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Tanaka T, Akishita M, Kojima T, Son BK, Iijima K. Medical care priorities of community-dwelling older adults according to three dimensions of quality of life: Quality of daily living, satisfaction and happiness from birth to death, and human vitality. Geriatr Gerontol Int 2024; 24:493-498. [PMID: 38602076 DOI: 10.1111/ggi.14870] [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: 02/20/2024] [Revised: 03/23/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
AIM Although the maintenance and improvement of quality of life (QoL) through holistic care are important in geriatric medical care, care priorities might differ depending on three essential aspects of QoL: the quality of daily living, satisfaction and happiness from birth to death, and human vitality, which are "Seikatsu," "Jinsei," "Seimei" in Japanese, respectively. We aimed to clarify these priorities in terms of medical care and examined how the definitions of QoL affected these priorities' rankings. METHODS This cross-sectional study involved community-dwelling older adults aged ≥65 years living in Kashiwa City, Chiba Prefecture, Japan. The number of participants was 1550 (mean age, 76.1 ± 5.8 years; 699 women [45.1%]). A self-administered questionnaire distributed in advance was used to rank 12 items sought in medical care. Participants were randomly assigned to one of three groups and sent the corresponding questionnaire, which differed only in the definition of QoL. RESULTS The top priorities for medical care were "effective treatment of illness," "improvement of physical function," and "maintaining a high level of activity." When QoL was defined as "the quality of daily living, satisfaction and happiness from birth to death, and human vitality," participants were significantly more likely to rank QoL improvement as one of the top three items (adjusted odds ratio, 1.46; 95% confidence interval, 1.03-2.05). CONCLUSIONS As a medical care priority, older adults desire improvement of multidimensional elements of life, including human vitality. Health care providers should consider this when making medical care decisions. Geriatr Gerontol Int 2024; 24: 493-498.
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Affiliation(s)
- Tomoki Tanaka
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
| | - Masahiro Akishita
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Taro Kojima
- Department of Geriatric Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Bo-Kyung Son
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
| | - Katsuya Iijima
- Institute of Gerontology, The University of Tokyo, Tokyo, Japan
- Institute for Future Initiatives, The University of Tokyo, Tokyo, Japan
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Durão S, Effa E, Mbeye N, Mthethwa M, McCaul M, Naude C, Brand A, Blose N, Mabetha D, Chibuzor M, Arikpo D, Chipojola R, Kunje G, Vandvik PO, Esu E, Lewin S, Kredo T. Using a priority setting exercise to identify priorities for guidelines on newborn and child health in South Africa, Malawi, and Nigeria. Health Res Policy Syst 2024; 22:48. [PMID: 38627761 PMCID: PMC11020907 DOI: 10.1186/s12961-024-01133-7] [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: 07/24/2023] [Accepted: 03/30/2024] [Indexed: 04/19/2024] Open
Abstract
BACKGROUND Sub-Saharan Africa is the region with the highest under-five mortality rate globally. Child healthcare decisions should be based on rigorously developed evidence-informed guidelines. The Global Evidence, Local Adaptation (GELA) project is enhancing capacity to use global research to develop locally relevant guidelines for newborn and child health in South Africa (SA), Malawi, and Nigeria. The first step in this process was to identify national priorities for newborn and child health guideline development, and this paper describes our approach. METHODS We followed a good practice method for priority setting, including stakeholder engagement, online priority setting surveys and consensus meetings, conducted separately in South Africa, Malawi and Nigeria. We established national Steering Groups (SG), comprising 10-13 members representing government, academia, and other stakeholders, identified through existing contacts and references, who helped prioritise initial topics identified by research teams and oversaw the process. Various stakeholders were consulted via online surveys to rate the importance of topics, with results informing consensus meetings with SGs where final priority topics were agreed. RESULTS Based on survey results, nine, 10 and 11 topics were identified in SA, Malawi, and Nigeria respectively, which informed consensus meetings. Through voting and discussion within meetings, and further engagement after the meetings, the top three priority topics were identified in each country. In SA, the topics concerned anemia prevention in infants and young children and post-discharge support for caregivers of preterm and LBW babies. In Malawi, they focused on enteral nutrition in critically ill children, diagnosis of childhood cancers in the community, and caring for neonates. In Nigeria, the topics focused on identifying pre-eclampsia in the community, hand hygiene compliance to prevent infections, and enteral nutrition for LBW and preterm infants. CONCLUSIONS Through dynamic and iterative stakeholder engagement, we identified three priority topics for guideline development on newborn and child health in SA, Malawi and Nigeria. Topics were specific to contexts, with no overlap, which highlights the importance of contextualised priority setting as well as of the relationships with key decisionmakers who help define the priorities.
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Affiliation(s)
- Solange Durão
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa.
| | - Emmanuel Effa
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Nyanyiwe Mbeye
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Mashudu Mthethwa
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Michael McCaul
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Celeste Naude
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Amanda Brand
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Ntombifuthi Blose
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Denny Mabetha
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Moriam Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Roselyn Chipojola
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Gertrude Kunje
- Evidence Informed Decision-Making Centre, Department of Community and Environmental Health, School of Global and Public Health, Kamuzu University of Health Sciences, Blantyre, Malawi
| | - Per Olav Vandvik
- MAGIC Evidence Ecosystem Foundation, Oslo, Norway
- Department of Medicine, Lovisenberg Diaconal Trust, Oslo, Norway
| | - Ekpereonne Esu
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
| | - Simon Lewin
- Department of Health Sciences Alesund, Norwegian University of Science and Technology, Trondheim, Norway
| | - Tamara Kredo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching Hospital, Calabar, Nigeria
- Centre for Evidence-Based Health Care, Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
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Schoenberger SF, Park TW, dellaBitta V, Hadland SE, Bagley SM. "My Life Isn't Defined by Substance Use": Recovery Perspectives Among Young Adults with Substance Use Disorder. J Gen Intern Med 2022; 37:816-822. [PMID: 34100229 PMCID: PMC8904703 DOI: 10.1007/s11606-021-06934-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND While substance use disorder remains a leading cause of morbidity and mortality for young adults, low rates of treatment engagement and retention persist. One explanation is that substance use disorder treatment approaches do not match young adults' expectations for recovery. While the concept of recovery has been explored among adult populations, less is known about how young adults think about recovery. OBJECTIVE To describe perspectives of recovery among young adults with substance use disorder. DESIGN Qualitative, in-depth interviews exploring young adults' definitions of recovery. PARTICIPANTS Twenty English-speaking young adults (7 women; 21-29 years old) diagnosed with substance use disorder recruited from an urban safety net hospital in Massachusetts. APPROACH Interviews were recorded and transcribed verbatim. An iterative categorization analytic approach was used to identify and interpret themes. KEY RESULTS Four themes related to recovery were identified. First, young adults described recovery as a way to grow up and live a normal life not defined by the substance use. A second theme was recovery had to include multiple components, such as mental health treatment, to be successful. Third, young adults described recovery as a self-motivated process, and it was important that young adults had agency in recovery decision-making. Fourth, recovery was described as a lifelong pursuit that required vigilance and commitment. CONCLUSIONS In this qualitative study of young adults with substance use disorder, participants identified themes that have implications for treatment models. Participants recognized recovery as a complex and individually motivated process that includes multiple components such as mental health treatment and re-engagement in regular daily activities. Models of care for young adults should consider incorporating these treatment elements to improve engagement and retention.
