1
|
Ginman H, Sitch M. Older adult's experiences of navigating healthcare whilst living with multimorbidity. Psychol Health 2024:1-19. [PMID: 38693663 DOI: 10.1080/08870446.2024.2339327] [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: 07/27/2023] [Accepted: 04/01/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE The way older adults navigate their healthcare is critical to supporting positive health outcomes. However, navigating healthcare with multimorbidity is typically disjointed due to complexities in treatment, management, and service provision. This study sought to examine how older patients navigate healthcare whilst living with multimorbidity. METHODS AND MEASURES Semi-structured interviews were undertaken with five older adults, aged 65 or older, living with multimorbidity in residential care in England. An Interpretive Phenomenological Analysis was undertaken. RESULTS Overall, participants experienced navigating healthcare whilst living with multimorbidity as challenging. Group Experiential Themes included 'Health knowledge and understanding', 'Relationships and expectations' and 'Navigating health care with a single lens'. Collectively these themes represented narratives involving how having limited understanding of health conditions, experiencing challenges in communication with health professionals, and receiving segmented care in a health care system driven by a single condition focus interfered with navigation. CONCLUSION These findings highlight experiences of older adults living with multimorbidity navigating healthcare and illustrate several ways older adults living with multimorbidity may be supported to navigate services with less challenges. The research also promotes the need for future research in this area.
Collapse
|
2
|
Joffe M, Ayeni OA, Mapanga W, Ruff P, Murugan N, Cubasch H, Norris SA. Perspectives on common chronic diseases in adult cancer patients in South Africa. Glob Health Action 2023; 16:2228567. [PMID: 37431748 PMCID: PMC10337486 DOI: 10.1080/16549716.2023.2228567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Accepted: 06/19/2023] [Indexed: 07/12/2023] Open
Abstract
There is a rising noncommunicable disease (NCD) burden in low- and middle-income countries. Sub-Saharan Africa (SSA) bears a higher burden than the global average with South Africa (SA) enduring the highest regional burden. SA among other southern African countries also bears a high prevalence of HIV and other chronic communicable diseases. Having a perspective on common chronic diseases in the ever-increasing numbers of adult cancer patients in SA will inform our understanding of approaches to better manage them. This commentary reviews regional and national studies and data of low- and middle-income countries and particularly SA on the chronic infectious and NCD multimorbidity burden among adult cancer patients. It also reflects on the considerable health system challenges of managing discordant multimorbidity among adult cancer patients within the SA Public Health System. Despite the critical need to better manage the growing MM burden in general and particularly the high prevalence of discordant multimorbidity among cancer patients, there is a dearth of research into MM management generally and in LMICs particularly.
Collapse
Affiliation(s)
- Maureen Joffe
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- South African MRC and the University of the Witwatersrand Centre for Common Epithelial Cancers Research Centre (CECRC), Johannesburg, South Africa
| | - Oluwatosin A. Ayeni
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- Department of Radiation Oncology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Witness Mapanga
- Strengthening Oncology Services Research Unit, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Paul Ruff
- South African MRC and the University of the Witwatersrand Centre for Common Epithelial Cancers Research Centre (CECRC), Johannesburg, South Africa
- Division of Medical Oncology, University of Witwatersrand Faculty of Health Sciences, Johannesburg, South Africa
- Soweto Comprehensive Cancer Centre (SCCC), Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa
| | - Nivashini Murugan
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Herbert Cubasch
- South African MRC and the University of the Witwatersrand Centre for Common Epithelial Cancers Research Centre (CECRC), Johannesburg, South Africa
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Shane A. Norris
