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Ufere NN, Lago-Hernandez C, Alejandro-Soto A, Walker T, Li L, Schoener K, Keegan E, Gonzalez C, Bethea E, Singh S, El-Jawahri A, Nephew L, Jones P, Serper M. Health care-related transportation insecurity is associated with adverse health outcomes among adults with chronic liver disease. Hepatol Commun 2024; 8:e0358. [PMID: 38206200 PMCID: PMC10786597 DOI: 10.1097/hc9.0000000000000358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Accepted: 11/07/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Health care-related transportation insecurity (delayed or forgone medical care due to transportation barriers) is being increasingly recognized as a social risk factor affecting health outcomes. We estimated the national burden and adverse outcomes of health care-related transportation insecurity among US adults with chronic liver disease (CLD). METHODS Using the U.S. National Health Interview Survey from 2014 to 2018, we identified adults with self-reported CLD. We used complex weighted survey analysis to obtain national estimates of health care-related transportation insecurity. We examined the associations between health care-related transportation insecurity and health care-related financial insecurity, food insecurity, self-reported health status, work productivity, health care use, and mortality. RESULTS Of the 3643 (representing 5.2 million) US adults with CLD, 267 [representing 307,628 (6%; 95% CI: 5%-7%)] reported health care-related transportation insecurity. Adults with CLD experiencing health care-related transportation insecurity had 3.5 times higher odds of cost-related medication nonadherence [aOR, 3.5; (2.4-5.0)], 3.5 times higher odds of food insecurity [aOR, 3.5; (2.4-5.3)], 2.5 times higher odds of worsening self-reported health status over the past year [aOR, 2.5; (1.7-3.7)], 3.1 times higher odds of being unable to work due to poor health over the past year [aOR, 3.1; (2.0-4.9)], and 1.7 times higher odds of being in a higher-risk category group for number of hospitalizations annually [aOR, 1.7; (1.2-2.5)]. Health care-related transportation insecurity was independently associated with mortality after controlling for age, income, insurance status, comorbidity burden, financial insecurity, and food insecurity [aHR, 1.7; (1.4-2.0)]. CONCLUSIONS Health care-related transportation insecurity is a critical social risk factor that is associated with health care-related financial insecurity, food insecurity, poorer self-reported health status and work productivity, and increased health care use and mortality among US adults with CLD. Efforts to screen for and reduce health care-related transportation insecurity are warranted.
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Affiliation(s)
- Nneka N. Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carlos Lago-Hernandez
- Department of Medicine, Division of Hospital Medicine, University of California San Diego, La Jolla, California, USA
| | - Alysa Alejandro-Soto
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Tiana Walker
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucinda Li
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kimberly Schoener
- Department of Social Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Eileen Keegan
- Department of Social Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Carolina Gonzalez
- Department of Social Services, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Emily Bethea
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Siddharth Singh
- Department of Medicine, Division of Gastroenterology and Hepatology, University of California San Diego, La Jolla, California, USA
- Department of Medicine, Division of Biomedical Informatics, University of California San Diego, La Jolla, California, USA
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Lauren Nephew
- Division of Gastroenterology & Hepatology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Patricia Jones
- Department of Medicine, Division of Digestive Health and Liver Services, University of Miami Miller School of Medicine, Miami, Florida, USA
| | - Marina Serper
- Division of Gastroenterology and Hepatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA
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Hayward KL, Weersink RA, Bernardes CM, McIvor C, Rahman T, Skoien R, Clark PJ, Stuart KA, Hartel G, Valery PC, Powell EE. Changing Prevalence of Medication Use in People with Cirrhosis: A Retrospective Cohort Study Using Pharmaceutical Benefits Scheme Data. Drugs Real World Outcomes 2023; 10:605-618. [PMID: 37828144 PMCID: PMC10730495 DOI: 10.1007/s40801-023-00390-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Safe and appropriate use of medicines is essential to improve health outcomes in cirrhosis. However, little is known about the number and type of medicines dispensed to people with cirrhosis in Australia, as this predominantly occurs in the community. We aimed to characterise the prescriptions dispensed to people with cirrhosis and explore changes in the use of medication groups over time. METHODS Pharmaceutical Benefits Scheme data between 1 January 2016 and 30 June 2020 was extracted for consenting CirCare participants (multi-site, prospective, observational study). Prescriptions dispensed from cirrhosis diagnosis until liver transplant or death were included. Safety classifications for dispensed medicines were defined using published evidence-based recommendations. The pattern of medication use was analysed in 6-monthly time intervals. Generalised estimating equations models were used to estimate the change in consumption of medicines over time. RESULTS Five hundred twenty-two patients (mean age 60 years, 70% male, 34% decompensated at recruitment) were dispensed 89,615 prescriptions during the follow-up period, representing a median of 136 [interquartile range (IQR) 62-237] prescriptions and a median of 16 (IQR 11-23) unique medicines per patient (total n = 9306 medicines). The most commonly used medicines were proton pump inhibitors (PPIs) (dispensed at least once to 73% of patients), opioids (68%) and antibiotics (89%). Polypharmacy was prevalent, with 59-69% of observed participants in each time period dispensed five or more unique medicines. Prescription medication use increased over time (p < 0.001) independently of age, comorbidity burden and liver disease aetiology. The likelihood of taking PPIs, opioids, antidepressants and inhaled medicines also increased with each successive time period. Use of angiotensin therapies, metformin and statins differed over time between patients with compensated versus decompensated cirrhosis. General practitioners prescribed 69% of dispensed medicines, including a higher proportion of 'unsafe' and 'safety unknown' medicines compared with consultants/specialists (p < 0.001). CONCLUSIONS Polypharmacy is common in people with cirrhosis and some medication groups may be overused. Pharmacovigilance is required and future medication safety efforts should target high-risk prescribing practices and promote medication rationalisation in the community.