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Affiliation(s)
- Samantha F Schoenberger
- Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA.
| | - Tae Woo Park
- Department of Psychiatry, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
| | - Vanessa dellaBitta
- Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Scott E Hadland
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
| | - Sarah M Bagley
- Section of General Internal Medicine, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
- Grayken Center for Addiction, Boston Medical Center, Boston, MA, USA
- Division of General Pediatrics, Department of Pediatrics, Boston University School of Medicine/Boston Medical Center, Boston, MA, USA
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Boeykens D, Boeckxstaens P, De Sutter A, Lahousse L, Pype P, De Vriendt P, Van de Velde D. Goal-oriented care for patients with chronic conditions or multimorbidity in primary care: A scoping review and concept analysis. PLoS One 2022; 17:e0262843. [PMID: 35120137 PMCID: PMC8815876 DOI: 10.1371/journal.pone.0262843] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 01/06/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND The healthcare system is faced by an ageing population, increase in chronic conditions and multimorbidity. Multimorbid patients are faced with multiple parallel care processes leading to a risk of fragmented care. These problems relate to the disease-oriented paradigm. In this paradigm the treatment goals can be in contrast with what patients value. The concept of goal-oriented care is proposed as an alternative way of providing care as meeting patients' goals could have potential benefits. Though, there is a need to translate this concept into tangible knowledge so providers can better understand and use the concept in clinical practice. The aim of this study is to address this need by means of a concept analysis. METHOD This concept analysis using the method of Walker and Avant is based on a literature search in PubMed, Embase, Cochrane Library, PsychInfo, CINAHL, OTSeeker and Web of Science. The method provides eight iterative steps: select a concept, determine purpose, determine defining attributes, identify model case, identify additional case, identify antecedents and consequences and define empirical referents. RESULTS The analysis of 37 articles revealed that goal-oriented care is a dynamic and iterative process of three stages: goal-elicitation, goal-setting, and goal-evaluation. The process is underpinned by the patient's context and values. Provider and patient preparedness are required to provide goal-oriented care. Goal-oriented care has the potential to improve patients' experiences and providers' well-being, to reduce costs, and improve the overall population health. The challenge is to identify empirical referents to evaluate the process of goal-oriented care. CONCLUSION A common understanding of goal-oriented care is presented. Further research should focus on how and what goals are set by the patient, how this knowledge could be translated into a tangible workflow and should support the development of a strategy to evaluate the goal-oriented process of care.
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Affiliation(s)
- Dagje Boeykens
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
| | - Pauline Boeckxstaens
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
| | - An De Sutter
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
| | - Lies Lahousse
- Faculty of Pharmaceutical Sciences, Department of Bioanalysis, Ghent University, Ghent, Belgium
| | - Peter Pype
- Faculty of Medicine and Health Sciences, Department of Public Health and Primary Care, Center for Family Medicine, Ghent University, Ghent, Belgium
- Faculty of Medicine and Health Sciences, End-of-Life Care Research Group, Vrije Universiteit Brussel and Ghent University, Ghent, Belgium
| | - Patricia De Vriendt
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Ghent University, Ghent, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
- Faculty of Medicine and Pharmacy, Department of Gerontology and Mental Health and Wellbeing (MENT) Research Group, Frailty in Ageing (FRIA) Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Dominique Van de Velde
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Occupational Therapy, Ghent University, Ghent, Belgium
- Department of Occupational Therapy, Artevelde University of Applied Sciences, Ghent, Belgium
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Iqbal H, McEachan RRC, West J, Haith-Cooper M. Research priority setting in obesity: a systematic review. ZEITSCHRIFT FUR GESUNDHEITSWISSENSCHAFTEN = JOURNAL OF PUBLIC HEALTH 2021; 31:1-17. [PMID: 34877248 PMCID: PMC8641289 DOI: 10.1007/s10389-021-01679-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 11/11/2021] [Indexed: 12/23/2022]
Abstract
AIM Obesity research priority setting, if conducted to a high standard, can help promote policy-relevant and efficient research. Therefore, there is a need to identify existing research priority setting studies conducted in the topic area of obesity and to determine the extent to which they followed good practice principles for research priority setting. METHOD Studies examining research priority setting in obesity were identified through searching the MEDLINE, PBSC, CINAHL, PsycINFO databases and the grey literature. The nine common themes of good practice in research priority setting were used as a methodological framework to evaluate the processes of the included studies. These were context, use of a comprehensive approach, inclusiveness, information gathering, planning for implementation, criteria, methods for deciding on priorities, evaluation and transparency. RESULTS Thirteen articles reporting research prioritisation exercises conducted in different areas of obesity research were included. All studies reported engaging with various stakeholders such as policy makers, researchers and healthcare professionals. Public involvement was included in six studies. Methods of research prioritisation commonly included both Delphi and nominal group techniques and surveys. None of the 13 studies fulfilled all nine of the good practice criteria for research priority setting, with the most common limitations including not using a comprehensive approach and lack of inclusivity and evaluating on their processes. CONCLUSION There is a need for research priority setting studies in obesity to involve the public and to evaluate their exercises to ensure they are of high quality.