- SAMRC/Wits Developmental Pathways for Health Research Unit, Department of Paediatrics, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Human Development and Health, University of Southampton, Southampton, UK
| |
Collapse
|
3
|
Di Raimondo D, Pirera E, Pintus C, De Rosa R, Profita M, Musiari G, Siscaro G, Tuttolomondo A. The Role of the Cumulative Illness Rating Scale (CIRS) in Estimating the Impact of Comorbidities on Chronic Obstructive Pulmonary Disease (COPD) Outcomes: A Pilot Study of the MACH (Multidimensional Approach for COPD and High Complexity) Study. J Pers Med 2023; 13:1674. [PMID: 38138901 PMCID: PMC10745043 DOI: 10.3390/jpm13121674] [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: 11/04/2023] [Revised: 11/19/2023] [Accepted: 11/28/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a heterogeneous systemic syndrome that often coexists with multiple comorbidities. In highly complex COPD patients, the role of the Cumulative Illness Rating Scale (CIRS) as a risk predictor of COPD exacerbation is not known. OBJECTIVE The objective of this study was determine the effectiveness of the CIRS score in detecting the association of comorbidities and disease severity with the risk of acute exacerbations in COPD patients. METHODS In total, 105 adults with COPD (mean age 72.1 ± 9.0 years) were included in this prospective study. All participants at baseline had at least two moderate exacerbations or one leading to hospitalization. The primary outcome was a composite of moderate or severe COPD exacerbation during the 12 months of follow-up. RESULTS The CIRS indices (CIRS total score, Severity Index and Comorbidity Index) showed a positive correlation with modified Medical Research Council (mMRC), COPD assessment test (CAT) and a negative correlation with forced expiratory volume in the first second (FEV1), Forced Vital Capacity (FVC), and FEV1/FVC. The three CIRS indices were able to predict the 12-month rate of moderate or severe exacerbation (CIRS Total Score: Hazard Ratio (HR) = 1.12 (95% CI: 1.08-1.21); CIRS Severity Index: HR = 1.21 (95% CI: 1.12-1.31); CIRS Comorbidity Index = 1.58 (95% CI: 1.33-1.89)). CONCLUSIONS Among patients with COPD, the comorbidity number and severity, as assessed by the CIRS score, influence the risk in moderate-to-severe exacerbations. The CIRS score also correlates with the severity of respiratory symptoms and lung function.
Collapse
Affiliation(s)
- Domenico Di Raimondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Edoardo Pirera
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Chiara Pintus
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Riccardo De Rosa
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Martina Profita
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | - Gaia Musiari
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| | | | - Antonino Tuttolomondo
- Division of Internal Medicine and Stroke Care, Department of Promoting Health, Maternal-Infant, Excellence and Internal and Specialized Medicine (ProMISE) “G. D’Alessandro”, University of Palermo, 90133 Palermo, Italy; (E.P.); (C.P.); (R.D.R.); (M.P.); (G.M.); (A.T.)
| |
Collapse
|
4
|
Gaitatzis A, Majeed A. Multimorbidity in People with Epilepsy. Seizure 2023; 107:136-145. [PMID: 37023627 DOI: 10.1016/j.seizure.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 03/31/2023] Open
Abstract
Multimorbidity is an emerging priority in healthcare due to associations with the ageing population, frailty, polypharmacy, health and social care demands. It affects 60-70% of adults and 80% of children with epilepsy. Neurodevelopmental conditions are commonly seen in children with epilepsy, while cancer, cardiovascular and neurodegenerative conditions often afflict older people with epilepsy. Mental health problems are common across the lifespan. Genetic, environmental, social and lifestyle factors contribute to multimorbidity and its consequences. Multimorbid people with epilepsy (PWE) are at higher risk of depression and suicide, premature death, suffer lower health-related quality of life, and require more hospital admissions and health care costs. The best management of multimorbid PWE requires a paradigm shift from the traditional single disease-single comorbidity approach and a refocus on a person-centred approach. Improvements in health care must be informed by assessing the burden of multimorbidity associated with epilepsy, delineating disease clusters, and measuring the effects on health outcomes.