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Affiliation(s)
- Kelly L Hayward
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
| | - Rianne A Weersink
- Department of Clinical Pharmacy, Deventer Hospital, Deventer, The Netherlands
| | | | - Carolyn McIvor
- Department of Gastroenterology and Hepatology, Logan Hospital, Meadowbrook, QLD, Australia
| | - Tony Rahman
- Gastroenterology and Hepatology Department, The Prince Charles Hospital, Chermside, QLD, Australia
| | - Richard Skoien
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Herston, QLD, Australia
| | - Paul J Clark
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia
- Department of Gastroenterology and Hepatology, Mater Hospital, South Brisbane, QLD, Australia
| | - Katherine A Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
- School of Nursing, Queensland University of Technology, Brisbane, QLD, Australia
| | | | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, QLD, Australia.
- Faculty of Medicine, The University of Queensland, Woolloongabba, QLD, Australia.
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia.
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Valery PC, Stuart KA, Bernardes CM, Hartel G, Martin C, Gordon L, Powell EE. Higher levels of supportive care needs are linked to higher health service use and cost, poor quality of life, and high distress in patients with cirrhosis in Queensland, Australia. Hepatol Commun 2023; 7:e0066. [PMID: 36848120 PMCID: PMC9974077 DOI: 10.1097/hc9.0000000000000066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 12/19/2022] [Indexed: 03/01/2023] Open
Abstract
BACKGROUND Australians with cirrhosis have significant practical and psychosocial needs. This longitudinal study examined the association between supportive care needs and health service use and costs, and patient outcomes from June 2017 to December 2018. METHODS The Supportive Needs Assessment tool for Cirrhosis (SNAC), quality of life (Chronic Liver Disease Questionnaire and Short Form 36), and distress (distress thermometer) were self-reported through an interview at recruitment (n=433). Clinical data were obtained from medical records and through linkage, and health service use and costs through linkage. Patients were grouped as by needs status. Rates of hospital admissions (per person days at risk) and costs were assessed by needs status [incidence rate ratios (IRR), Poisson regression]. Multivariable linear regression was used to assess the differences in SNAC scores by quality of life and distress. Multivariable models included Child-Pugh class, age, sex, recruitment hospital, living arrangements, place of residence, comorbidity burden, and primary liver disease etiology. RESULTS In adjusted analyses, compared with patients with low/no needs, patients with unmet needs had more cirrhosis-related admissions (adjusted IRR=2.11, 95% CI=1.48-3.13; p<0.001), admissions through the emergency department (IRR=2.99, 95% CI=1.80-4.97, p<0.001), and emergency presentations (IRR=3.57, 95% CI=1.41-9.02; p<0.001). Total hospitalization costs for cirrhosis admissions were higher for those with unmet needs ($431,242 per person days at risk) compared with those with met needs ($87,363 per person days at risk, adjusted cost ratio=3.52, 95%CI=3.49-3.54; p<0.001). In multivariable analysis, increasing overall mean SNAC scores (higher needs) were correlated with poorer quality of life and higher level of distress (p<0.001 for all comparisons). CONCLUSIONS Patients with cirrhosis and high unmet psychosocial needs and practical and physical needs have poor quality of life, high distress, and very high service use and costs, highlighting the importance of urgently addressing unmet needs.
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Affiliation(s)
- Patricia C. Valery
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Katherine A. Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Christina M. Bernardes
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Gunter Hartel
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Cathy Martin
- Social Work Department, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Louisa Gordon
- Population Health Program, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Elizabeth E. Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Bonacchi A, Chiesi F, Marunic G, Campani C, Gitto S, Lau C, Tagliaferro C, Forte P, Tarocchi M, Marra F. Needs evaluation questionnaire for liver disease: a novel assessment of unmet needs in patients with chronic liver disease. Hepatol Commun 2023; 7:e0007. [PMID: 36706170 PMCID: PMC9988321 DOI: 10.1097/hc9.0000000000000007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 09/05/2022] [Accepted: 09/17/2022] [Indexed: 01/29/2023] Open
Abstract
Patients with chronic liver disease face debilitating complications in their daily living and constantly report several types of unmet needs, but there is a paucity of validated questionnaires to assess these needs. In this study, we present the development of the Needs Evaluation Questionnaire for Liver Diseases (NEQ-LD) for the assessment of unmet needs in patients with chronic liver disease. Two hundred eighty-six outpatients with chronic liver diseases from a single tertiary referral center completed the NEQ-LD and related validity measures. Item response theory analyses were performed and demonstrated the strong psychometric properties of the questionnaire. Differential item functioning analyses showed that the scale functions equally across groups differing for age, sex, and presence of cirrhosis, suggesting the large applicability of the NEQ-LD for the assessment of unmet needs and between-group comparisons. Criterion validity measures provided evidence that unmet needs were positively associated with measures of depression and anxiety and negatively associated with measures of subjective well-being and physical and mental health. Unmet needs were expressed by a high percentage of patients, especially in the areas of information and dialogue with clinicians. One third of the sample reported material needs. Most of the items describing unmet needs were reported more frequently by patients with cirrhosis. Conclusion: We developed a reliable, valid, and largely employable instrument that can promote patient-centered care and facilitate support services in Hepatology.