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Affiliation(s)
- Halima Iqbal
- Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
| | - Rosemary R. C. McEachan
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
| | - Jane West
- Bradford Institute for Health Research, Bradford Teaching Hospital NHS Foundation Trust, Bradford, UK
| | - Melanie Haith-Cooper
- Faculty of Health Studies, University of Bradford, Richmond Road, Bradford, BD7 1DP UK
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[Prioritization by patients of a series of common components in the standard comprehensive geriatric assessment in Primary Care]. Rev Esp Geriatr Gerontol 2021; 57:13-19. [PMID: 34330542 DOI: 10.1016/j.regg.2021.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/27/2021] [Accepted: 05/11/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To know the prioritization by people aged ≥70 of a series of common components in the comprehensive geriatric assessment (CGA) in primary care (PC), according to the influence on health. METHOD Cross-sectional descriptive study through questionnaire to 109 people, have been excluded those at the end of life or with cognitive, sensory or mental/psychiatric impairment that made collaboration difficult. The main variable was a selection of 23 items of the physical/clinical, functional, mental and social/family, common components on a CGA in PC. Others: age, sex, VIDA questionnaire of instrumental activities of daily living (IADL), number of medications, and Charlson comorbidity index. RESULTS Median age 78 years, 75 percentile of 84; 64.2% women. Four people (3.7%) had altered VIDA questionnaire (<32 points). Median of 5 chronic medications, and 98 (90%) comorbidity absence considering Charlson index. Without statistically significant differences contrasting gender with age, result in VIDA, nor number of chronic medications. The best scored items according to centralization statistics were smoking and memory, and considering the best score (4-5 out of 5) of the Likert scale: proper medication (93.6% of the people surveyed, 95% CI: 87.3-96.8), mouth/teeth condition (92.7%, 95% CI: 86.2-96.2), mood (91.7%, 95% CI: 85.1-95.6), and capacity for ADL (91.7%, 95% CI:85.1-95.6). CONCLUSIONS Smoking, memory, proper medication, mouth/teeth condition, mood and ADL were considered as the most influential in health by patients. Because of the important of patient participation in the content of the CGA and the scarcity of these kind of studies, new studies that deepen this issue become relevant.
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How Do Treatment Priorities Differ Between Patients in HIV Care and Their Providers? A Mixed-Methods Study. AIDS Behav 2020; 24:1170-1180. [PMID: 31832854 DOI: 10.1007/s10461-019-02746-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Evidence suggests priorities differ between patients in HIV care and their providers regarding topics most important to address in care. At five U.S. sites, we asked patients and providers to prioritize 25 potential topic areas to address during routine visits, and invited patients to discuss selection rationale. Patients (n = 206) and providers (n = 17) showed high discordance in rank order priorities (X2 (24, 223) = 71.12; p < 0.0001). Patients ranked social domains such as HIV stigma highly; a higher proportion of providers prioritized substance use domains. HIV stigma was a higher priority for patients in care fewer than 6 years (Fisher's exact p = 0.0062), nonwhite patients (Fisher's exact p = 0.0114), and younger patients (Fisher's exact p = 0.0281). Patients' priorities differed between men and women (X2 (24, 188) = 52.89; p < 0.0001), white race vs. other races (X2 (24, 206) = 48.32; p = 0.0023), and Latinos vs. non-Latinos (X2 (24, 206) = 48.65; p = 0.0021). Interviews (n = 79) revealed perceived impact of social context on health and health behaviors.
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Eidam A, Roth A, Lacroix A, Goisser S, Seidling HM, Haefeli WE, Bauer JM. Methods to Assess Patient Preferences in Old Age Pharmacotherapy - A Systematic Review. Patient Prefer Adherence 2020; 14:467-497. [PMID: 32184575 PMCID: PMC7061412 DOI: 10.2147/ppa.s236964] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/14/2020] [Indexed: 12/21/2022] Open
Abstract
PURPOSE The aim of this systematic review was to identify methods used to assess medication preferences in older adults and evaluate their advantages and disadvantages with respect to their applicability to the context of multimorbidity and polypharmacy. MATERIAL AND METHODS Three electronic databases (PubMed, Web of Science, PsycINFO) were searched. Eligible studies elicited individual treatment or outcome preferences in a context that involved long-term pharmacological treatment options. We included studies with a study population aged ≥ 65 years and/or with a mean or median age of ≥ 75 years. Qualitative studies, studies assessing preferences for only two different treatments, and studies targeting preferences for life-sustaining treatments were excluded. The identified preference measurement methods were evaluated based on four criteria (time budget, cognitive demand, variety of pharmacological aspects, and link with treatment strategies) judged to be relevant for the elicitation of patient preferences in polypharmacy. RESULTS Sixty articles met the eligibility criteria and were included in the narrative synthesis. Fifty-five different instruments to assess patient preferences, based on 24 different elicitation methods, were identified. The most commonly applied preference measurement techniques were "medication willingness" (description of a specific medication with inquiry of the participant's willingness to take it), discrete choice experiments, Likert scale-based questionnaires, and rank prioritization. The majority of the instruments were created for disease-specific or context-specific settings. Only three instruments (Outcome Prioritization Tool, a complex intervention, "MediMol" questionnaire) dealt with the broader issue of geriatric multimorbidity. Only seven of the identified tools showed somewhat favorable characteristics for a potential use of the respective method in the context of polypharmacy. CONCLUSION Up to now, few instruments have been specifically designed for the assessment of medication preferences in older patients with multimorbidity. To facilitate valid preference elicitation in the context of geriatric polypharmacy, future research should focus on suitable characteristics of existing techniques to develop new measurement approaches for this increasingly relevant population.
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Affiliation(s)
- Annette Eidam
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
| | - Anja Roth
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
| | - André Lacroix
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
| | - Sabine Goisser
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
- Network Aging Research (NAR), Heidelberg University, Heidelberg69115, Germany
| | - Hanna M Seidling
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg69120, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg69120, Germany
| | - Walter E Haefeli
- Department of Clinical Pharmacology and Pharmacoepidemiology, Heidelberg University, Heidelberg69120, Germany
- Cooperation Unit Clinical Pharmacy, Heidelberg University, Heidelberg69120, Germany
| | - Jürgen M Bauer
- Center of Geriatric Medicine, Heidelberg University, AGAPLESION Bethanien Hospital Heidelberg, Heidelberg69126, Germany
- Network Aging Research (NAR), Heidelberg University, Heidelberg69115, Germany
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Sayyed Kassem L, Aron DC. The assessment and management of quality of life of older adults with diabetes mellitus. Expert Rev Endocrinol Metab 2020; 15:71-81. [PMID: 32176560 DOI: 10.1080/17446651.2020.1737520] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 02/28/2020] [Indexed: 12/11/2022]
Abstract
Introduction: As the population ages, the number of older adults with diabetes mellitus will continue to rise. The burden of diabetes on older adults is significant due to the disease itself, its complications, and its treatments. This is compounded by geriatric syndromes such as frailty and cognitive dysfunction. Consequently, health and diabetes-related quality of life (QoL) are diminished.Areas covered: This article reviews the value of assessing QoL in providing patient-centered care and the associations between QoL measures and health outcomes. The determinants of QoL particular to diabetes and the older population are reviewed, including psychosocial, physical, and cognitive burdens of diabetes and aging and the impact of hypoglycemia on QoL. Strategies are described to alleviate these burdens and improve QoL, and barriers to multidisciplinary patient-centered care are discussed. QoL measurement instruments are reviewed.Expert opinion: The goals of treating diabetes and its complications should be considered carefully along with each patient's capacity to withstand the burdens of treatment. This capacity is reduced by socioeconomic, psychological, cognitive, and physical factors reduces this capacity. Incorporating measurement of HRQoL into clinical practices is possible, but deficiencies in the systems of health-care delivery need to be addressed to facilitate their use.
