prevalent in hospital inpatient populations, leading to significant mortality and morbidity, reduced quality of life and high short- and long-term health-care costs for the NHS. New diagnostic tests may offer an earlier diagnosis or improved care, but evidence of benefit to patients and of value to the NHS is required before national adoption. OBJECTIVES To evaluate the potential for AKI in vitro diagnostic tests to enhance the NHS care of patients admitted to the intensive care unit (ICU) and identify an efficient supporting research strategy. DATA SOURCES We searched ClinicalTrials.gov, The Cochrane Library databases, Embase, Health Management Information Consortium, International Clinical Trials Registry Platform, MEDLINE, metaRegister of Current Controlled Trials, PubMed and Web of Science databases from their inception dates until September 2014 (review 1), November 2015 (review 2) and July 2015 (economic model). Details of databases used for each review and coverage dates are listed in the main report. REVIEW METHODS The AKI-Diagnostics project included horizon scanning, systematic reviewing, meta-analysis of sensitivity and specificity, appraisal of analytical validity, care pathway analysis, model-based lifetime economic evaluation from a UK NHS perspective and value of information (VOI) analysis. RESULTS The horizon-scanning search identified 152 potential tests and biomarkers. Three tests, Nephrocheck® (Astute Medical, Inc., San Diego, CA, USA), NGAL and cystatin C, were subjected to detailed review. The meta-analysis was limited by variable reporting standards, study quality and heterogeneity, but sensitivity was between 0.54 and 0.92 and specificity was between 0.49 and 0.95 depending on the test. A bespoke critical appraisal framework demonstrated that analytical validity was also poorly reported in many instances. In the economic model the incremental cost-effectiveness ratios ranged from £11,476 to £19,324 per quality-adjusted life-year (QALY), with a probability of cost-effectiveness between 48% and 54% when tests were compared with current standard care. LIMITATIONS The major limitation in the evidence on tests was the heterogeneity between studies in the definitions of AKI and the timing of testing. CONCLUSIONS Diagnostic tests for AKI in the ICU offer the potential to improve patient care and add value to the NHS, but cost-effectiveness remains highly uncertain. Further research should focus on the mechanisms by which a new test might change current care processes in the ICU and the subsequent cost and QALY implications. The VOI analysis suggested that further observational research to better define the prevalence of AKI developing in the ICU would be worthwhile. A formal randomised controlled trial of biomarker use linked to a standardised AKI care pathway is necessary to provide definitive evidence on whether or not adoption of tests by the NHS would be of value. STUDY REGISTRATION The systematic review within this study is registered as PROSPERO CRD42014013919. FUNDING The National Institute for Health Research Health Technology Assessment programme.
Collapse
Affiliation(s)
- Peter S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | | | - Alison F Smith
- Academy of Primary Care, Hull York Medical School, Hull, UK.,National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Leeds, Leeds, UK
| | - David A Cairns
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Messenger
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Leeds, Leeds, UK
| | | | - Judy Wright
- Academy of Primary Care, Hull York Medical School, Hull, UK
| | | | | | - Patrick Hamilton
- Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - David Meads
- Academy of Primary Care, Hull York Medical School, Hull, UK
| | | |
Collapse
|
30
|
Coventry PA, Blakemore A, Baker E, Sidhu M, Fitzmaurice D, Jolly K. The Push and Pull of Self-Managing Mild COPD: An Evaluation of Participant Experiences of a Nurse-Led Telephone Health Coaching Intervention. QUALITATIVE HEALTH RESEARCH 2019; 29:658-671. [PMID: 30501475 DOI: 10.1177/1049732318809679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Health coaching is a novel population intervention to support self-management but it is untested in people with mild disease. People with chronic obstructive pulmonary disease with mild dyspnea are a population excluded from supported self-management and whose illness might progress without intervention. We explored participants' experiences about how health coaching motivated behavior change. Interviews were conducted with 21 intervention and 10 control participants at 6 months, and 20 intervention participants at 12 months. Participants were identified from a randomized controlled trial of telephone health coaching. Data were analyzed using the framework method. Participants positively enacted behavior change to become more physically active. Participants took advantage of environmental affordances to pull themselves toward activity targets, or relied on being pushed to be more active by the health coach or significant others. Behavior change was maintained where efforts to be more active were built into the everyday lifeworld of participants.
Collapse
Affiliation(s)
| | - Amy Blakemore
- 2 The University of Manchester, Manchester, United Kingdom
| | | | | | | | - Kate Jolly
- 3 University of Birmingham, Birmingham, United Kingdom
| |
Collapse
|
31
|
Nguyen NT, Douglas C, Bonner A. Effectiveness of self-management programme in people with chronic kidney disease: A pragmatic randomized controlled trial. J Adv Nurs 2019; 75:652-664. [PMID: 30537153 DOI: 10.1111/jan.13924] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Revised: 10/16/2018] [Accepted: 10/22/2018] [Indexed: 11/28/2022]
Abstract
AIMS To examine the effectiveness of a self-management intervention compared with usual care in adults with chronic kidney disease (CKD) on self-management, knowledge, self-efficacy, health-related quality of life, and blood pressure. DESIGN A parallel group randomized controlled trial. METHODS Patients aged ≥ 18 years with CKD stages 3-5 were recruited between November 2015 and June 2016. Participants were randomly allocated into either the intervention (N = 68) or control group (N = 67). The control group received usual care, while the intervention group received usual care plus a self-management programme from a nurse. The intervention was guided by social cognitive theory (SCT) and included a face-to-face educational session followed by telephone support. Both groups were followed for 16 weeks. RESULTS There were no significant differences in self-management, knowledge, self-efficacy, health-related quality of life, and blood pressure between the two groups at baseline. At week 16, compared with the control group, large effect sizes for improved self-management, knowledge, and self-efficacy were detected. For health-related quality of life, the physical and mental health components significantly improved. However, no significant differences in either systolic or diastolic blood pressures were found. CONCLUSION In earlier stages of CKD, a simple self-management education benefits patients. IMPACT Effective self-management in the earlier stages of CKD contributes to slowing its progression, improving health outcomes and lowering the burden on healthcare systems. This study demonstrated that SCT increases CKD self-management by strengthening knowledge and self-efficacy. Nurses can give this education. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12616000038493.