Collapse
|
5
|
Ukhanova M, Markwardt S, Furuno JP, Davis L, Noble BN, Quiñones AR. Are there sex differences in potentially inappropriate prescribing in adults with multimorbidity? J Am Geriatr Soc 2021; 69:2163-2175. [PMID: 33959939 DOI: 10.1111/jgs.17194] [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: 12/03/2020] [Revised: 04/02/2021] [Accepted: 04/08/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND/OBJECTIVES Limited knowledge exists regarding sex differences in prescribing potentially inappropriate medications (PIMs) for various multimorbidity patterns. This study sought to determine sex differences in PIM prescribing in older adults with cardiovascular-metabolic patterns. DESIGN Retrospective cohort study. SETTING Health and Retirement Study (HRS) 2004-2014 interview data, linked to HRS-Medicare claims data annualized for 2005-2014. STUDY SAMPLE Six thousand three-hundred and forty-one HRS participants aged 65 and older with two and more chronic conditions. MEASUREMENTS PIM events were calculated using 2015 American Geriatrics Society Beers Criteria. Multimorbidity patterns included: "cardiovascular-metabolic only," "cardiovascular-metabolic plus other physical conditions," "cardiovascular-metabolic plus mental conditions," and "no cardiovascular-metabolic disease" patterns. Logistic regression models were used to determine the association between PIM and sex, including interaction between sex and multimorbidity categories in the model, for PIM overall and for each PIM drug class. RESULTS Women were prescribed PIMs more often than men (39.4% vs 32.8%). Overall, women had increased odds of PIM (Adj. odds ratio [OR] = 1.30, 95% confidence interval [CI]: 1.16-1.46). Women had higher odds of PIM than men with cardiovascular-metabolic plus physical patterns (Adj. OR = 1.25, 95% CI: 1.07-1.45) and cardiovascular-metabolic plus mental patterns (Adj. OR = 1.25, 95% CI: 1.06-1.48), and there were no sex differences in adults with a cardiovascular-metabolic only patterns (Adj. OR = 1.13, 95% CI: 0.79-1.62). Women had greater odds of being prescribed the following PIMs: anticholinergics, antidepressants, antispasmodics, benzodiazepines, skeletal muscle relaxants, and had lower odds of being prescribed pain drugs and sulfonylureas compared with men. CONCLUSION This study evaluated sex differences in PIM prescribing among adults with complex cardiovascular-metabolic multimorbidity patterns. The effect of sex varied across multimorbidity patterns and by different PIM drug classes. This study identified important opportunities for future interventions to improve medication prescribing among older adults at risk for PIM.
Collapse
Affiliation(s)
- Maria Ukhanova
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA
| | - Sheila Markwardt
- School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| | - Jon P Furuno
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA
| | - Laura Davis
- Neighborhood Health Center, Hillsboro, Oregon, USA
| | - Brie N Noble
- Department of Pharmacy Practice, Oregon State University College of Pharmacy, Portland, Oregon, USA
| | - Ana R Quiñones
- Department of Family Medicine, Oregon Health and Science University, Portland, Oregon, USA.,School of Public Health, Oregon Health & Science University, Portland, Oregon, USA
| |
Collapse
|
6
|
Hudon É, Hudon C, Lambert M, Bisson M, Chouinard MC. Generic Self-Reported Questionnaires Measuring Self-Management: A Scoping Review. Clin Nurs Res 2020; 30:855-865. [PMID: 33252267 PMCID: PMC8216317 DOI: 10.1177/1054773820974149] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to (1) identify generic questionnaires that measure self-management in people with chronic conditions, (2) describe their characteristics, (3) describe their development and theoretical foundations, and (4) identify categories of self-management strategies they assessed. This scoping review was based on the methodological framework developed by Arksey and O’Malley and completed by Levac et al. A thematic analysis was used to examine self-management strategies assessed by the questionnaires published between 1976 and 2019. A total of 21 articles on 10 generic, self-reported questionnaires were identified. The questionnaires were developed using various theoretical foundations. The Patient Assessment of Self-Management Tasks and Partners in Health scale questionnaires possessed characteristics that made them suitable for use in clinical and research settings and for evaluating all categories of self-management strategies. This study provides clinicians and researchers with an overview of generic, self-reported questionnaires and highlights some of their practical characteristics.