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Affiliation(s)
- Andrea Bonacchi
- Clinical Epidemiology Unit, Oncological Network, Prevention and Research Institute—ISPRO, Florence, Italy
- Centro Studi e Ricerca Synthesis, Associazione Promozione Sociale Sul Sentiero, Florence, Italy
| | - Francesca Chiesi
- Department of Neuroscience, Psychology, Drug, and Child’s Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Georgia Marunic
- Department of Neuroscience, Psychology, Drug, and Child’s Health (NEUROFARBA), University of Florence, Florence, Italy
| | - Claudia Campani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Gitto
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Chloe Lau
- Department of Psychology, Western University, London, Ontario, Canada
| | | | - Paolo Forte
- Clinical Gastroenterology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Mirko Tarocchi
- Clinical Gastroenterology Unit, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
- Department of Biomedical Sciences ‘Mario Serio,’ University of Florence, Florence, Italy
| | - Fabio Marra
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Powell EE, Stuart KA, Finnigan S, Hinson J, Bernardes CM, Hartel G, Valery PC. Low Prevalence of Use of Allied Health and Community Services for Patients with Cirrhosis in Australia: A Need for Greater Engagement. Patient Prefer Adherence 2023; 17:1117-1130. [PMID: 37102126 PMCID: PMC10124554 DOI: 10.2147/ppa.s405567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 03/22/2023] [Indexed: 04/28/2023] Open
Abstract
Background Psychosocial, lifestyle and practical needs are not routinely attended to during outpatient hepatology management, and little is known about the type and effectiveness of support services accessed by patients with cirrhosis. We quantified the type and use of community and allied health services in patients with cirrhosis. Methods The study included 562 Australian adults with a diagnosis of cirrhosis. Health service use was assessed via questionnaire and via linkage to the Australian Medicare Benefits Schedule. Patient needs were assessed using the Supportive Needs Assessment tool for Cirrhosis (SNAC). Results Although most patients (85.9%) used at least one community/allied health service for support with their liver disease, many reported requiring additional help with psychosocial (67.4%), lifestyle (34.3%) or practical needs (21.9%) that were not met by available services, or patients did not access services. A multidisciplinary care plan or case conference (in the 12 months prior to recruitment) was accessed by 48% of patients, 56.2% reported the use of a general practitioner for support with cirrhosis, and a dietician was the allied health clinician most accessed by patients (45.9%). Despite the high prevalence of psychosocial needs, there was relatively limited use of mental health and social work services (14.1% of patients reported the use of a psychologist), confirmed by a low prevalence of use of mental health services (17.7%) in the linked data. Conclusion Patients with cirrhosis who have unmet complex physical and psychosocial needs require better strategies to increase their engagement with allied health and community services.
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Affiliation(s)
- Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
- Centre for Liver Disease Research, Faculty of Medicine, the University of Queensland, Woolloongabba, Queensland, Australia
| | - Katherine A Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Simon Finnigan
- Community and Oral Health, Metro North Health, Chermside, Queensland, Australia
| | - Jan Hinson
- Faculty of Health Sciences, School of Allied Health, Australian Catholic University, Banyo, Queensland, Australia
| | - Christina M Bernardes
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Gunter Hartel
- Statistics, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Patricia C Valery
- Centre for Liver Disease Research, Faculty of Medicine, the University of Queensland, Woolloongabba, Queensland, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
- Correspondence: Patricia C Valery, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, Queensland, 4006, Australia, Tel +61 07 3362 0376, Email
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Amarasena S, Clark PJ, Gordon LG, Toombs M, Pratt G, Hartel G, Bernardes CM, Powell EE, Valery PC. Differences in the pattern and cost of hospital care between Indigenous and non-Indigenous Australians with cirrhosis: an exploratory study. Intern Med J 2022. [PMID: 35717648 DOI: 10.1111/imj.15854] [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: 09/12/2021] [Accepted: 06/09/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND Liver diseases are important contributors to the mortality gap between Indigenous and non-Indigenous Australians. AIMS This cohort study examined factors associated with hospital admissions and healthcare outcomes among Indigenous Australians with cirrhosis. METHODS Patient-reported outcomes were obtained by face-to-face interview (Chronic Liver Disease Questionnaire and Short Form 36 (SF-36)). Clinical data were extracted from medical records and through data linkage for 534 patients (25 indigenous). Cumulative overall survival (Kaplan-Meier), rates of hospital admissions and emergency presentations, and costs were assessed by indigenous status. Incidence rate ratios (IRR; Poisson regression) were reported. RESULTS Indigenous Australians admitted to hospital with cirrhosis had lower educational status compared with non-indigenous patients (79.2% vs 43.4%; P < 0.001). The two groups had, in general, similar clinical characteristics including disease severity (P = 0.78), presence of cirrhosis complications (P = 0.67), comorbidities (P = 0.62), rates of cirrhosis-related admissions (P = 0.86) and 5-year survival (P = 0.30). However, indigenous patients had a lower score in the SF-36 domain related to bodily pain (P = 0.037), more cirrhosis admissions via the emergency department (IRR = 1.42, 95% confidence interval (CI) 1.10-1.83) and fewer planned cirrhosis admissions (IRR = 0.32, 95% CI 0.14-0.72). The total cost for cirrhosis-related hospital admissions for 534 patients over 6 years (July 2012 to June 2018) was A$13.7 million. The cost of cirrhosis-related hospital admissions was double for indigenous patients (cost ratio = 2.04, 95% CI 2.04-2.05). CONCLUSIONS Our data highlight the disparities in health service use and patient-reported outcomes, despite having similar clinical profiles. Integration between primary care, Aboriginal Community Controlled Health Organisations and liver specialists is critical for appropriate health service delivery and effective use of resources. Chronic liver disease costs the community dearly.