Collapse
Affiliation(s)
- Nguyet Thi Nguyen
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,Hanoi Medical College, Hanoi, Vietnam.,NHMRC Chronic Kidney Disease Centre of Research Excellence, University of Queensland, Brisbane, Qld, Australia
| | - Clint Douglas
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,Metro North Hospital and Health Service, Brisbane, Qld, Australia
| | - Ann Bonner
- School of Nursing, Queensland University of Technology (QUT), Brisbane, Qld, Australia.,NHMRC Chronic Kidney Disease Centre of Research Excellence, University of Queensland, Brisbane, Qld, Australia.,Kidney Health Service, Metro North Hospital and Health Service, Brisbane, Qld, Australia
| |
Collapse
|
32
|
Kelly JT, Warner MM, Conley M, Reidlinger DP, Hoffmann T, Craig J, Tong A, Reeves M, Johnson DW, Palmer S, Campbell KL. Feasibility and acceptability of telehealth coaching to promote healthy eating in chronic kidney disease: a mixed-methods process evaluation. BMJ Open 2019; 9:e024551. [PMID: 30700482 PMCID: PMC6352771 DOI: 10.1136/bmjopen-2018-024551] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate the feasibility and acceptability of a personalised telehealth intervention to support dietary self-management in adults with stage 3-4 chronic kidney disease (CKD). DESIGN Mixed-methods process evaluation embedded in a randomised controlled trial. PARTICIPANTS People with stage 3-4 CKD (estimated glomerular filtration rate [eGFR]15-60 mL/min/1.73 m2). SETTING Participants were recruited from three hospitals in Australia and completed the intervention in ambulatory community settings. INTERVENTION The intervention group received one telephone call per fortnight and 2-8 tailored text messages for 3 months, and then 4-12 tailored text messages for 3 months without telephone calls. The control group received usual care for 3 months then non-tailored education-only text messages for 3 months. MAIN OUTCOME MEASURES Feasibility (recruitment, non-participation and retention rates, intervention fidelity and participant adherence) and acceptability (questionnaire and semistructured interviews). STATISTICAL ANALYSES PERFORMED Descriptive statistics and qualitative content analysis. RESULTS Overall, 80/230 (35%) eligible patients who were approached consented to participate (mean±SD age 61.5±12.6 years). Retention was 93% and 98% in the intervention and control groups, respectively, and 96% of all planned intervention calls were completed. All participants in the intervention arm identified the tailored text messages as useful in supporting dietary self-management. In the control group, 27 (69%) reported the non-tailored text messages were useful in supporting change. Intervention group participants reported that the telehealth programme delivery methods were practical and able to be integrated into their lifestyle. Participants viewed the intervention as an acceptable, personalised alternative to face-face clinic consultations, and were satisfied with the frequency of contact. CONCLUSIONS This telehealth-delivered dietary coaching programme is an acceptable intervention which appears feasible for supporting dietary self-management in stage 3-4 CKD. A larger-scale randomised controlled trial is needed to evaluate the efficacy of the coaching programme on clinical and patient-reported outcomes. TRIAL REGISTRATION NUMBER ACTRN12616001212448; Results.
Collapse
Affiliation(s)
- Jaimon T Kelly
- Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Molly M Warner
- Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Marguerite Conley
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Dianne P Reidlinger
- Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia
| | - Tammy Hoffmann
- Centre for Research in Evidence Based Practice, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Queensland, Australia
| | - Jonathan Craig
- College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia
- Sydney School of Public Health, The University of Sydney, Adelaide, South Australia, Australia
| | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Adelaide, South Australia, Australia
- Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Marina Reeves
- Cancer Prevention Research Centre, School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Kidney Disease Research, University of Queensland, Brisbane, Queensland, Australia
- Translational Research Institute, Brisbane, Queensland, Australia
| | - Suetonia Palmer
- Department of Medicine, University of Otago Christchurch, Christchurch, New Zealand
| | - Katrina L Campbell
- Faculty of Health Science and Medicine, Bond University, Robina, Queensland, Australia
- Department of Nutrition and Dietetics, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| |
Collapse
|
33
|
Vassilev I, Rogers A, Kennedy A, Oatley C, James E. Identifying the processes of change and engagement from using a social network intervention for people with long-term conditions. A qualitative study. Health Expect 2018; 22:173-182. [PMID: 30318769 PMCID: PMC6433331 DOI: 10.1111/hex.12839] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 09/02/2018] [Accepted: 09/04/2018] [Indexed: 12/23/2022] Open
Abstract
Background Personal and community networks are recognized as influencing and shaping self‐management activities and practices. An acceptable intervention which facilitates self‐management by mobilizing network support and improves network engagement has a positive impact on health and quality of life. This study aims to identify the processes through which such changes and engagement take place. Methods The study was conducted in the south of England in 2016‐2017 and adopted a longitudinal case study of networks design. Purposive sample of respondents with long‐term conditions (n = 15) was recruited from local groups. Barriers and facilitators to implementation were explored in interviews with key stakeholders (5). Results Intervention engagement leads to a deepening of relationships within networks, adding new links and achieving personal objectives relevant for improving the health and well‐being of users and network members. Such changes are supported through two pathways: the mobilization of network capabilities and by acting as a nudge. The first is a gradual process where potentially relevant changes are further contemplated by forefronting immediate concerns and negotiating acceptable means for achieving change, prioritizing objective over subjective valuations of support provided by network members and rehearsing justifications for keeping the status quo or adopting change. The second pathway changes are enacted through the availability of a potential fit between individual, network and environmental conditions of readiness. Conclusions The two pathways of network mobilization identified in this study illuminate the individual, network and environmental level processes involved in moving from cognitive engagement with the intervention to adopting changes in existing practice.