Collapse
Affiliation(s)
- Émilie Hudon
- Université de Sherbrooke, Québec, Canada.,Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada
| | - Catherine Hudon
- Université de Sherbrooke, Québec, Canada.,Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Québec, Canada
| | - Mireille Lambert
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada
| | | | - Maud-Christine Chouinard
- Centre Intégré Universitaire de Santé et de Services Sociaux du Saguenay-Lac-Saint-Jean, Chicoutimi, Québec, Canada.,Université de Montréal, Québec, Canada
| |
Collapse
|
7
|
Mutabazi JC, Gray C, Muhwava L, Trottier H, Ware LJ, Norris S, Murphy K, Levitt N, Zarowsky C. Integrating the prevention of mother-to-child transmission of HIV into primary healthcare services after AIDS denialism in South Africa: perspectives of experts and health care workers - a qualitative study. BMC Health Serv Res 2020; 20:582. [PMID: 32586318 PMCID: PMC7318762 DOI: 10.1186/s12913-020-05381-5] [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: 03/26/2020] [Accepted: 05/31/2020] [Indexed: 11/23/2022] Open
Abstract
Background Integrating Prevention of Mother-to-Child Transmission (PMTCT) programmes into routine health services under complex socio-political and health system conditions is a priority and a challenge. The successful rollout of PMTCT in sub-Saharan Africa has decreased Human Immunodeficiency Virus (HIV), reduced child mortality and improved maternal health. In South Africa, PMTCT is now integrated into existing primary health care (PHC) services and this experience could serve as a relevant example for integrating other programmes into comprehensive primary care. This study explored the perspectives of both experts or key informants and frontline health workers (FHCWs) in South Africa on PMTCT integration into PHC in the context of post-AIDS denialism using a Complex Adaptive Systems framework. Methods A total of 20 in-depth semi-structured interviews were conducted; 10 with experts including national and international health systems and HIV/PMTCT policy makers and researchers, and 10 FHCWs including clinic managers, nurses and midwives. All interviews were conducted in person, audio-recorded and transcribed. Three investigators collaborated in coding transcripts and used an iterative approach for thematic analysis. Results Experts and FHCWs agreed on the importance of integrated PMTCT services. Experts reported a slow and partial integration of PMTCT programmes into PHC following its initial rollout as a stand-alone programme in the aftermath of the AIDS denialism period. Experts and FHCWs diverged on the challenges associated with integration of PMTCT. Experts highlighted bureaucracy, HIV stigma and discrimination and a shortage of training for staff as major barriers to PMTCT integration. In comparison, FHCWs emphasized high workloads, staff turnover and infrastructural issues (e.g., lack of rooms, small spaces) as their main challenges to integration. Both experts and FHCWs suggested that working with community health workers, particularly in the post-partum period, helped to address cases of loss to follow-up of women and their babies and to improve linkages to polymerase-chain reaction (PCR) testing and immunisation. Conclusions Despite organised efforts in South Africa, experts and FHCWs reported multiple barriers for the full integration of PMTCT in PHC, especially postpartum. The results suggest opportunities to address operational challenges towards more integrated PMTCT and other health services in order to improve maternal and child health.
Collapse
Affiliation(s)
- Jean Claude Mutabazi
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montréal, QC, H3N 1X7, Canada. .,Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, H3L 1M3, Canada. .,Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montréal, QC, H3T 1C5,, Canada.
| | - Corie Gray
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - Lorrein Muhwava
- Division of Endocrinology, Department of Medicine, Faculty of Health Science, University of Cape Town, Chronic Disease Initiative for Africa, J Floor, Old Main Building, Groote Schuur Hospital, Observatory 7925, Cape Town, Western Cape, South Africa
| | - Helen Trottier
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montréal, QC, H3N 1X7, Canada.,Centre de Recherche du Centre Hospitalier Universitaire Sainte Justine, Montréal, QC, H3T 1C5,, Canada
| | - Lisa Jayne Ware
- Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, 26 Chris Hani Road, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - Shane Norris
- Developmental Pathways for Health Research Unit, Department of Paediatrics, School of Clinical Medicine, University of the Witwatersrand, 26 Chris Hani Road, Chris Hani Baragwanath Academic Hospital, Soweto, Johannesburg, South Africa
| | - Katherine Murphy
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - Naomi Levitt
- Collaboration for Evidence, Research and Impact in Public Health, School of Public Health, Curtin University, Kent Street, Bentley, Perth, Western Australia 6102, Australia
| | - Christina Zarowsky
- Département de médecine sociale et préventive, École de Santé Publique, Université de Montréal, Pavillon 7101, Avenue du Parc, Montréal, QC, H3N 1X7, Canada.,Centre de recherche en santé publique (CReSP), Université de Montréal et CIUSSS du Centre-Sud-de-l'Île-de-Montréal, Montréal, QC, H3L 1M3, Canada.,School of Public Health, University of the Western Cape, Robert Sobukwe Rd, Bellville 7535, Cape Town, Western Cape, South Africa
| |
Collapse
|
8
|