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Affiliation(s)
- Samath Amarasena
- Department of Gastroenterology and Hepatology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Paul J Clark
- Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, Queensland, Australia.,Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Louisa G Gordon
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, University of Queensland, Toowoomba, Queensland, Australia
| | - Greg Pratt
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Gunter Hartel
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Christina M Bernardes
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Patricia C Valery
- Population Health Department, QIMR Berghofer Medical Research Institute, Brisbane, Queensland, Australia
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Ufere NN, Hinson J, Finnigan S, Powell EE, Donlan J, Martin C, Clark P, Valery PC. The Impact of Social Workers in Cirrhosis Care: a Systematic Review. CURRENT TREATMENT OPTIONS IN GASTROENTEROLOGY 2022; 20:160-176. [PMID: 35676928 PMCID: PMC9167183 DOI: 10.1007/s11938-022-00381-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 02/15/2022] [Indexed: 01/23/2023]
Abstract
Purpose of review To report social workers' involvement in supporting patients with cirrhosis. Recent findings Six intervention studies (three published in the past 3 years) highlighed the potential role of social worker-led interventions to improve the outcomes of patients with cirrhosis. In studies of patients with alcohol-related liver disease (n = 4), social workers conducted psychosocial assessments, screened for substance use disorder and psychological distress, coordinated referrals to addiction services, and provided relapse prevention therapy. In studies including transplant recipients or candidates (n = 2), social workers focused on psychosocial interventions. In two studies (n = 1 patient with alcohol-related liver disease; n = 1 transplant recipients), social workers provided practical support (e.g., housing, transportation). Most articles provided limited information about the intervention and the role of the social worker, making comparisons of the studies difficult. Summary More high-quality evidence is needed to formally assess the impact of social workers in improving the outcomes of patients with cirrhosis. Supplementary Information The online version contains supplementary material available at 10.1007/s11938-022-00381-2.
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Affiliation(s)
- Nneka N Ufere
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114 USA
| | - Jan Hinson
- Faculty of Health Sciences, School of Allied Health, Social Work Discipline, Australian Catholic University, Brisbane Campus (McAuley), 1100 Nudgee Road, Banyo, QLD 4014 Australia
| | - Simon Finnigan
- Centre for Functioning and Health Research, Metro South Health, Level 3, Buranda Village, Buranda, QLD 4102 Australia.,Department of Social Work, Princess Alexandra Hospital, 199 Ipswish Road, Woolloongabba, QLD 4102 Australia.,UQ Centre for Clinical Research, The University of Queensland, Herston, QLD 4029 Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, 199 Ipswish Road, Woolloongabba, QLD 4102 Australia
| | - John Donlan
- Harvard Medical School, 25 Shattuck St, Boston, MA 02115 USA
| | - Cathy Martin
- Queensland Liver Transplant Service, Princess Alexandra Hospital, 199 Ipswish Road, Woolloongabba, QLD 4102 Australia
| | - Phil Clark
- Faculty of Health Sciences, School of Allied Health, Social Work Discipline, Australian Catholic University, Brisbane Campus (McAuley), 1100 Nudgee Road, Banyo, QLD 4014 Australia
| | - Patricia C Valery
- Population Health Department, QIMR Berghofer Medical Research Institute, 300 Herston Road, Herston, QLD 4006 Australia
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Grønkjær LL, Lauridsen MM. Reply to: "Comment on "Quality of life and unmet needs in patients with chronic liver disease: A mixed-method systematic review"". JHEP Rep 2022; 4:100414. [PMID: 34984332 PMCID: PMC8693004 DOI: 10.1016/j.jhepr.2021.100414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
| | - Mette Munk Lauridsen
- Department of Gastroenterology, University Hospital of South Denmark Esbjerg, Denmark
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Valery PC, Powell EE. Comment on "Quality of life and unmet needs in patients with chronic liver disease: A mixed-method systematic review". JHEP REPORTS : INNOVATION IN HEPATOLOGY 2022; 4:100393. [PMID: 34984331 PMCID: PMC8693009 DOI: 10.1016/j.jhepr.2021.100393] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022]
Affiliation(s)
| | - Elizabeth Ellen Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
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Ufere NN, Donlan J, Indriolo T, Richter J, Thompson R, Jackson V, Volandes A, Chung RT, Traeger L, El-Jawahri A. Burdensome Transitions of Care for Patients with End-Stage Liver Disease and Their Caregivers. Dig Dis Sci 2021; 66:2942-2955. [PMID: 32964286 DOI: 10.1007/s10620-020-06617-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/14/2020] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with end-stage liver disease (ESLD) experience frequent readmissions; however, studies focused on patients' and caregivers' perceptions of their transitional care experiences to identify root causes of burdensome transitions of care are lacking. AIM To explore the transitional care experiences of patients with ESLD and their caregivers in order to identify their supportive care needs. METHODS We conducted interviews with 15 patients with ESLD and 14 informal caregivers. We used semi-structured interview guides to explore their experiences since the diagnosis of ESLD including their care transitions. Two raters coded interviews independently (κ = 0.95) using template analysis. RESULTS Participants reported feeling unprepared to manage their informational, psychosocial, and practical care needs as they transitioned from hospital to home after the diagnosis of ESLD. Delay in the timely receipt of supportive care services addressing these care needs resulted in hospital readmissions, emotional distress, caregiver burnout, reduced work capacity, and financial hardship. Participants shared the following resources that they perceived would improve their quality of care: (1) discharge checklist, (2) online resources, (3) mental health support, (4) caregiver support and training, and (5) financial navigation. CONCLUSION Transitional care models that attend to the informational, psychosocial, and practical domains of care are needed to better support patients with ESLD and their caregivers at the time of diagnosis and beyond. Without attending to the multidimensional care needs of newly diagnosed patients with ESLD and their caregivers, they are at risk of burdensome transitions of care, high healthcare utilization, and poor health-related quality of life.
