Are care plans suitable for the management of multiple conditions?

Experience of living with multimorbidity and health workers perspectives on the organization of health services for people living with multiple chronic conditions in Bahir Dar, northwest Ethiopia: a qualitative study

BACKGROUND

Multimorbidity-the simultaneous occurrence of two or more chronic Non-Communicable Diseases) in an individual is increasing globally and challenging health systems. Although individuals living with multimorbidity face a range of adverse consequences and difficulty in getting optimal health care, the evidence base in understanding the burden and capacity of the health system in managing multimorbidity is sparse in low-and middle-income countries (LMICs). This study aimed at understanding the lived experiences of patients with multimorbidity and perspective of service providers on multimorbidity and its care provision, and perceived capacity of the health system for managing multimorbidity in Bahir Dar City, northwest Ethiopia.

METHODS

A facility-based phenomenological study design was conducted in three public and three private health facilities rendering chronic outpatient Non-Communicable Diseases (NCDs) care in Bahir Dar City, Ethiopia. Nineteen patient participants with two or more chronic NCDs and nine health care providers (six medical doctors and three nurses) were purposively selected and interviewed using semi-structured in-depth interview guides. Data were collected by trained researchers. Interviews were audio-recorded using digital recorders, stored and transferred to computers, transcribed verbatim by the data collectors, translated into English and then imported into NVivo V.12 software for data analysis. We employed a six-step inductive thematic framework analysis approach to construct meaning and interpret experiences and perceptions of individual patients and service providers. Codes were identified and categorized into sub-themes, organizing themes and main themes iteratively to identify similarities and differences across themes, and to interpret them accordingly.

RESULTS

A total of 19 patient participants (5 Females) and nine health workers (2 females) responded to the interviews. Participants' age ranged from 39 to 79 years for patients and 30 to 50 years for health professionals. About half (n = 9) of the participants had three or more chronic conditions. The key themes produced were feeling dependency, social rejection, psychological distress, poor medication adherence and poor quality of care. Living with multimorbidity poses a huge burden on the physical, psychological, social and sexual health of patients. In addition, patients with multimorbidity are facing financial hardship to access optimal multimorbidity care. On the other hand, the health system is not appropriately prepared to provide integrated, person-centered and coordinated care for people living with multiple chronic conditions.

CONCLUSION AND RECOMMENDATIONS

Living with multimorbidity poses huge impact on physical, psychological, social and sexual health of patients. Patients seeking multimorbidity care are facing challenges to access care attributable to either financial constraints or the lack of integrated, respectful and compassionate health care. It is recommended that the health system must understand and respond to the complex care needs of the patients with multimorbidity.

Multimorbidity and health-related quality of life among patients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia: The application of partial proportional odds model

BACKGROUND

Multimorbidity, the presence of two or more chronic non-communicable diseases (NCDs) in a given person affects all aspects of people's lives. Poor quality of life (QoL) is one of the major consequences of living with multimorbidity. Although healthcare should support multimorbid individuals to achieve a better quality of life, little is known about the effect of multimorbidity on the QoL of patients living with chronic conditions. This study aimed to determine the influence of multimorbidity on QoL among clients attending chronic outpatient medical care in Bahir Dar, Northwest Ethiopia.

METHODOLOGY

A multi-centered facility-based study was conducted among 1440 participants aged 40+ years. Two complementary methods were employed to collect sociodemographic and disease related data. We used the short form (SF-12 V2) instrument to measure quality of life (QoL). The data were analyzed by STATA V.16, and a multivariate partial proportional odds model was fitted to identify covariates associated with quality of life. Statistical significance was considered at p-value <0.05.

PRINCIPAL FINDINGS

Multimorbidity was identified in 54.8% (95% CI = 52.2%-57.4%) of the sample. A significant proportion (33.5%) of the study participants had poor QoL and a quarter (25.8%) of them had moderate QoL. Advanced age, obesity and living with multimorbidity were the factors associated with poor QoL. Conversely, perceived social support and satisfaction with care were the variables positively associated with better QoL.

CONCLUSION

The magnitude of multimorbidity in this study was high and individuals living with multimorbidity had a relatively poorer QoL than those without multimorbidity. Care of people with chronic multiple conditions has to be oriented to the realities of multimorbidity burden and its implication on QoL. It is also imperative to replicate the methods we employed to measure and analyze QoL data in this study for facilitating comparison and further development of the approaches.

Randomized controlled study of the impact of a participatory patient care plan among primary care patients with common chronic diseases: a one-year follow-up study

Backround

Chronic diseases and multimorbidity are common in the ageing population and affect the health related quality of life. Health care resources are limited and the continuity of care has to be assured. Therefore it is essential to find demonstrable tools for best treatment practices for patients with chronic diseases.

Our aim was to study the influence of a participatory patient care plan on the health-related quality of life and disease specific outcomes related to diabetes, ischemic heart disease and hypertension.

Methods

The data of the present study were based on the Participatory Patient Care Planning in Primary Care. A total of 605 patients were recruited in the Siilinjärvi Health Center in the years 2017–2018 from those patients who were followed up due to the treatment of hypertension, ischemic heart disease or diabetes. Patients were randomized into usual care and intervention groups. The intervention consisted of a participatory patient care plan, which was formulated in collaboration with the patient and the nurse and the physician during the first health care visit.

Health-related quality of life with the 15D instrument and the disease-specific outcomes of body mass index (BMI), low density lipoprotein cholesterol (LDL-C), hemoglobin A1c (HbA1C) and blood pressure were assessed at the baseline and after a one-year follow-up.

Results

A total of 587 patients with a mean age of 69 years were followed for 12 months. In the intervention group there were 289 patients (54% women) and in the usual care group there were 298 patients (50% women). During the follow-up there were no significant changes between the groups in health-related quality and disease-specific outcomes.

Conclusions

During the 12-month follow-up, no significant differences between the intervention and the usual care groups were detected, as the intervention and the usual care groups were already in good therapeutic equilibrium at the baseline.

Trial registration

ClinicalTrials.gov Identifier: NCT02992431. Registered 14/12/2016

Development of a model to deliver primary health care in Qatar

Background

Healthcare providers around the world are seeking to manage the rising burden of chronic conditions against a backdrop of both growing and ageing populations as well as greater expectations of health services. This paper describes the development of an integrated primary care model ‘the family medicine model (FMM)’ to deliver primary healthcare in Qatar to better address some of the healthcare challenges faced.

Methods

A developmental approach was adopted in defining an FMM for Qatar that could potentially address health needs of its population, while acknowledging local context and addressing complexities. A literature review was undertaken followed by field visits and setting up of a working group in order to identify, develop and adapt a model suitable for delivery of primary care in Qatar.

Results

Key principles of the proposed model and its component were defined. Components included primary care workforce and practice-based teams, service provision and practice-based services, health information and technology, access to care and information, care management, care coordination, practice management and quality and safety.

Conclusions

The proposed model is an innovative approach which utilises and integrates these components to deliver holistic primary care. It is anticipated that its introduction will help redesign and integrate the way primary healthcare is delivered to the population of Qatar in helping patients manage their own health and reduce the numbers that need to be admitted to secondary care, improving patients’ independence and well-being as well as dramatically reducing the cost to the overall health system.