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Affiliation(s)
- Laure Sayyed Kassem
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - David C Aron
- Endocrinology Section, Northeast Ohio Veterans Healthcare System, Cleveland, OH, USA
- Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, OH, USA
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Sathanapally H, Sidhu M, Fahami R, Gillies C, Kadam U, Davies MJ, Khunti K, Seidu S. Priorities of patients with multimorbidity and of clinicians regarding treatment and health outcomes: a systematic mixed studies review. BMJ Open 2020; 10:e033445. [PMID: 32051314 PMCID: PMC7045037 DOI: 10.1136/bmjopen-2019-033445] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To identify studies that have investigated the health outcome and treatment priorities of patients with multimorbidity, clinicians or both, in order to assess whether the priorities of the two groups are in alignment, or whether a disparity exists between the priorities of patients with multimorbidity and clinicians. DESIGN Systematic review. DATA SOURCES MEDLINE, EMBASE, CINHAL and Cochrane databases from inception to May 2019 using a predefined search strategy, as well as reference lists containing any relevant articles, as per Preferred Reporting Items for Systematic Reviews and Meta-Analyses and Cochrane guidelines. ELIGIBILITY CRITERIA We included studies reporting health outcome and treatment priorities of adult patients with multimorbidity, defined as suffering from two or more chronic conditions, or of clinicians in the context of multimorbidity or both. There was no restriction by study design, and studies using quantitative and/or qualitative methodologies were included. DATA SYNTHESIS We used a narrative synthesis approach to synthesise the quantitative findings, and a meta-ethnography approach to synthesise the qualitative findings. RESULTS Our search identified 24 studies for inclusion, which comprised 12 quantitative studies, 10 qualitative studies and 2 mixed-methods studies. Twelve studies reported the priorities of both patients and clinicians, 10 studies reported the priorities of patients and 2 studies reported the priorities of clinicians alone. Our findings have shown a mostly low level of agreement between the priorities of patients with multimorbidity and clinicians. We found that prioritisation by patients was mainly driven by their illness experiences, while clinicians focused on longer-term risks. Preserving functional ability emerged as a key priority for patients from across our quantitative and qualitative analyses. CONCLUSION Recognising that there may be a disparity in prioritisation and understanding the reasons for why this might occur, can facilitate clinicians in accurately eliciting the priorities that are most important to their patients and delivering patient-centred care. PROSPERO REGISTRATION NUMBER CRD42018076076.
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Affiliation(s)
| | - Manbinder Sidhu
- School of Social Policy, Health Services Management Centre, University of Birmingham, Birmingham, UK
| | - Radia Fahami
- University of Leicester Diabetes Research Centre, Leicester, UK
| | - Clare Gillies
- University of Leicester Diabetes Research Centre, Leicester, UK
| | - Umesh Kadam
- University of Leicester Diabetes Research Centre, Leicester, UK
| | | | - Kamlesh Khunti
- University of Leicester Diabetes Research Centre, Leicester, UK
| | - Samuel Seidu
- University of Leicester Diabetes Research Centre, Leicester, UK
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Huiskes VJB, Cramer-van der Welle CM, van den Ende CHM, van Dijk L, Bos JM, Kramers C, van den Bemt BJF. Communication about Drug-Related Problems (DRPs) during Patients' Visits to Dutch Physicians and Pharmacies. HEALTH COMMUNICATION 2020; 35:201-208. [PMID: 30526088 DOI: 10.1080/10410236.2018.1551301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The objective of this study is to assess the frequency and type of drug-related problems (DRPs) (1) raised and discussed (2) raised but not discussed or (3) not raised during patients' visits to healthcare practitioners (HCPs). In this cross-sectional study in Dutch outpatient clinics, GP practices and pharmacies, verbal cues from patients and HCPs indicating DRPs were inventoried by an observer during visits. It was also observed whether raised DRPs were discussed between patient and HCP. Post-encounter interviews (HCPs) were conducted and post-encounter questionnaires (patient) were distributed to identify DRPs not raised. In total, 431 patients were observed during a single visit. In 42.2% of these visits, 311 DRPs were raised (weighted mean (SD) 0.7 (±1.1) DRP/patient). Of these 311 DRPs, 82.0% were discussed between HCP and patient. HCPs did not raise existing DRPs in 3.9% of the 431 visits; in 6.3% of the 176 questionnaires the patient reported an existing DRP that had not been raised. In conclusion, almost one in six of the DRPs raised during visits are not discussed between HCP and patient. Furthermore, existing DRPs are not even raised in 4-6% of the visits. HCPs and patients should be aware that, although patients often have DRPs, these are not always discussed or not even raised during patients' visits.
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Affiliation(s)
| | | | | | - Liset van Dijk
- NIVEL, Netherlands Institute for Health Services Research
| | | | - Cornelis Kramers
- Department of Clinical Pharmacy, Canisius-Wilhelmina Hospital
- Department of Pharmacology-Toxicology and Internal Medicine, Radboud University Medical Center
| | - Bart J F van den Bemt
- Department of Pharmacy, Sint Maartenskliniek
- Department of Pharmacy, Radboud University Medical Center
- Department of Clinical Pharmacy and Toxicology, Maastricht University Medical Center
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12
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Galof K, Žnidaršič A, Balantič Z. Independence and Caregiver Preferences Among Community-Dwelling Older People in Slovenia: A Cross-Sectional Study. INQUIRY: The Journal of Health Care Organization, Provision, and Financing 2020; 56:46958019869155. [PMID: 31394962 PMCID: PMC6689914 DOI: 10.1177/0046958019869155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although Slovenia is becoming an aging society, very little is known about the abilities and needs of home-dwelling older people or their preferences regarding assistance. The aim of the study was to explore the need for assistance in daily activities among older Slovenian people living at home. Older adults aged between 65 and 97 years (N = 358) participated in the cross-sectional survey study. A questionnaire that assessed independence in daily activities and assistance in the home environment was developed. Data were analyzed using descriptive statistics, a nonparametric test (Wilcoxon signed rank test), and the chi-square test. The results showed that older Slovenians were more independent in activities of daily living (ADLs) than instrumental activities of daily living (IADLs). Independence was the highest for using the toilet, feeding, and mobility transfers, and the lowest for bathing. With IADLs, assistance was most often required with shopping and housework; this assistance was usually provided by family members. The provider of assistance was generally compatible with older people’s preferences concerning assistance at home. We found no differences in care preferences between urban and rural settings. Assistance in the home environment was predominantly provided by unpaid helpers, which reflects recent developments in health and social services that put an emphasis on a person’s social network. Due to demographic changes and the decrease in the number of adult children, reliance on close relatives might soon become a challenge. These findings can help policy makers understand older people’s choices and preferences better when planning long-term care.