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Affiliation(s)
- Nneka N Ufere
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA.
| | - John Donlan
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Teresa Indriolo
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - James Richter
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Ryan Thompson
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Vicki Jackson
- Division of Palliative Care and Geriatric Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Angelo Volandes
- Section of General Internal Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Raymond T Chung
- Liver Center, Gastrointestinal Division, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Lara Traeger
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Areej El-Jawahri
- Division of Hematology and Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
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11
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Valery PC, Bernardes CM, Mckillen B, Amarasena S, Stuart KA, Hartel G, Clark PJ, Skoien R, Rahman T, Horsfall L, Hayward K, Gupta R, Lee A, Pillay L, Powell EE. The Patient's Perspective in Cirrhosis: Unmet Supportive Care Needs Differ by Disease Severity, Etiology, and Age. Hepatol Commun 2021; 5:891-905. [PMID: 34027276 PMCID: PMC8122374 DOI: 10.1002/hep4.1681] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 12/09/2020] [Accepted: 12/26/2020] [Indexed: 12/13/2022] Open
Abstract
Patients with cirrhosis have significant physical, psychological, and practical needs. We documented patients' perceived need for support with these issues and the differences with increasing liver disease severity, etiology, and age. Using the supportive needs assessment tool for cirrhosis (SNAC), we examined the rate of moderate-to-high unmet needs (Poisson regression; incidence rate ratio [IRR]) and the correlation between needs and sociodemographic/clinical characteristics (multivariable linear regression) in 458 Australians adults with cirrhosis. Primary liver disease etiology was alcohol in 37.6% of patients, chronic viral hepatitis C in 25.5%, and nonalcoholic fatty liver disease (NAFLD)/nonalcoholic steatohepatitis (NASH) in 23.8%. A total of 64.6% of patients had Child-Pugh class A cirrhosis. Most patients (81.2%) had at least one moderate-to-high unmet need item; more than 25% reported a moderate-to-high need for help with "lack of energy," "sleep poorly," "feel unwell," "worry about … illness getting worse (liver cancer)," "have anxiety/stress," and "difficulty with daily tasks." Adjusting for key sociodemographic/clinical factors, patients with Child-Pugh C had a greater rate of "practical and physical needs" (vs. Child-Pugh A; IRR = 2.94, 95% confidence interval [CI] 2.57-3.37), patients with NAFLD/NASH had a greater rate of needs with "lifestyle changes" (vs. alcohol; IRR = 1.81, 95% CI 1.18-2.77) and "practical and physical needs" (IRR = 1.43, 95% CI 1.23-1.65), and patients aged ≥65 years had fewer needs overall (vs. 18-64 years; IRR = 0.70, 95% CI 0.64-0.76). Higher overall SNAC scores were associated with Child-Pugh B and C (both P < 0.001), NAFLD/NASH (P = 0.028), patients with "no partner, do not live alone" (P = 0.004), unemployment (P = 0.039), ascites (P = 0.022), and dyslipidemia (P = 0.024) compared with their counterparts. Conclusion: Very high levels of needs were reported by patients with cirrhosis. This information is important to tailor patient-centered care and facilitate timely interventions or referral to support services.
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Affiliation(s)
| | | | - Benjamin Mckillen
- Department of Gastroenterology and HepatologyPrincess Alexandra HospitalBrisbaneQLDAustralia.,Centre for Liver Disease ResearchTranslational Research InstituteFaculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Samath Amarasena
- Department of Gastroenterology and HepatologyRoyal Brisbane and Women's HospitalBrisbaneQLDAustralia
| | - Katherine A Stuart
- Department of Gastroenterology and HepatologyPrincess Alexandra HospitalBrisbaneQLDAustralia
| | - Gunter Hartel
- QIMR Berghofer Medical Research InstituteHerstonQLDAustralia
| | - Paul J Clark
- Department of Gastroenterology and HepatologyPrincess Alexandra HospitalBrisbaneQLDAustralia.,Department of Gastroenterology and HepatologyMater HospitalsBrisbaneQLDAustralia
| | - Richard Skoien
- Department of Gastroenterology and HepatologyRoyal Brisbane and Women's HospitalBrisbaneQLDAustralia
| | - Tony Rahman
- Gastroenterology & Hepatology DepartmentPrince Charles HospitalChermsideQLDAustralia
| | - Leigh Horsfall
- Department of Gastroenterology and HepatologyPrincess Alexandra HospitalBrisbaneQLDAustralia.,Centre for Liver Disease ResearchTranslational Research InstituteFaculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Kelly Hayward
- Department of Gastroenterology and HepatologyPrincess Alexandra HospitalBrisbaneQLDAustralia.,Centre for Liver Disease ResearchTranslational Research InstituteFaculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
| | - Rohit Gupta
- Gastroenterology & Hepatology DepartmentPrince Charles HospitalChermsideQLDAustralia
| | - Andrew Lee
- Department of Gastroenterology and HepatologyMater HospitalsBrisbaneQLDAustralia
| | - Leshni Pillay
- Department of Gastroenterology and HepatologyLogan HospitalMeadowbrookQLDAustralia
| | - Elizabeth E Powell
- Department of Gastroenterology and HepatologyPrincess Alexandra HospitalBrisbaneQLDAustralia.,Centre for Liver Disease ResearchTranslational Research InstituteFaculty of MedicineUniversity of QueenslandBrisbaneQLDAustralia
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12
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Sousa H, Oliveira J, Figueiredo D, Ribeiro O. The clinical utility of the Distress Thermometer in non-oncological contexts: A scoping review. J Clin Nurs 2021; 30:2131-2150. [PMID: 33555631 DOI: 10.1111/jocn.15698] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 01/18/2021] [Accepted: 01/29/2021] [Indexed: 12/22/2022]
Abstract
AIMS To assess the clinical utility of the Distress Thermometer (DT) in non-cancer populations. METHODS The search was performed between the 6th and the 18th of April 2020, on the following databases: Web of Science (all databases included), Scopus and Science Direct. One last update was performed on 5 June 2020. The findings were reported using the PRISMA-ScR. RESULTS Fifty-three studies were included. Overall results indicated that this tool has been used in several contexts and populations (clinical and non-clinical). The DT is highly accessible, suitable and relevant for health professionals and/or researchers who aim to use it as a distress screening tool, particularly in patients with chronic physical conditions. Assumptions about its practicality and acceptability in non-oncology care should be made with caution since few studies have explored the psychometric qualities of this instrument, the completers' perceptions about completing the DT and the perceptions of health professionals who administer the tool. CONCLUSIONS This lack of information undermines conclusions about the overall clinical utility of the DT as a screening tool for distress in individuals who do not have cancer. IMPLICATIONS FOR PRACTICE Future research should aim to fill this gap and investigate the psychometric qualities of the DT through validation studies and, thus, increase the rigour of its application and clinical utility in non-oncological contexts.