Collapse
Affiliation(s)
- Ivaylo Vassilev
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Anne Rogers
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Anne Kennedy
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| | - Chad Oatley
- School for Sport, Health and Social Sciences, Solent University, Southampton, UK
| | - Elizabeth James
- NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| |
Collapse
|
34
|
Bower P, Reeves D, Sutton M, Lovell K, Blakemore A, Hann M, Howells K, Meacock R, Munford L, Panagioti M, Parkinson B, Riste L, Sidaway M, Lau YS, Warwick-Giles L, Ainsworth J, Blakeman T, Boaden R, Buchan I, Campbell S, Coventry P, Reilly S, Sanders C, Skevington S, Waheed W, Checkland K. Improving care for older people with long-term conditions and social care needs in Salford: the CLASSIC mixed-methods study, including RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2018. [DOI: 10.3310/hsdr06310] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundThe Salford Integrated Care Programme (SICP) was a large-scale transformation project to improve care for older people with long-term conditions and social care needs. We report an evaluation of the ability of the SICP to deliver an enhanced experience of care, improved quality of life, reduced costs of care and improved cost-effectiveness.ObjectivesTo explore the process of implementation of the SICP and the impact on patient outcomes and costs.DesignQualitative methods (interviews and observations) to explore implementation, a cohort multiple randomised controlled trial to assess patient outcomes through quasi-experiments and a formal trial, and an analysis of routine data sets and appropriate comparators using non-randomised methodologies.SettingSalford in the north-west of England.ParticipantsOlder people aged ≥ 65 years, carers, and health and social care professionals.InterventionsA large-scale integrated care project with three core mechanisms of integration (community assets, multidisciplinary groups and an ‘integrated contact centre’).Main outcome measuresPatient self-management, care experience and quality of life, and health-care utilisation and costs.Data sourcesProfessional and patient interviews, patient self-report measures, and routine quantitative data on service utilisation.ResultsThe SICP and subsequent developments have been sustained by strong partnerships between organisations. The SICP achieved ‘functional integration’ through the pooling of health and social care budgets, the development of the Alliance Agreement between four organisations and the development of the shared care record. ‘Service-level’ integration was slow and engagement with general practice was a challenge. We saw only minor changes in patient experience measures over the period of the evaluation (both improvements and reductions), with some increase in the use of community assets and care plans. Compared with other sites, the difference in the rates of admissions showed an increase in emergency admissions. Patient experience of health coaching was largely positive, although the effects of health coaching on activation and depression were not statistically significant. Economic analyses suggested that coaching was likely to be cost-effective, generating improvements in quality of life [mean incremental quality-adjusted life-year gain of 0.019, 95% confidence interval (CI) –0.006 to 0.043] at increased cost (mean incremental total cost increase of £150.58, 95% CI –£470.611 to £711.776).LimitationsThe Comprehensive Longitudinal Assessment of Salford Integrated Care study represents a single site evaluation, with consequent limits on external validity. Patient response rates to the cohort survey were < 40%.ConclusionsThe SICP has been implemented in a way that is consistent with the original vision. However, there has been more rapid success in establishing new integrated structures (such as a formal integrated care organisation), rather than in delivering mechanisms of integration at sufficient scale to have a large impact on patient outcomes.Future workFurther research could focus on each of the mechanisms of integration. The multidisciplinary groups may require improved targeting of patients or disease subgroups to demonstrate effectiveness. Development of a proven model of health coaching that can be implemented at scale is required, especially one that would provide cost savings for commissioners or providers. Similarly, further exploration is required to assess the longer-term benefits of community assets and whether or not health impacts translate to reductions in care use.Trial registrationCurrent Controlled Trials ISRCTN12286422.FundingThis project was funded by the NIHR Health Services and Delivery Research programme and will be published in full inHealth Services and Delivery Research; Vol. 6, No. 31. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Peter Bower
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - David Reeves
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Matt Sutton
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Karina Lovell
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Amy Blakemore
- Division of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
| | - Mark Hann
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Kelly Howells
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Rachel Meacock
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Luke Munford
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Maria Panagioti
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Beth Parkinson
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Lisa Riste
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | | | - Yiu-Shing Lau
- Manchester Centre for Health Economics, University of Manchester, Manchester, UK
| | - Lynsey Warwick-Giles
- Policy Research Unit in Commissioning and the Healthcare System, Centre for Primary Care, University of Manchester, Manchester, UK
| | - John Ainsworth
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Thomas Blakeman
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Ruth Boaden
- National Institute for Health Research Collaborations for Leadership in Applied Health Research and Care for Greater Manchester, Alliance Business School Manchester, University of Manchester, Manchester, UK
| | - Iain Buchan
- Centre for Health Informatics, University of Manchester, Manchester, UK
| | - Stephen Campbell
- National Institute for Health Research Greater Manchester Primary Care Patient Safety Translational Research Centre, Centre for Primary Care, University of Manchester, Manchester, UK
| | | | | | - Caroline Sanders
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Suzanne Skevington
- Manchester Centre for Health Psychology, University of Manchester, Manchester, UK
| | - Waquas Waheed
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Katherine Checkland
- Policy Research Unit in Commissioning and the Healthcare System, Centre for Primary Care, University of Manchester, Manchester, UK
| |
Collapse
|
35
|
Zimbudzi E, Lo C, Misso ML, Ranasinha S, Kerr PG, Teede HJ, Zoungas S. Effectiveness of self-management support interventions for people with comorbid diabetes and chronic kidney disease: a systematic review and meta-analysis. Syst Rev 2018; 7:84. [PMID: 29898785 PMCID: PMC6001117 DOI: 10.1186/s13643-018-0748-z] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 05/24/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Self-management support interventions may potentially delay kidney function decline and associated complications in patients with comorbid diabetes and chronic kidney disease. However, the effectiveness of these interventions remains unclear. We investigated the effectiveness of current self-management support interventions and their specific components and elements in improving patient outcomes. METHODS Electronic databases were systematically searched from January 1, 1994, to December 19, 2017. Eligible studies were randomized controlled trials on self-management support interventions for adults with comorbid diabetes and chronic kidney disease. Primary outcomes were systolic blood pressure, diastolic blood pressure, estimated glomerular filtration rate, and glycated hemoglobin. Secondary outcomes included self-management activity, health service utilization, health-related quality of life, medication adherence, and death. RESULTS Of the 48 trials identified, eight studies (835 patients) were eligible. There was moderate-quality evidence that self-management support interventions improved self-management activity (standard mean difference 0.56, 95% CI 0.15 to 0.97, p < 0.007) compared to usual care. There was low-quality evidence that self-management support interventions reduced systolic blood pressure (mean difference - 4.26 mmHg, 95% CI - 7.81 to - 0.70, p = 0.02) and glycated hemoglobin (mean difference - 0.5%, 95% CI - 0.8 to - 0.1, p = 0.01) compared to usual care. CONCLUSIONS Self-management support interventions may improve self-care activities, systolic blood pressure, and glycated hemoglobin in patients with comorbid diabetes and chronic kidney disease. It was not possible to determine which self-management components and elements were more effective, but interventions that utilized provider reminders, patient education, and goal setting were associated with improved outcomes. More evidence from high-quality studies is required to support future self-management programs. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42015017316 .