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Affiliation(s)
- Katarina Galof
- 1 University of Ljubljana, Faculty of Health Sciences, Ljubljana, Slovenia
| | - Anja Žnidaršič
- 2 University of Maribor, Faculty of Organizational Sciences, Kranj, Slovenia
| | - Zvone Balantič
- 2 University of Maribor, Faculty of Organizational Sciences, Kranj, Slovenia
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13
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Abstract
Objective: Definitions of shared decision-making (SDM) have largely neglected to consider goal setting as an explicit component. Applying SDM to people with multiple long-term conditions requires attention to goal setting. We propose an integrated model, which shows how goal setting, at 3 levels, can be integrated into the 3-talk SDM model. Method: The model was developed by integrating 2 published models. Results: An integrated, goal-based SDM model is proposed and applied to a patient with multiple, complex, long-term clinical conditions to illustrate the use of a visualization tool called a Goal Board. A Goal Board prioritizes collaborative goals and aligns goals with interventional options. Conclusion: The model provides an approach to achieve person-centered decision-making by not only eliciting and prioritizing goals but also by aligning prioritized goals and interventions. Practice Implications: Further research is required to evaluate the utility of the proposed model.
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Affiliation(s)
- Glyn Elwyn
- The Dartmouth Institute for Health Policy and Clinical Practice - Williamson Translational Research Building, Dartmouth College, Hanover, USA.,Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands.,Both authors have equal contribution to the authorship of the article
| | - Neeltje Petronella Catharina Anna Vermunt
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), Nijmegen, the Netherlands.,The Dutch Council for Health and Society, Raad voor Volksgezondheid en Samenleving, The Hague, the Netherlands.,Both authors have equal contribution to the authorship of the article
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14
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Poleshuck E, Wittink M, Crean HF, Juskiewicz I, Bell E, Harrington A, Cerulli C. A Comparative Effectiveness Trial of Two Patient-Centered Interventions for Women with Unmet Social Needs: Personalized Support for Progress and Enhanced Screening and Referral. J Womens Health (Larchmt) 2019; 29:242-252. [PMID: 31502906 DOI: 10.1089/jwh.2018.7640] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: Despite recent widespread acceptance that unmet social needs are critically relevant to health, limited guidance exists about how best to address them in the context of women's health care delivery. We aimed to evaluate two interventions: enhanced screening and referral (ESR), a screening intervention with facilitated referral and follow-up calls, and personalized support for progress (PSP), a community health worker intervention tailored to women's priorities. Materials and Methods: Women >18 years were screened for presence of elevated depressive symptoms in three women's health clinics serving primarily Medicaid-eligible patients. If eligible and interested, we enrolled and randomized women to ESR or PSP. Pre- and postintervention assessments were conducted. Primary outcomes were satisfaction, depression, and quality of life (QOL). Planned analyses of subgroup differences were also explored. Results: A total of 235 participants were randomized; 54% identified as African American, 19% as White, and 15% as Latina. Participant mean age was 30 years; 77% reported annual incomes below US $20,000/year; and 30% were pregnant at enrollment. Participants in both arms found the interventions satisfactory and improved for depression (p < 0.001). There were no differences between groups for the primary outcomes. Subgroups reporting greater improvement in QOL in PSP compared with ESR included participants who at baseline reported anxiety (p = 0.05), lack of access to depression treatment (p = 0.02), pain (p = 0.04), and intimate partner violence (p = 0.02). Conclusions: Clinics serving women with unmet social needs may benefit from offering PSP or ESR. Distinguishing how best to use these interventions in practice is the next step.
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Affiliation(s)
- Ellen Poleshuck
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Marsha Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,Department of Family Medicine, University of Rochester Medical Center, Rochester, New York
| | - Hugh F Crean
- School of Nursing, University of Rochester, Rochester, New York
| | - Iwona Juskiewicz
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Elaine Bell
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York
| | - Amy Harrington
- Department of Obstetrics and Gynecology, University of Rochester Medical Center, Rochester, New York
| | - Catherine Cerulli
- Department of Psychiatry, University of Rochester Medical Center, Rochester, New York.,Susan B. Anthony Center, University of Rochester, Rochester, New York
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15
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Abstract
OBJECTIVES Since the population continues ageing and the number of patients with multiple chronic diseases is rising in Western countries, a shift is recommended from disease oriented towards goal-oriented healthcare. As little is known about individual goals and preferences of older hospitalised patients, the aim of this study is to elucidate the goals of a diverse group of older hospitalised patients. DESIGN Qualitative descriptive method with open interviews analysed with inductive content analysis. SETTING A university teaching hospital and a regional teaching hospital. PARTICIPANTS Twenty-eight hospitalised patients aged 70 years and older. RESULTS Some older hospitalised patients initially had difficulties describing concrete goals, but after probing all were able to state more concrete goals. A great diversity of goals were categorised into wanting to know what the matter is, controlling disease, staying alive, improving condition, alleviating complaints, improving daily functioning, improving/maintaining social functioning, resuming work/hobbies and regaining/maintaining autonomy. CONCLUSIONS Older hospitalised patients have a diversity of goals in different domains. Discussing goals with older patients is not a common practice yet. Timely discussions about goals should be encouraged because individual goals are not self-evident and this discussion can guide decision making, especially in patients with multimorbidity and frailty. Aids can be helpful to facilitate the discussion about goals and evaluate the outcomes of hospitalisation.