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Affiliation(s)
- Helena Sousa
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro (Campus Universitário de Santiago), Aveiro, Portugal
| | - Jaime Oliveira
- Department of Education and Psychology, Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro (Campus Universitário de Santiago), Aveiro, Portugal
| | - Daniela Figueiredo
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro (Campus Universitário de Santiago), Aveiro, Portugal
| | - Oscar Ribeiro
- Department of Education and Psychology, Center for Health Technology and Services Research (CINTESIS.UA), University of Aveiro (Campus Universitário de Santiago), Aveiro, Portugal
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13
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Hayward KL, Johnson AL, Horsfall LU, Moser C, Valery PC, Powell EE. Detecting non-alcoholic fatty liver disease and risk factors in health databases: accuracy and limitations of the ICD-10-AM. BMJ Open Gastroenterol 2021; 8:bmjgast-2020-000572. [PMID: 33568418 PMCID: PMC7878135 DOI: 10.1136/bmjgast-2020-000572] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Revised: 12/22/2020] [Accepted: 01/06/2021] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVE The prevalence of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH) cirrhosis is often underestimated in healthcare and administrative databases that define disease burden using International Classification of Diseases (ICD) codes. This retrospective audit was conducted to explore the accuracy and limitations of the ICD, Tenth Revision, Australian Modification (ICD-10-AM) to detect NAFLD, metabolic risk factors (obesity and diabetes) and other aetiologies of chronic liver disease. DESIGN/METHOD ICD-10-AM codes in 308 admitted patient encounters at two major Australian tertiary hospitals were compared with data abstracted from patients' electronic medical records. Accuracy of individual codes and grouped combinations was determined by calculating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV) and Cohen's kappa coefficient (κ). RESULTS The presence of an ICD-10-AM code accurately predicted the presence of NAFLD/NASH (PPV 91.2%) and obesity (PPV 91.6%) in most instances. However, codes underestimated the prevalence of NAFLD/NASH and obesity by 42.9% and 45.3%, respectively. Overall concordance between clinical documentation and 'grouped alcohol' codes (κ 0.75) and hepatitis C codes (κ 0.88) was high. Hepatitis B codes detected false-positive cases in patients with previous exposure (PPV 55.6%). Accuracy of codes to detect diabetes was excellent (sensitivity 95.8%; specificity 97.6%; PPV 94.9%; NPV 98.1%) with almost perfect concordance between codes and documentation in medical records (κ 0.93). CONCLUSION Recognition of the utility and limitations of ICD-10-AM codes to study the burden of NAFLD/NASH cirrhosis is imperative to inform public health strategies and appropriate investment of resources to manage this burgeoning chronic disease.
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Affiliation(s)
- Kelly Lee Hayward
- Centre for Liver Disease Research, The University of Queensland, Woolloongabba, Queensland, Australia.,Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Amy L Johnson
- Centre for Liver Disease Research, The University of Queensland, Woolloongabba, Queensland, Australia.,Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Leigh U Horsfall
- Centre for Liver Disease Research, The University of Queensland, Woolloongabba, Queensland, Australia.,Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
| | - Chris Moser
- Statistical Services Branch, Queensland Government Department of Health and Ageing, Brisbane, Queensland, Australia
| | - Patricia C Valery
- Centre for Liver Disease Research, The University of Queensland, Woolloongabba, Queensland, Australia.,QIMR Berghofer Medical Research Institute, Population Health, Herston, Queensland, Australia
| | - Elizabeth E Powell
- Centre for Liver Disease Research, The University of Queensland, Woolloongabba, Queensland, Australia .,Princess Alexandra Hospital, Metro South Hospital and Health Service, Woolloongabba, Queensland, Australia
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14
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Ren J, Han D, Zhang J, Wang Y, Huang Q, Tian T, Li X. Development and Psychometric Testing of the Supportive Care Needs Scale for Patients with Tuberculosis (SCN-TB). Patient Prefer Adherence 2021; 15:2267-2278. [PMID: 34675491 PMCID: PMC8502070 DOI: 10.2147/ppa.s330225] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Accepted: 09/24/2021] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patients affected by tuberculosis have diverse unmet supportive care needs (SCN) that may seriously affect their treatment adherence. Accurately assessing patients' SCN is important for providing efficient patient-centred care, but few instruments are suitable for use in clinical practice. Therefore, the purpose of this study was to develop an SCN scale for patients with tuberculosis (SCN-TB) and to evaluate its psychometrical properties. PATIENTS AND METHODS Based on the SCN framework, the SCN-TB was designed via a literature review, Delphi consultation and pilot study. Then, 550 patients from four tuberculosis specialist hospitals in Shaanxi Province were enrolled by convenience sampling to further test the validity and reliability of the SCN-TB. RESULTS A total of 518 patients completed the survey. The final scale encompasses 25 items in five domains: physical, practical, psycho-emotional, social, and informational. The content validity for the scale was 0.93, with that for each item ranging from 0.80 to 1.00. Five factors that explained 80.38% of the variance were identified in exploratory factor analysis. A five-factor model was then confirmed with confirmatory factor analysis using maximum likelihood estimation with bootstrapping. The model fit indices were χ 2/df=1.062 (Bollen-Stine χ 2=281.382, df=265, p<0.001), CFI=0.997, RMSEA=0.016, SRMR=0.053, NFI=0.951, and GFI=0.929. All factors had acceptable convergent and discriminant validity. The Cronbach's α, split-half, and test-retest reliability coefficients of the scale were 0.884, 0.883, and 0.854, respectively. CONCLUSION The SCN-TB is a valid and reliable theory based tool for assessing the needs of patients with tuberculosis and can be applied in both clinical practice and research.