Collapse
Affiliation(s)
- Edward Zimbudzi
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
- Department of Nephrology, Monash Health, Melbourne, Victoria Australia
| | - Clement Lo
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria Australia
| | - Marie L. Misso
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
| | - Sanjeeva Ranasinha
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
| | - Peter G. Kerr
- Department of Nephrology, Monash Health, Melbourne, Victoria Australia
- Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria Australia
| | - Helena J. Teede
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria Australia
| | - Sophia Zoungas
- Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, 43-51 Kanooka Grove, Clayton, Melbourne, Victoria Australia
- Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria Australia
- The George Institute for Global Health, University of Sydney, Sydney, New South Wales Australia
| |
Collapse
|
36
|
Donald M, Kahlon BK, Beanlands H, Straus S, Ronksley P, Herrington G, Tong A, Grill A, Waldvogel B, Large CA, Large CL, Harwood L, Novak M, James MT, Elliott M, Fernandez N, Brimble S, Samuel S, Hemmelgarn BR. Self-management interventions for adults with chronic kidney disease: a scoping review. BMJ Open 2018; 8:e019814. [PMID: 29567848 PMCID: PMC5875600 DOI: 10.1136/bmjopen-2017-019814] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 01/22/2018] [Accepted: 01/24/2018] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To systematically identify and describe self-management interventions for adult patients with chronic kidney disease (CKD). SETTING Community-based. PARTICIPANTS Adults with CKD stages 1-5 (not requiring kidney replacement therapy). INTERVENTIONS Self-management strategies for adults with CKD. PRIMARY AND SECONDARY OUTCOME MEASURES Using a scoping review, electronic databases and grey literature were searched in October 2016 to identify self-management interventions for adults with CKD stages 1-5 (not requiring kidney replacement therapy). Randomised controlled trials (RCTs), non-RCTs, qualitative and mixed method studies were included and study selection and data extraction were independently performed by two reviewers. Outcomes included behaviours, cognitions, physiological measures, symptoms, health status and healthcare. RESULTS Fifty studies (19 RCTs, 7 quasi-experimental, 5 observational, 13 pre-post intervention, 1 mixed method and 5 qualitative) reporting 45 interventions were included. The most common intervention topic was diet/nutrition and interventions were regularly delivered face to face. Interventions were administered by a variety of providers, with nursing professionals the most common health professional group. Cognitions (ie, changes in general CKD knowledge, perceived self-management and motivation) were the most frequently reported outcome domain that showed improvement. Less than 1% of the interventions were co-developed with patients and 20% were based on a theory or framework. CONCLUSIONS There was a wide range of self-management interventions with considerable variability in outcomes for adults with CKD. Major gaps in the literature include lack of patient engagement in the design of the interventions, with the majority of interventions not applying a behavioural change theory to inform their development. This work highlights the need to involve patients to co-developed and evaluate a self-management intervention based on sound theories and clinical evidence.
Collapse
Affiliation(s)
- Maoliosa Donald
- Department of Medicine, University of Calgary, Calgary, Canada
- Interdisciplinary Chronic Disease Collaboration, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | | | - Heather Beanlands
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Sharon Straus
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | - Paul Ronksley
- Interdisciplinary Chronic Disease Collaboration, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | | | - Allison Tong
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales
| | - Allan Grill
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | | | | | - Claire L Large
- Can-SOLVE CKD Network, Patient Partner, Pouce Coupe, Canada
| | | | - Marta Novak
- Centre for Mental Health, University Health Network, Toronto, Canada
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Matthew T James
- Department of Medicine, University of Calgary, Calgary, Canada
- Interdisciplinary Chronic Disease Collaboration, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| | - Meghan Elliott
- Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Canada
| | | | - Scott Brimble
- Department of Medicine, McMaster University, Ontario, Canada
| | - Susan Samuel
- Department of Pediatrics, University of Calgary, Calgary, Canada
| | - Brenda R Hemmelgarn
- Department of Medicine, University of Calgary, Calgary, Canada
- Interdisciplinary Chronic Disease Collaboration, Calgary, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
| |
Collapse
|
37
|
Valentijn PP, Pereira FA, Ruospo M, Palmer SC, Hegbrant J, Sterner CW, Vrijhoef HJM, Ruwaard D, Strippoli GFM. Person-Centered Integrated Care for Chronic Kidney Disease: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Clin J Am Soc Nephrol 2018; 13:375-386. [PMID: 29438975 PMCID: PMC5967678 DOI: 10.2215/cjn.09960917] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/15/2017] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The effectiveness of person-centered integrated care strategies for CKD is uncertain. We conducted a systematic review and meta-analysis of randomized, controlled trials to assess the effect of person-centered integrated care for CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We searched MEDLINE, Embase, and Cochrane Central Register of Controlled Trials (from inception to April of 2016), and selected randomized, controlled trials of person-centered integrated care interventions with a minimum follow-up of 3 months. Random-effects meta-analysis was used to assess the effect of person-centered integrated care. RESULTS We included 14 eligible studies covering 4693 participants with a mean follow-up of 12 months. In moderate quality evidence, person-centered integrated care probably had no effect on all-cause mortality (relative risk [RR], 0.86; 95% confidence interval [95% CI], 0.68 to 1.08) or health-related quality of life (standardized mean difference, 0.02; 95% CI, -0.05 to 0.10). The effects on renal replacement therapy (RRT) (RR, 1.00; 95% CI, 0.65 to 1.55), serum creatinine levels (mean difference, 0.59 mg/dl; 95% CI, -0.38 to 0.36), and eGFR (mean difference, 1.51 ml/min per 1.73 m2; 95% CI, -3.25 to 6.27) were very uncertain. Quantitative analysis suggested that person-centered integrated care interventions may reduce all-cause hospitalization (RR, 0.38; 95% CI, 0.15 to 0.95) and improve BP control (RR, 1.20; 95% CI, 1.00 to 1.44), although the certainty of the evidence was very low. CONCLUSIONS Person-centered integrated care may have little effect on mortality or quality of life. The effects on serum creatinine, eGFR, and RRT are uncertain, although person-centered integrated care may lead to fewer hospitalizations and improved BP control.