Lang C, Voigt K, Neumann R, Bergmann A, Holthoff-Detto V. Adherence and acceptance of a home-based telemonitoring application used by multi-morbid patients aged 65 years and older. J Telemed Telecare 2020; 28:37-51. [PMID: 32009577 PMCID: PMC8721554 DOI: 10.1177/1357633x20901400] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Currently, there are only a small number of comprehensive study results on adherence and acceptance of telemonitoring applications (TMAs) regarding multi-morbid older patients. The ATMoSPHAERE study aimed to develop an information and communication platform for an intersectoral networking of, for example, general practitioners, therapists, social services and the multi-morbid older patient. Methods The study presented was designed as a longitudinal bicentric intervention study which focused on multi-morbid patients aged ≥65 years using home-based telemedical measurement and input devices. The development and testing of this TMA aimed to optimise patients’ health care through intersectoral networking of all treating actors. Quantitative methods of data collection and analysis were used. Results Patients who completed the study were significantly younger than drop-outs and non-participants. The mental health of study patients significantly improved between the beginning and end of TMA use. The main reason for non-participation in the study was the high time expenditure when participating in the study. No perceived (information) benefits for health and insufficient content variety were the main reasons for drop-out. Appropriateness and handling of TMAs must be aligned with the needs of the heterogeneous user group of multi-morbid patients in order to increase acceptance and the added value of TMAs. Telemonitoring hardware should be oriented on functional capabilities of the older target group. Telemonitoring software content requires an individual, disease-specific approach for patients. The TMA should be unobtrusively integrated into usual daily life and be used to an appropriate extent according to the underlying disease in order to avoid stressing patients. With regard to adherence concerning TMAs, it is crucial to provide a contact person who is always available for patients having problems handling TMAs. Health concerns and questions can thus be addressed early, providing a feeling of safety in the care process. Discussion User acceptance of TMAs is an essential indicator and driver for use and for future implementation efforts in health care. In order to achieve maximum user centricity in development processes, patients must be involved as experts, co-designers and future users, considering their needs and perceptions.
Collapse
Affiliation(s)
- Caroline Lang
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany.,Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany
| | - Karen Voigt
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany
| | - Robert Neumann
- Institute of Sociology, Philosophical Faculty, Technische Universität Dresden, Germany
| | - Antje Bergmann
- Department of General Practice, Medical Clinic III, Medical Faculty, Technische Universität Dresden, Germany
| | - Vjera Holthoff-Detto
- Department of Psychiatry and Psychotherapy, University Hospital Carl Gustav Carus at the Technische Universität Dresden, Germany.,Department of Psychiatry, Psychotherapy and Psychosomatics, Alexianer Hospital Hedwigshöhe, St. Hedwig Hospital Berlin, Germany
| |
Collapse
|
9
|
Ørtenblad L, Nissen NK. General practitioners’ considerations of and experiences with multimorbidity patients: A qualitative study. INTERNATIONAL JOURNAL OF CARE COORDINATION 2019. [DOI: 10.1177/2053434519890050] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction General practitioners’ management of multimorbid patients is mostly described as a burden, although it is also indicated that fundamental characteristics of general practice are well-suited to accommodate appropriate management of multimorbidity. However, little is known about actual practices among general practitioners. This study explores general practitioners’ management of their multimorbid patients. Methods A qualitative methodological design using participant observation and interviews. Interpretive description was used as the analytical framework. The study took place in a provincial town in Denmark. Three general practices with a total of 12 general practitioners participated. Results ‘Multimorbidity’ as general terminology does not reflect the practice of the general practitioners. Their approach is based on the functional capacity of individual patients. The heterogeneity of the group was classified into three categories determining the general practitioners’ approach: the well-functioning patients, the surprising patients and the fragile patients. Three core characteristics were identified as pivotal for the general practitioners’ approach: holistic view of the patient’s situation, patient-centred focus and coordinator and facilitator. These are fundamental characteristics of general practice, but become especially significant because they accommodate the complexity and heterogeneity of multimorbid patients. Discussion This study expands the subject field by exploring the general practitioners’ actual practices, thereby providing new perspectives into features that support appropriate management of multimorbid patients. General practitioners balance administrative and clinical regulations in their considerations of accommodating the heterogeneity and complexity of multimorbid patients. This suggests that better possibilities must be provided to realize the fundamental characteristics of general practice to support their management of multimorbid patients.
Collapse
|
10
|
Ryan JG. Emerging Diabetes Research From Early Investigators. Clin Ther 2018; 40:820-822. [PMID: 29861190 DOI: 10.1016/j.clinthera.2018.05.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2018] [Accepted: 05/14/2018] [Indexed: 10/14/2022]
Affiliation(s)
- John G Ryan
- Miller School of Medicine, University of Miami, Miami, Florida
| |
Collapse
|