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Affiliation(s)
- Jing Ren
- School of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of China
| | - Dongfang Han
- Department of Obstetrics and Gynecology, First Affiliated Hospital of Xi’an Jiaotong University, Xi’an City, People’s Republic of China
| | - Jingjun Zhang
- School of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of China
| | - Yingli Wang
- Department of Internal Medicine of Tuberculosis, Fourth Hospital of Inner Mongolia Autonomous Region, Hohhot City, People’s Republic of China
| | - Qiaoqiao Huang
- Department of Nursing, Fourth Hospital of Inner Mongolia Autonomous Region, Huhhot City, People’s Republic of China
| | - Tian Tian
- School of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of China
| | - Xiaomei Li
- School of Nursing, Health Science Center, Xi’an Jiaotong University, Xi’an City, People’s Republic of China
- Correspondence: Xiaomei Li School of Nursing, Health Science Center, Xi’an Jiaotong University, No. 76 Yanta West Road, Yanta District, Xi’an City, Shanxi, 710061, People’s Republic of ChinaTel/Fax +86 29 82657017 Email
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15
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Bernardes CM, Clark PJ, Brown C, Stuart K, Pratt G, Toombs M, Hartel G, Powell EE, Valery PC. Disparities in Unmet Needs in Indigenous and Non-Indigenous Australians with Cirrhosis: An Exploratory Study. Patient Prefer Adherence 2021; 15:2649-2658. [PMID: 34853510 PMCID: PMC8628121 DOI: 10.2147/ppa.s341566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/09/2021] [Indexed: 12/11/2022] Open
Abstract
PURPOSE Understanding and responding to the supportive care needs of people with cirrhosis is essential to quality care. Indigenous Australians, Aboriginal and Torres Strait Islander people, are overrepresented amongst patients with cirrhosis. This study documented the nature and extent of supportive care needs of Indigenous Australians with cirrhosis, in comparison with non-Indigenous Australians. PATIENTS AND METHODS The supportive care needs of adult patients diagnosed with cirrhosis attending public hospitals in Queensland were assessed through the Supportive Needs Assessment tool for Cirrhosis (SNAC). Patients indicated how much additional help they needed on four subscales: 1. psychosocial issues; 2. practical and physical needs; 3. information needs; and 4. lifestyle changes. We examined the rate of moderate-to-high unmet needs based on Indigenous status (Poisson regression; incidence rate ratio (IRR)). RESULTS Indigenous (n=20) and non-Indigenous (n=438) patients included in the study had similar sociodemographic and clinical characteristics except for a lower educational level among Indigenous patients (p<0.01). Most Indigenous patients (85.0%) reported having moderate-to-high unmet needs with at least one item in the SNAC tool. Following adjustment for key sociodemographic and clinical factors, Indigenous patients had a greater rate of moderate-to-high unmet needs overall (IRR=1.5, 95% CI 1.31-1.72; p<0.001), and specifically for psychosocial issues (IRR=1.7, 95% CI 1.39-2.15; p<0.001), and practical and physical needs subscales (IRR=1.5, 95% CI 1.22-1.83; p<0.001), compared to non-Indigenous patients. CONCLUSION Indigenous Australians with cirrhosis more frequently had moderate-to-high unmet supportive care needs than non-Indigenous patients. Specific targeting of culturally appropriate supportive care for psychosocial, practical and physical needs may optimize cirrhosis care and improve the quality of life for Indigenous Australians with cirrhosis.
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Affiliation(s)
| | - Paul J Clark
- Department of Gastroenterology and Hepatology, Mater Hospitals, Brisbane, QLD, Australia
| | - Cath Brown
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Katherine Stuart
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
| | - Gregory Pratt
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Maree Toombs
- Rural Clinical School, Faculty of Medicine, University of Queensland, Toowoomba, QLD, Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, QLD, Australia
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute, Herston, QLD, Australia
- Correspondence: Patricia C Valery Tel +61 07 3362 0376 Email
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16
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McPhail SM, Amarasena S, Stuart KA, Hayward K, Gupta R, Brain D, Hartel G, Rahman T, Clark PJ, Bernardes CM, Skoien R, Mckillen B, Lee A, Pillay L, Lin L, Khaing MM, Horsfall L, Powell EE, Valery PC. Assessment of health-related quality of life and health utilities in Australian patients with cirrhosis. JGH OPEN 2020; 5:133-142. [PMID: 33490623 PMCID: PMC7812472 DOI: 10.1002/jgh3.12462] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Accepted: 11/11/2020] [Indexed: 12/24/2022]
Abstract
Background and Aim Health‐related quality‐of‐life measurements are important to understand lived experiences of patients who have cirrhosis. These measures also inform economic evaluations by modelling quality‐adjusted life years (QALYs). We aimed to describe health‐related quality of life, specifically multiattribute utility (scale anchors of death = 0.00 and full health = 1.00), across various stages and etiologies of cirrhosis. Methods Face‐to‐face interviews were used to collect Short Form 36 (SF‐36) questionnaire responses from CirCare study participants with cirrhosis (June 2017 to December 2018). The severity of cirrhosis was assessed using the Child‐Pugh score classified as class A (5–6 points), B (7–9), or C (10–15) and by the absence (“compensated”) versus presence (“decompensated”) of cirrhosis‐related complications. Results Patients (n = 562, average 59.8 years [SD = 11.0], male 69.9%) had a range of primary etiologies (alcohol‐related 35.2%, chronic hepatitis C 25.4%, non‐alcoholic fatty liver disease (NAFLD) 25.1%, chronic hepatitis B 5.9%, “other” 8.4%). Significantly lower (all P < 0.001) mean multiattribute utility was observed in the health states of patients with decompensated (mean = 0.62, SD = 0.15) versus compensated cirrhosis (mean = 0.68, SD = 0.12), Child‐Pugh class C (mean = 0.59, SD = 0.15) or B (mean = 0.63, SD = 0.15) versus A (mean = 0.68, SD = 0.16), and between those of working age (18–64 years; mean = 0.64, SD = 0.16) versus those aged 65+ years (mean = 0.70, SD = 0.16). The greatest decrements in health‐related quality of life relative to Australian population norms were observed across physical SF‐36 domains. Conclusions Persons with more advanced cirrhosis report greater life impacts. Estimates from this study are suitable for informing economic evaluations, particularly cost‐utility modelling, which captures the benefits of effective prevention, surveillance, and treatments on both the quality and quantity of patients' lives.