Collapse
Affiliation(s)
- Pim P Valentijn
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Brooks HL, Lovell K, Bee P, Sanders C, Rogers A. Is it time to abandon care planning in mental health services? A qualitative study exploring the views of professionals, service users and carers. Health Expect 2017; 21:597-605. [PMID: 29144591 PMCID: PMC5980609 DOI: 10.1111/hex.12650] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND It has been established that mental health-care planning does not adequately respond to the needs of those accessing services. Understanding the reasons for this and identifying whose needs care plans serve requires an exploration of the perspectives of service users, carers and professionals within the wider organizational context. OBJECTIVE To explore the current operationalization of care planning and perceptions of its function within mental health services from the perspectives of multiple stakeholders. SETTINGS AND PARTICIPANTS Participants included 21 mental health professionals, 29 service users and 4 carers from seven Mental Health Trusts in England. All participants had experience of care planning processes within secondary mental health-care services. METHODS Fifty-four semi-structured interviews were conducted with participants and analysed utilizing a qualitative framework approach. FINDINGS Care plans and care planning were characterized by a failure to meet the complexity of mental health needs, and care planning processes were seen to prioritize organizational agendas and risk prevention which distanced care planning from the everyday lives of service users. DISCUSSION AND CONCLUSIONS Care planning is recognized, embedded and well established in the practices of mental health professionals and service users. However, it is considered too superficial and mainly irrelevant to users for managing mental health in their everyday lives. Those responsible for the planning and delivery of mental health services should consider ways to increase the relevance of care planning to the everyday lives of service users including separating risk from holistic needs assessment, using support aids and utilizing a peer workforce in this regard.
Collapse
Affiliation(s)
- Helen L Brooks
- Department of Psychological Sciences, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK
| | - Karina Lovell
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Penny Bee
- Mental Health Research Group, Division of Nursing, Midwifery and Social Work, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Caroline Sanders
- NIHR School for Primary Care Research, Division of Population Health, Faculty of Biology, Medicine and Health, School of Health Sciences, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Anne Rogers
- Faculty of Health Sciences, NIHR CLAHRC Wessex, University of Southampton, Southampton, UK
| |
Collapse
|
39
|
Rempel ES, Wilson EN, Durrant H, Barnett J. Preparing the prescription: a review of the aim and measurement of social referral programmes. BMJ Open 2017; 7:e017734. [PMID: 29025843 PMCID: PMC5652530 DOI: 10.1136/bmjopen-2017-017734] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Revised: 07/15/2017] [Accepted: 08/03/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Our aim is to review, and qualitatively evaluate, the aims and measures of social referral programmes. Our first objective is to identify the aims of social referral initiatives. Our second objective is to identify the measures used to evaluate whether the aims of social referral were met. DESIGN Literature review. BACKGROUND Social referral programmes, also called social prescribing and emergency case referral, link primary and secondary healthcare with community services, often under the guise of decreasing health system costs. METHOD Following the PRISMA guidelines, we undertook a literature review to address that aim. We searched in five academic online databases and in one online non-academic search engine, including both academic and grey literature, for articles referring to 'social prescribing' or 'community referral'. RESULTS We identified 41 relevant articles and reports. After extracting the aims, measures and type of study, we found that most social referral programmes aimed to address a wide variety of system and individual health problems. This included cost savings, resource reallocation and improved mental, physical and social well-being. Across the 41 studies and reports, there were 154 different kinds of measures or methods of evaluation identified. Of these, the most commonly used individual measure was the Warwick-Edinburgh Mental Well-being Scale, used in nine studies and reports. CONCLUSIONS These inconsistencies in aims and measures used pose serious problems when social prescribing and other referral programmes are often advertised as a solution to health services-budgeting constraints, as well as a range of chronic mental and physical health conditions. We recommend researchers and local community organisers alike to critically evaluate for whom, where and why their social referral programmes 'work'.
Collapse
Affiliation(s)
| | - Emma N Wilson
- Department of Psychology, University of Bath, Bath, UK
| | - Hannah Durrant
- Institute for Policy Research, University of Bath, Bath, UK
| | - Julie Barnett
- Department of Psychology, University of Bath, Bath, UK
- Institute for Policy Research, University of Bath, Bath, UK
| |
Collapse
|
40
|
Silver SA, Bell CM, Chertow GM, Shah PS, Shojania K, Wald R, Harel Z. Effectiveness of Quality Improvement Strategies for the Management of CKD: A Meta-Analysis. Clin J Am Soc Nephrol 2017; 12:1601-1614. [PMID: 28877926 PMCID: PMC5628709 DOI: 10.2215/cjn.02490317] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2017] [Accepted: 06/12/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND OBJECTIVES Quality improvement interventions have enhanced care for other chronic illnesses, but their effectiveness for patients with CKD is unknown. We sought to determine the effects of quality improvement strategies on clinical outcomes in adult patients with nondialysis-requiring CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS We conducted a systematic review of randomized trials, searching Medline and the Cochrane Effective Practice and Organization of Care database from January of 2003 to April of 2015. Eligible studies evaluated one or more of 11 prespecified quality improvement strategies, and prespecified study outcomes included at least one process of care measure, surrogate outcome, or hard clinical outcome. We used a random effects model to estimate the pooled risk ratio (RR; dichotomous data) or the mean difference (continuous data). RESULTS We reviewed 15 patient-level randomized trials (n=3298 patients), and six cluster-randomized trials (n=30,042 patients). Quality improvement strategies reduced dialysis incidence (seven trials; RR, 0.85; 95% confidence interval [95% CI], 0.74 to 0.97) and LDL cholesterol concentrations (four trials; mean difference, -17.6 mg/dl; 95% CI, -28.7 to -6.5), and increased the likelihood that patients received renin-angiotensin-aldosterone system inhibitors (nine trials; RR, 1.16; 95% CI, 1.06 to 1.27). We did not observe statistically significant effects on mortality, cardiovascular events, eGFR, glycated hemoglobin, and systolic or diastolic BP. CONCLUSIONS Quality improvement interventions yielded significant beneficial effects on three elements of CKD care. Estimates of the effectiveness of quality improvement strategies were limited by study number and adherence to quality improvement principles. PODCAST This article contains a podcast at https://www.asn-online.org/media/podcast/CJASN/2017_09_06_CJASNPodcast_17_10.mp3.