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Affiliation(s)
- Maria Johanna van der Kluit
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
| | - Geke J Dijkstra
- University of Groningen, University Medical Center Groningen, Department of Health Sciences, Applied Health Research, Groningen, The Netherlands
| | - Sophia E de Rooij
- University of Groningen, University Medical Center Groningen, University Center for Geriatric Medicine, Groningen, The Netherlands
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16
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Vermunt N, Elwyn G, Westert G, Harmsen M, Olde Rikkert M, Meinders M. Goal setting is insufficiently recognised as an essential part of shared decision-making in the complex care of older patients: a framework analysis. BMC FAMILY PRACTICE 2019; 20:76. [PMID: 31170920 PMCID: PMC6555756 DOI: 10.1186/s12875-019-0966-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Accepted: 05/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Multimorbidity poses a challenge for decision-making processes and requires that more attention is paid to patient goals, preferences and needs; however, goal setting is not yet widely recognised as a core aspect of the shared decision-making (SDM) approach. This study aims to analyse clinician perceptions of the concept of goal setting within the context of SDM with older patients with multimorbidity. METHODS Semi-structured interviews with general practitioners (GPs) and clinical geriatricians (CGs) were analysed using a framework analysis. The integrative model of SDM was used to develop a categorisation matrix, including goal setting as an additional component. RESULTS Sixteen of the 33 clinicians mentioned explicit Goal setting as an integrated component of their definition of SDM, which was comparable to the number of clinicians who listed Patient values and preferences (n = 16), Doctor knowledge and recommendations (n = 19) and Make or explicitly defer a decision (n = 19), elements which are commonly considered to be important aspects of SDM. The other 17 clinicians (6 CGs and 11 GPs) did not mention Goal setting as an explicit component of SDM. Our analysis revealed two potential reasons for this observation. Besides the use of other terminology, part of clinicians viewed collaborative goal setting and SDM as separate but related processes. CONCLUSIONS Our study on clinician perspectives highlighted goal setting as component of a SDM approach and could therefore be considered supportive of recent theoretical insights that SDM models that lack an explicit goal-setting component appear to be deficient and overlook an important aspect of engaging patients in decision-making, particularly for patients with complex multimorbidities. We therefore call for the further development of a comprehensive SDM approach for older patients with multimorbidity to include explicit and unequivocal goal setting elements to sufficiently meet the expectations and needs of clinicians and their patients.
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Affiliation(s)
- Neeltje Vermunt
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500 HB Nijmegen, The Netherlands
- The Dutch Council for Health and Society, (Raad voor Volksgezondheid en Samenleving, RVS), The Hague, the Netherlands
| | - Glyn Elwyn
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500 HB Nijmegen, The Netherlands
- The Dartmouth Institute for Health Policy & Clinical Practice, Level 5 Williamson Translational Research Building, One Medical Center Drive, Lebanon, NH 03756 USA
- Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Gert Westert
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Mirjam Harmsen
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marcel Olde Rikkert
- Radboud university Medical Center, Radboudumc Alzheimer Center, Donders Institute for Brain, Cognition and Behavior, PO Box 9101, 6500 HB Nijmegen, The Netherlands
- Department of Geriatrics, Radboud University Medical Center, PO Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marjan Meinders
- Radboud University Medical Center, Radboud Institute for Health Sciences, Scientific Institute for Quality of Healthcare (IQ Healthcare), PO Box 9101, 6500 HB Nijmegen, The Netherlands
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17
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Lubenow JAM, Silva AO. What the elderly think of the care provided by health services. REVISTA BRASILEIRA DE GERIATRIA E GERONTOLOGIA 2019. [DOI: 10.1590/1981-22562019022.180195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Abstract Objective: To identify the social representations of the elderly on the care provided in health services. Method: An exploratory study with a qualitative approach was carried out, in which 238 elderly persons were interviewed about the care they received in Basic Health Units and in a center of specialized care. Their discourse was recorded and transcribed in its entirety, and processed using Iramuteq software. The results were discussed using Social Representation Theory. Results: The elderly associated good care with being treated with respect, attentiveness and politeness; and, at the same time, the requesting of diagnostic exams, referrals to medical specialists and the prescription of medicines. In their imaginary, the Basic Health Unit hinders their access to specialized care and doctors in this service do not know enough to meet the needs of people of different age groups and health problems, meaning that consulting with a specialist becomes more important. In practice, they encounter difficulties related to delays in being attended to and obtaining appointments with specialists, diagnostic exams and with the first come, first served appointment system, which is further limited by the number of places and treatment of specific groups on certain days. Conclusion: The practices in the care provided to the elderly in health services need to be reviewed to offer humanized and qualified care that can meet their needs. Health professionals and managers should consider the different characteristics of the elderly when approaching care.
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18
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Déruaz-Luyet A, N'Goran AA, Pasquier J, Burnand B, Bodenmann P, Zechmann S, Neuner-Jehle S, Senn N, Widmer D, Streit S, Zeller A, Haller DM, Herzig L. Multimorbidity: can general practitioners identify the health conditions most important to their patients? Results from a national cross-sectional study in Switzerland. BMC FAMILY PRACTICE 2018; 19:66. [PMID: 29776442 PMCID: PMC5960174 DOI: 10.1186/s12875-018-0757-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 05/01/2018] [Indexed: 11/22/2022]
Abstract
Background Faced with patients suffering from more than one chronic condition, or multimorbidity, general practitioners (GPs) must establish diagnostic and treatment priorities. Patients also set their own priorities to handle the everyday burdens associated with their multimorbidity and these may be different from the priorities established by their GP. A shared patient–GP agenda, driven by knowledge of each other’s priorities, would seem central to managing patients with multimorbidity. We evaluated GPs’ ability to identify the health condition most important to their patients. Methods Data on 888 patients were collected as part of a cross-sectional Swiss study on multimorbidity in family medicine. For the main analyses on patients-GP agreement, data from 572 of these patients could be included. GPs were asked to identify the two conditions which their patient considered most important, and we tested whether either of them agreed with the condition mentioned as most important by the patient. In the main analysis, we studied the agreement rate between GPs and patients by grouping items medically-related into 46 groups of conditions. Socio-demographic and clinical variables were fitted into univariate and multivariate models. Results In 54.9% of cases, GPs were able to identify the health condition most important to the patient. In the multivariate model, the only variable significantly associated with patient–GP agreement was the number of chronic conditions: the higher the number of conditions, the less likely the agreement. Conclusion GPs were able to correctly identify the health condition most important to their patients in half of the cases. It therefore seems important that GPs learn how to better adapt treatment targets and priorities by taking patients’ perspectives into account. Electronic supplementary material The online version of this article (10.1186/s12875-018-0757-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anouk Déruaz-Luyet
- Institute of Family Medicine, University of Lausanne, 44 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Alexandra A N'Goran
- Institute of Family Medicine, University of Lausanne, 44 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Jérôme Pasquier
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bernard Burnand
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Patrick Bodenmann
- Department of Ambulatory Care and Community Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Stefan Zechmann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | | | - Nicolas Senn
- Institute of Family Medicine, University of Lausanne, 44 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Daniel Widmer
- Institute of Family Medicine, University of Lausanne, 44 rue du Bugnon, 1011, Lausanne, Switzerland
| | - Sven Streit
- Institute of Primary Health Care (BIHAM), University of Berne, Berne, Switzerland
| | - Andreas Zeller
- Centre for Primary Health Care, University of Basel, Basel, Switzerland
| | - Dagmar M Haller
- Primary Care Unit, Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Lilli Herzig
- Institute of Family Medicine, University of Lausanne, 44 rue du Bugnon, 1011, Lausanne, Switzerland.