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Affiliation(s)
- Steven M McPhail
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work Queensland University of Technology Brisbane Queensland Australia.,Clinical Informatics Directorate Metro South Health Brisbane Queensland Australia
| | - Samath Amarasena
- Department of Gastroenterology and Hepatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Katherine A Stuart
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia
| | - Kelly Hayward
- Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Rohit Gupta
- Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia
| | - David Brain
- Australian Centre for Health Services Innovation and Centre for Healthcare Transformation, School of Public Health and Social Work Queensland University of Technology Brisbane Queensland Australia.,Clinical Informatics Directorate Metro South Health Brisbane Queensland Australia
| | - Gunter Hartel
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
| | - Tony Rahman
- Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia
| | - Paul J Clark
- Department of Gastroenterology and Hepatology Mater Hospitals Brisbane Queensland Australia
| | - Christina M Bernardes
- Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia
| | - Richard Skoien
- Department of Gastroenterology and Hepatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Benjamin Mckillen
- Department of Gastroenterology and Hepatology Royal Brisbane and Women's Hospital Brisbane Queensland Australia
| | - Andrew Lee
- Department of Gastroenterology and Hepatology Mater Hospitals Brisbane Queensland Australia
| | - Leshni Pillay
- Department of Gastroenterology and Hepatology Logan Hospital Brisbane Queensland Australia
| | - Lei Lin
- Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia
| | - Myat Myat Khaing
- Gastroenterology and Hepatology Department The Prince Charles Hospital Brisbane Queensland Australia
| | - Leigh Horsfall
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Elizabeth E Powell
- Department of Gastroenterology and Hepatology Princess Alexandra Hospital Brisbane Queensland Australia.,Centre for Liver Disease Research, Translational Research Institute, Faculty of Medicine The University of Queensland Brisbane Queensland Australia
| | - Patricia C Valery
- QIMR Berghofer Medical Research Institute Brisbane Queensland Australia
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17
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Ramachandran J, Smith D, Woodman R, Muller K, Wundke R, McCormick R, Kaambwa B, Wigg A. Psychometric validation of the Partners in Health scale as a self-management tool in patients with liver cirrhosis. Intern Med J 2020; 51:2104-2110. [PMID: 32833278 DOI: 10.1111/imj.15031] [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: 04/19/2020] [Revised: 08/17/2020] [Accepted: 08/18/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIM Liver cirrhosis is a chronic disease complicated by recurrent hospital admissions. Self-management skills could facilitate optimal disease management. At present there is no validated instrument for measuring self-management in these patients. Hence, we evaluated the internal reliability and construct validity of the Partners in Health (PIH) scale, a chronic condition self-management tool in cirrhotic patients. METHODS In this prospective cohort study, the PIH scale was administered to 133 consenting patients within a Chronic Liver Failure Program of a tertiary hospital from February 2017 to May 2018. A Bayesian confirmatory factor analysis was used to evaluate a priori four-factor structure. Omega coefficients and 95% credible intervals (CrI) were used to assess internal reliability. Known-group validity was assessed in patients receiving active case management (n = 60) versus those without (n = 73). RESULTS The mean (± standard deviation (SD)) age of the participants was 62 (±11) years. Model fit for the hypothesised model was adequate (posterior predictive P-value = 0.073) and all hypothesised factor loadings were substantial (>0.6) and significant (P < 0.001). Omega coefficients (95% CrI) for the PIH subscales of Knowledge, Partnership, Management and Coping were 0.88 (0.82-0.91), 0.68 (0.57-0.76), 0.92 (0.89-0.94) and 0.89 (0.85-0.92) respectively. The mean (±SD) overall PIH score was higher in patients receiving case management compared to those without case management (81 ± 12 vs 73 ± 17, P < 0.001). CONCLUSION The dimensionality, known-group validity and reliability of the PIH scale for measuring self-management in patients with liver cirrhosis were confirmed. Its clinical predictive value requires further assessment.
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Affiliation(s)
- Jeyamani Ramachandran
- Hepatology and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
| | - David Smith
- College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
| | - Richard Woodman
- College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
| | - Kate Muller
- Hepatology and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
| | - Rachel Wundke
- Hepatology and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Rosemary McCormick
- Hepatology and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia
| | - Billingsley Kaambwa
- College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
| | - Alan Wigg
- Hepatology and Liver Transplant Unit, Flinders Medical Centre, Adelaide, South Australia, Australia.,College of Medicine and Public health, Flinders University, Adelaide, South Australia, Australia
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