Collapse
Affiliation(s)
- Samuel A. Silver
- Division of Nephrology and
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Chaim M. Bell
- Departments of Medicine and
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; and
| | - Glenn M. Chertow
- Division of Nephrology, Stanford University School of Medicine, Palo Alto, California
| | - Prakesh S. Shah
- Pediatrics, Mount Sinai Hospital, University of Toronto, Toronto, Canada
| | - Kaveh Shojania
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Canada; and
- Department of Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Ron Wald
- Division of Nephrology and
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| | - Ziv Harel
- Division of Nephrology and
- Keenan Research Center, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, Canada
| |
Collapse
|
41
|
Effects of self-management on chronic kidney disease: A meta-analysis. Int J Nurs Stud 2017; 74:128-137. [PMID: 28689160 DOI: 10.1016/j.ijnurstu.2017.06.008] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 06/15/2017] [Accepted: 06/15/2017] [Indexed: 01/20/2023]
Abstract
BACKGROUND Self-management programs may facilitate the improvement of outcomes in medical, role, and emotional management and health-related quality of life in patients with chronic kidney disease. Studies on the effect of three self-management tasks have reported conflicting findings. In addition, systematic reviews are unavailable. OBJECTIVE This study evaluated the effects of self-management programs on medical, role, and emotional management and health-related quality of life in chronic kidney disease. DESIGN Meta-analysis of randomized controlled studies. DATA SOURCES The meta-analysis involved an online search of the English literature from PubMed, Cochrane, Web of Science, and CINAHL and the Chinese literature from the Airiti Library that were published from the inception of the websites until January 1, 2017. REVIEW METHODS The meta-analysis was conducted to evaluate the effects of self-management on chronic kidney disease outcomes. Electronic databases were searched by using keywords: chronic kidney disease, end-stage renal disease, renal failure, dialysis, self-management, self-efficacy, empowerment, cognitive behavioral, and educational. The methodological quality of randomized controlled trials was assessed using the Cochrane Handbook. Data were analyzed using Comprehensive Meta-Analysis software 2.0. RESULTS Eighteen randomized controlled trials met our inclusion criteria. The results revealed that the self-management program significantly enhanced the effects of self-management on outcomes of medical, role, and emotional management and health-related quality of life in patients with chronic kidney disease. The following Hedges' g (effect size) values were obtained: (1) interdialytic weight gain, -0.36 (95% confidence interval, -0.60 to -0.12, p<0.01); (2) self-efficacy, 0.57 (95% confidence interval, 0.18-0.96, p<0.01); (3) anxiety, -0.95 (95% confidence interval, -1.65 to -0.25, p=0.01); (4) depression, -0.63 (95% confidence interval, -0.85 to -0.41, p<0.01) (5) health-related quality of life for the mental component of the SF-36, 0.71 (95% confidence interval, 0.45-0.97, p<0.01); (6) the physical component of the SF-36, 0.61 (95% confidence interval, 0.35-0.86, p<0.01); and (7) the Kidney Disease Quality of Life, 0.41 (95% confidence interval, 0.17-0.65, p<0.01). DISCUSSION This study revealed a small effect of self-management on interdialytic weight gain; medium effects on self-efficacy, depression, and health-related quality of life; and a large effect on anxiety. However, high-quality randomized controlled trial designs are required to confirm these results, although the existing evidence can guide clinical practitioners and health policy makers.
Collapse
|
42
|
Blakeman T, Griffith K, Lasserson D, Lopez B, Tsang JY, Campbell S, Tomson C. Development of guidance on the timeliness in response to acute kidney injury warning stage test results for adults in primary care: an appropriateness ratings evaluation. BMJ Open 2016; 6:e012865. [PMID: 27729353 PMCID: PMC5073517 DOI: 10.1136/bmjopen-2016-012865] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/19/2016] [Accepted: 09/12/2016] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVES Tackling the harm associated with acute kidney injury (AKI) is a global priority. In England, a national computerised AKI algorithm is being introduced across the National Health Service (NHS) to drive this change. The study sought to maximise its clinical utility and minimise the potential for burden on clinicians and patients in primary care. DESIGN An appropriateness ratings evaluation using the RAND/UCLA Appropriateness Method. SETTING Clinical scenarios were developed to test the timeliness in (1) communication of AKI warning stage test results from clinical pathology services to primary care, and (2) primary care clinician response to an AKI warning stage test result. PARTICIPANTS A 10-person panel was purposively sampled with representation from clinical biochemistry, acute and emergency medicine and general practice. General practitioners (GPs) represented typical practice in relation to rural and urban practice, out of hours care, GP commissioning and those interested in reducing the impact of medicalisation and 'overdiagnosis'. RESULTS There was agreement that delivery of AKI warning stage test results through interruptive methods of communication (ie, telephone) from laboratories to primary care was the appropriate next step for patients with an AKI warning stage 3 test result. In the context of acute illness, waiting up to 72 hours to respond to an AKI warning stage test result was deemed an inappropriate action in 62 out of the 65 (94.5%) cases. There was agreement that a clinician response was required within 6 hours, or less, in 39 out of 40 (97.5%) clinical cases relating AKI warning stage test results in the presence of moderate hyperkalaemia. CONCLUSIONS The study has informed national guidance to support a timely and calibrated response to AKI warning stage test results for adults in primary care. Further research is needed to support effective implementation, with a view to examine the effect on health outcomes and costs.