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19
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Wittink MN, Walsh P, Yilmaz S, Mendoza M, Street RL, Chapman BP, Duberstein P. Patient priorities and the doorknob phenomenon in primary care: Can technology improve disclosure of patient stressors? PATIENT EDUCATION AND COUNSELING 2018; 101:214-220. [PMID: 28844522 PMCID: PMC5803466 DOI: 10.1016/j.pec.2017.08.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Revised: 06/28/2017] [Accepted: 08/03/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Patients with multiple chronic conditions face many stressors (e.g. financial, safety, transportation stressors) that are rarely prioritized for discussion with the primary care provider (PCP). In this pilot randomized controlled trial we examined the effects of a novel technology-based intervention called Customized Care on stressor disclosure. METHODS The main outcomes were stressor disclosure, patient confidence and activation, as assessed by self-report and observational methods (transcribed and coded audio-recordings of the office visit). RESULTS Sixty patients were enrolled. Compared with care as usual, intervention patients were 6 times more likely to disclose stressors to the PCP (OR=6.16, 95% CI [1.53, 24.81], p=0.011) and reported greater stressor disclosure confidence (exp[B]=1.06, 95% CI [1.01, 1.12], p=0.028). No differences were found in patient activation or the length of the office visit. CONCLUSION Customized Care improved the likelihood of stressor disclosure without affecting the length of the PCP visit. PRACTICE IMPLICATIONS Brief technology-based interventions, like Customized Care could be made available through patient portals, or on smart phones, to prime patient-PCP discussion about difficult subjects, thereby improving the patient experience and efficiency of the visit.
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Affiliation(s)
- Marsha N Wittink
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA; Department of Family Medicine, University of Rochester Medical Center, Rochester, USA.
| | - Patrick Walsh
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA
| | - Sule Yilmaz
- Warner School for Education, University of Rochester, Rochester, USA
| | - Michael Mendoza
- Department of Family Medicine, University of Rochester Medical Center, Rochester, USA
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, USA; Houston VA Center for Innovation in Quality, Effectiveness and Safety, Houston, USA
| | - Benjamin P Chapman
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center, Rochester, USA; Department of Family Medicine, University of Rochester Medical Center, Rochester, USA; Department of Medicine, University of Rochester Medical Center, Rochester, USA
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20
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Berry ABL, Lim CY, Hartzler AL, Hirsch T, Ludman E, Wagner EH, Ralston JD. "It's good to know you're not a stranger every time". ACTA ACUST UNITED AC 2017. [DOI: 10.1145/3134658] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
| | - Catherine Y. Lim
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Andrea L. Hartzler
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Tad Hirsch
- University of Washington, Seattle, WA, USA
| | - Evette Ludman
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Edward H. Wagner
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - James D. Ralston
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
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21
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Lim CY, Berry ABL, Hirsch T, Hartzler AL, Wagner EH, Ludman EJ, Ralston JD. Understanding What Is Most Important to Individuals with Multiple Chronic Conditions: A Qualitative Study of Patients' Perspectives. J Gen Intern Med 2017; 32:1278-1284. [PMID: 28849368 PMCID: PMC5698221 DOI: 10.1007/s11606-017-4154-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/19/2017] [Accepted: 07/28/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND To improve care for individuals living with multiple chronic conditions, patients and providers must align care planning with what is most important to patients in their daily lives. We have a limited understanding of how to effectively encourage communication about patients' personal values during clinical care. OBJECTIVE To identify what patients with multiple chronic conditions describe as most important to their well-being and health. DESIGN We interviewed individuals with multiple chronic conditions in their homes and analyzed results qualitatively, guided by grounded theory. PARTICIPANTS A total of 31 patients (mean age 68.7 years) participated in the study, 19 of which included the participation of family members. Participants were from Kaiser Permanente Washington, an integrated health care system in Washington state. APPROACH Qualitative analysis of home visits, which consisted of semi-structured interviews aided by photo elicitation. KEY RESULTS Analysis revealed six domains of what patients described as most important for their well-being and health: principles, relationships, emotions, activities, abilities, and possessions. Personal values were interrelated and rarely expressed as individual values in isolation. CONCLUSIONS The domains describe the range and types of personal values multimorbid older adults deem important to well-being and health. Understanding patients' personal values across these domains may be useful for providers when developing, sharing, and following up on care plans.
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Affiliation(s)
- Catherine Y Lim
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA.
| | | | - Tad Hirsch
- University of Washington, Seattle, WA, USA
| | - Andrea L Hartzler
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | - Edward H Wagner
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | - Evette J Ludman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
- University of Washington, Seattle, WA, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
- University of Washington, Seattle, WA, USA
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22
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Vermunt NP, Harmsen M, Elwyn G, Westert GP, Burgers JS, Olde Rikkert MG, Faber MJ. A three-goal model for patients with multimorbidity: A qualitative approach. Health Expect 2017; 21:528-538. [PMID: 29193557 PMCID: PMC5867317 DOI: 10.1111/hex.12647] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/14/2017] [Indexed: 02/06/2023] Open
Abstract
Background To meet the challenge of multimorbidity in decision making, a switch from a disease‐oriented to a goal‐oriented approach could be beneficial for patients and clinicians. More insight about the concept and the implementation of this approach in clinical practice is needed. Objective This study aimed to develop conceptual descriptions of goal‐oriented care by examining the perspectives of general practitioners (GPs) and clinical geriatricians (CGs), and how the concept relates to collaborative communication and shared decision making with elderly patients with multimorbidity. Method Qualitative interviews with GPs and CGs were conducted and analyzed using thematic analysis. Results Clinicians distinguished disease‐ or symptom‐specific goals, functional goals and a new type of goals, which we labelled as fundamental goals. “Fundamental goals” are goals specifying patient's priorities in life, related to their values and core relationships. These fundamental goals can be considered implicitly or explicitly in decision making or can be ignored. Reasons to explicate goals are the potential mismatch between medical standards and patient preferences and the need to know individual patient values in case of multimorbidity, including the management in acute situations. Conclusion Based on the perspectives of clinicians, we expanded the concept of goal‐oriented care by identifying a three‐level goal hierarchy. This model could facilitate collaborative goal‐setting for patients with multiple long‐term conditions in clinical practice. Future research is needed to refine and validate this model and to provide specific guidance for medical training and practice.