Collapse
Affiliation(s)
- Tom Blakeman
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Kathryn Griffith
- RCGP Clinical champion for Kidney Care, Royal College of General Practitioners, London, UK
| | - Dan Lasserson
- Department of Geratology, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Berenice Lopez
- Department of Clinical Biochemistry, Norfolk and Norwich University Hospitals Foundation Trust, Norwich, UK
| | - Jung Y Tsang
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
| | - Stephen Campbell
- NIHR Greater Manchester Primary Care Patient Safety, Translational Research Centre, Institute of Population Health, Centre for Primary Care, University of Manchester, Manchester, UK
| | - Charles Tomson
- Department of Renal Medicine, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| |
Collapse
|
43
|
Abstract
Chronic kidney disease (CKD) is an important and common noncommunicable condition globally. In national and international guidelines, CKD is defined and staged according to measures of kidney function that allow for a degree of risk stratification using commonly available markers. It is often asymptomatic in its early stages, and early detection is important to reduce future risk. The risk of cardiovascular outcomes is greater than the risk of progression to end-stage kidney disease for most people with CKD. CKD also predisposes to acute kidney injury - a major cause of morbidity and mortality worldwide. Although only a small proportion of people with CKD progress to end-stage kidney disease, renal replacement therapy (dialysis or transplantation) represents major costs for health care systems and burden for patients. Efforts in primary care to reduce the risks of cardiovascular disease, acute kidney injury, and progression are therefore required. Monitoring renal function is an important task, and primary care clinicians are well placed to oversee this aspect of care along with the management of modifiable risk factors, particularly blood pressure and proteinuria. Good primary care judgment is also essential in making decisions about referral for specialist nephrology opinion. As CKD commonly occurs alongside other conditions, consideration of comorbidities and patient wishes is important, and primary care clinicians have a key role in coordinating care while adopting a holistic, patient-centered approach and providing continuity. This review aims to summarize the vital role that primary care plays in predialysis CKD care and to outline the main considerations in its identification, monitoring, and clinical management in this context.
Collapse
Affiliation(s)
- Simon DS Fraser
- Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton
| | - Tom Blakeman
- National Institute for Health Research Collaboration for Leadership in Applied Health Research Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK
| |
Collapse
|
44
|
Tsang JY, Blakeman T, Hegarty J, Humphreys J, Harvey G. Understanding the implementation of interventions to improve the management of chronic kidney disease in primary care: a rapid realist review. Implement Sci 2016; 11:47. [PMID: 27044401 PMCID: PMC4820872 DOI: 10.1186/s13012-016-0413-7] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 03/24/2016] [Indexed: 12/25/2022] Open
Abstract
Background Chronic kidney disease (CKD) is common and a significant marker of morbidity and mortality. Its management in primary care is essential for maintenance of cardiovascular health, avoidance of acute kidney injury (AKI) and delay in progression to end-stage renal disease. Although many guidelines and interventions have been established, there is global evidence of an implementation gap, including variable identification rates and low patient communication and awareness. The objective of this study is to understand the factors enabling and constraining the implementation of CKD interventions in primary care. Methods A rapid realist review was conducted that involved a primary literature search of three databases to identify existing CKD interventions in primary care between the years 2000 and 2014. A secondary search was performed as an iterative process and included bibliographic and grey literature searches of reference lists, authors and research groups. A systematic approach to data extraction using Normalisation Process Theory (NPT) illuminated key mechanisms and contextual factors that affected implementation. Results Our primary search returned 710 articles that were narrowed down to 18 relevant CKD interventions in primary care. Our findings suggested that effective management of resources (encompassing many types) was a significant contextual factor enabling or constraining the functioning of mechanisms. Three key intervention features were identified from the many that contributed to successful implementation. Firstly, it was important to frame CKD interventions appropriately, such as within the context of cardiovascular health and diabetes. This enabled buy-in and facilitated an understanding of the significance of CKD and the need for intervention. Secondly, interventions that were compatible with existing practices or patients’ everyday lives were readily accepted. In contrast, new systems that could not be integrated were abandoned as they were viewed as inconvenient, generating more work. Thirdly, ownership of the feedback process allowed users to make individualised improvements to the intervention to suit their needs. Conclusions Our rapid realist review identified mechanisms that need to be considered in order to optimise the implementation of interventions to improve the management of CKD in primary care. Further research into the factors that enable prolonged sustainability and cost-effectiveness is required for efficient resource utilisation. Electronic supplementary material The online version of this article (doi:10.1186/s13012-016-0413-7) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Jung Yin Tsang
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester (GM), Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, M13 9PL, UK.
| | - Tom Blakeman
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester (GM), Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, M13 9PL, UK
| | - Janet Hegarty
- Renal Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - John Humphreys
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Greater Manchester (GM), Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, M13 9PL, UK.,Renal Department, Salford Royal NHS Foundation Trust, Stott Lane, Salford, M6 8HD, UK
| | - Gill Harvey
- Alliance Manchester Business School, University of Manchester, Booth Street West, Manchester, M15 6PB, UK.,School of Nursing, University of Adelaide, Eleanor Harrald Building, Frome Road, Adelaide, SA5005, Australia
| |
Collapse
|
45
|
Simmonds R, Evans J, Feder G, Blakeman T, Lasserson D, Murray E, Bennert K, Locock L, Horwood J. Understanding tensions and identifying clinician agreement on improvements to early-stage chronic kidney disease monitoring in primary care: a qualitative study. BMJ Open 2016; 6:e010337. [PMID: 26988353 PMCID: PMC4800136 DOI: 10.1136/bmjopen-2015-010337] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES Since 2006, general practitioners (GPs) in England, UK, have been incentivised to keep a register and monitor patients with chronic kidney disease (CKD) stages 3-5. Despite tensions and debate around the merit of this activity, there has been little qualitative research exploring clinician perspectives on monitoring early-stage CKD in primary care. This study aimed to examine and understand a range of different healthcare professional views and experiences of identification and monitoring in primary care of early-stage CKD, in particular stage 3. DESIGN Qualitative design using semistructured interviews. SETTING National Health Service (NHS) settings across primary and secondary care in South West England, UK. PARTICIPANTS 25 clinicians: 16 GPs, 3 practice nurses, 4 renal consultants and 2 public health physicians. RESULTS We identified two related overarching themes of dissonance and consonance in clinician perspectives on early-stage CKD monitoring in primary care. Clinician dissonance around clinical guidelines for CKD monitoring emanated from different interpretations of CKD and different philosophies of healthcare and moral decision-making. Clinician consonance centred on the need for greater understanding of renal decline and increasing proteinuria testing to reduce overdiagnosis and identify those patients who were at risk of progression and further morbidity and who would benefit from early intervention. Clinicians recommended adopting a holistic approach for patients with CKD representing a barometer of overall health. CONCLUSIONS The introduction of new National Institute for Health and Care Excellence (NICE) CKD guidelines in 2014, which focus the meaning and purpose of CKD monitoring by increased proteinuria testing and assessment of risk, may help to resolve some of the ethical and moral tensions clinicians expressed regarding the overmedicalisation of patients with a CKD diagnosis.
Collapse
Affiliation(s)
- Rosemary Simmonds
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, UK
| | - Julie Evans
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Gene Feder
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, UK
| | - Tom Blakeman
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) Greater Manchester, Centre for Primary Care, Institute of Population Health, University of Manchester, Manchester, UK
| | - Dan Lasserson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Elizabeth Murray
- e-Health Unit, Research Department of Primary Care and Population Health, UCL, UK
| | - Kristina Bennert
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, UK
| | - Louise Locock
- Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
- NIHR Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Jeremy Horwood
- Centre for Academic Primary Care, School of Social and Community Medicine, University of Bristol, UK
- National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care (NIHR CLAHRC) West at University Hospitals Bristol NHS Foundation Trust
| |
Collapse
|
46
|
Kennedy A, Vassilev I, James E, Rogers A. Implementing a social network intervention designed to enhance and diversify support for people with long-term conditions. A qualitative study. Implement Sci 2016; 11:27. [PMID: 26926837 PMCID: PMC4772323 DOI: 10.1186/s13012-016-0384-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 02/16/2016] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND For people with long-term conditions, social networks provide a potentially central means of mobilising, mediating and accessing support for health and well-being. Few interventions address the implementation of improving engagement with and through social networks. This paper describes the development and implementation of a web-based tool which comprises: network mapping, user-centred preference elicitation and need assessment and facilitated engagement with resources. The study aimed to determine whether the intervention was acceptable, implementable and acted to enhance support and to add to theory concerning social networks and engagement with resources and activities. METHODS A longitudinal design with 15 case studies used ethnographic methods comprising video, non-participant observation of intervention delivery and qualitative interviews (baseline, 6 and 12 months). Participants were people with type 2 diabetes living in a marginalised island community. Facilitators were local health trainers and care navigators. Analysis applied concepts concerning implementation of technology for self-management support to explain how new practices of work were operationalised and how the technology impacted on relationships fit with everyday life and allowed for visual feedback. RESULTS Most participants reported identifying and taking up new activities as a result of using the tool. Thematic analysis suggested that workability of the tool was predicated on disruption and reconstruction of networks, challenging/supportive facilitation and change and reflection over time concerning network support. Visualisation of the network enabled people to mobilise support and engage in new activities. The tool aligned synergistically with the facilitators' role of linking people to local resources. CONCLUSIONS The social network tool works through a process of initiating positive disruption of established self-management practice through mapping and reflection on personal network membership and support. This opens up possibilities for reconstructing self-management differently from current practice. Key facets of successful implementation were: the visual maps of networks and support options; facilitation characterised by a perceived lack of status difference which assisted engagement and constructive discussion of support and preferences for activities; and background work (a reliable database, tailored preferences, option reduction) for facilitator and user ease of use.
Collapse
Affiliation(s)
- Anne Kennedy
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - Ivaylo Vassilev
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - Elizabeth James
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
| | - Anne Rogers
- NIHR Collaboration for Leadership in Applied Health Research (CLAHRC) Wessex, Health Sciences, University of Southampton, Highfield Campus, Southampton, SO17 1BJ, UK.
| |
Collapse
|
47
|
Why do people with chronic disease not contact consumer health organisations? A survey of general practice patients. Prim Health Care Res Dev 2015; 17:393-404. [PMID: 26573392 DOI: 10.1017/s146342361500050x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
UNLABELLED Aim Consumer health organisations (CHOs) are non-profit or voluntary sector organisations that promote and represent the interests of patients and carers affected by particular conditions. The purpose of this study was to examine, among patients with chronic disease, what differentiates those who contact CHOs from those who do not and what stops people from making contact. BACKGROUND CHOs can enhance people's capacity to manage chronic disease by providing information, education and psychosocial support, but are under-utilised. Little is known about barriers to access. METHODS Data were from a baseline telephone survey conducted as part of a randomised trial of an intervention to improve access to CHOs. Participants constituted a consecutive sample of 276 adults with diagnosed chronic disease recruited via 18 general practitioners in Brisbane, Australia. Quantitative survey items examined participants' use and perceptions of CHOs and a single open-ended question explored barriers to CHO use. Multiple logistic regression and thematic analysis were used. Findings Overall, 39% of participants had ever contacted a CHO for their health and 28% had contacted a CHO specifically focussed on their diagnosed chronic condition. Diabetes, poorer self-reported physical health and greater health system contact were significantly associated with CHO contact. The view that 'my doctor does it all' was prevalent and, together with a belief that their health problems were 'not serious enough', was the primary reason patients did not make contact. CONCLUSION Attitudinal and system-related barriers limit use of CHOs by those for whom they are designed. Developing referral pathways to CHOs and promoting awareness about what they offer is needed to improve access.
Collapse
|