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Affiliation(s)
- Neeltje P Vermunt
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,The Dutch Council for Health and Society (Raad voor Volksgezondheid en Samenleving, RVS), The Hague, The Netherlands
| | - Mirjam Harmsen
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Glyn Elwyn
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands.,The Dartmouth Institute for Health Policy & Clinical Practice, Lebanon, NH, USA.,Cochrane Institute for Primary Care and Public Health, Cardiff University, Cardiff, UK
| | - Gert P Westert
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jako S Burgers
- Family Medicine Department, School for Public Health and Primary Care (CAPHRI), Maastricht University, Maastricht, The Netherlands.,Dutch College of General Practitioners, Utrecht, The Netherlands
| | - Marcel G Olde Rikkert
- Radboud University Medical Center/Radboudumc Alzheimer Center, Nijmegen, The Netherlands
| | - Marjan J Faber
- Scientific Center for Quality of Healthcare (IQ healthcare), Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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Berry ABL, Lim C, Hartzler AL, Hirsch T, Ludman E, Wagner EH, Ralston JD. Creating Conditions for Patients' Values to Emerge in Clinical Conversations: Perspectives of Health Care Team Members. DIS. DESIGNING INTERACTIVE SYSTEMS (CONFERENCE) 2017; 2017:1165-1174. [PMID: 28890950 PMCID: PMC5589444 DOI: 10.1145/3064663.3064669] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Eliciting, understanding, and honoring patients' values- the things most important to them in daily life-is a cornerstone of patient-centered care. However, this rarely occurs explicitly as a routine part of clinical practice. This is particularly problematic for individuals with multiple chronic conditions (MCC) because they face difficult choices about how to balance competing demands for self-care in accordance with their values. In this study, we sought to inform the design of interventions to support conversations about patient values between patients with MCC and their health care providers. We conducted a field study that included observations of 21 clinic visits for patients who have MCC, and interviews with 16 care team members involved in those visits. This paper contributes a practice-based account of ways in which providers engage with patient values, and discusses how future work in interactive systems design might extend and enrich these engagements.
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Affiliation(s)
| | - Catherine Lim
- Kaiser Permanente Washington Health, Research Institute, Seattle, WA USA
| | - Andrea L Hartzler
- Kaiser Permanente Washington Health, Research Institute, Seattle, WA USA
| | - Tad Hirsch
- University of Washington, Seattle, WA USA
| | - Evette Ludman
- Kaiser Permanente Washington Health, Research Institute, Seattle, WA USA
| | - Edward H Wagner
- Kaiser Permanente Washington Health, Research Institute, Seattle, WA USA
| | - James D Ralston
- Kaiser Permanente Washington Health, Research Institute, Seattle, WA USA
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Schulc E, Gothe RM, Them C, Tufan İ, Mueller G. Self-Reported Questionnaire of Functional Health of Home-Dwelling Elderly People Living in Austria: Based on the Patient Questionnaire of the Standardized Assessment of Elderly People in Primary Care. J Nurs Meas 2017; 25:238-256. [DOI: 10.1891/1061-3749.25.2.238] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Aim: The aim was to review the construct validity and reliability of a functional health assessment questionnaire (Questionnaire on Functional Health 2 [Q-FH2]). Methods: The Q-FH2 was used to assess 344 elderly people in a home setting. A polychoric correlation matrix was applied to conduct a principal axis factor analysis with oblique rotation. The number of factors was determined using various procedures and calculated using theta coefficients to estimate ordinal reliability. Results: The exploratory factor analysis supported a 4-factor solution with an explained total variance of 82%. The internal consistency showed θ coefficients ranging from 0.758 to 0.854. Conclusion: The Q-FH2 appears to be a useful instrument to assess the multidimensionality of functional health as defined by the International Classification of Functioning, Disability and Health to determine the resources and deficits regarding the independent living of older adults and to derive appropriate consulting measures.
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Neuner-Jehle S, Zechmann S, Grundmann Maissen D, Rosemann T, Senn O. Patient-provider concordance in the perception of illness and disease: a cross-sectional study among multimorbid patients and their general practitioners in Switzerland. Patient Prefer Adherence 2017; 11:1451-1458. [PMID: 28860728 PMCID: PMC5572955 DOI: 10.2147/ppa.s137388] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Multiple chronic health conditions are leading to multiple treatment procedures and polypharmacy. Prioritizing treatment according to patients' needs and preferences may be helpful for deprescribing. Thus, for improving health care, it is crucial for general practitioners (GPs) to perceive the chief complaints (CCs) of patients. The primary aim of this study was to investigate the patient-provider concordance of CCs and the secondary aim was to investigate the concordance between CCs and diagnosis, in a sample of Swiss multimorbid patients. MATERIALS AND METHODS A cross-sectional analysis based on a cluster randomized controlled trial (RCT) among 46 GPs, recruited between March 2015 to July 2016, and 334 multimorbid patients (≥60 years taking ≥5 drugs for at least 6 months) in Northern Switzerland was performed. CCs listed by GPs and by patients (n=128) were classified according to the International Classification of Primary Care, version 2 (ICPC-2) coding system on chapter and component level and defined as concordant if ICPC-2 codes of patients and GPs were identical. Concordance was classified into full, moderate or low, depending on the ranking of patients' CCs on GPs' list. As secondary outcome, we compared patients' CCs to GPs' diagnosis. Statistics included descriptive measures and a multivariate regression analysis of factors that are modifying concordance. RESULTS The mean age of patients was 76.9 (SD 8.1) years, where 38% were male, taking 7.9 (SD 2.6) drugs on the long term. The most frequent complaint was pain. Concordance of the CC was given in 101/128 (78.9%) on the ICPC-2 chapter level, whereby 86/128 (67.2%) showed full, 8/128 (6.3%) moderate and 7/128 (5.5%) low concordance; 27/128 (21.1%) were discordant. Concordance between CCs and diagnosis was 53.6%. Concordance increased with the intensity of the CC rated by patients (OR 1.48, CI 1.13-1.94, P<0.001). The younger age and higher intake of drugs were significantly associated with an increased concordance between CCs and diagnosis. CONCLUSION A majority of GPs perceive the CCs of the multimorbid patients correctly, but there is room for improvement.
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Affiliation(s)
- Stefan Neuner-Jehle
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
- Correspondence: Stefan Neuner-Jehle, Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, 8091 Zurich, Switzerland, Tel +41 44 255 9855, Fax +41 44 255 9097, Email
| | - Stefan Zechmann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | | | - Thomas Rosemann
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
| | - Oliver Senn
- Institute of Primary Care, University of Zurich, Zurich, Switzerland
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Wittink MN, Yilmaz S, Walsh P, Chapman B, Duberstein P. Customized Care: An intervention to Improve Communication and health outcomes in multimorbidity. Contemp Clin Trials Commun 2016; 4:214-221. [PMID: 28191546 PMCID: PMC5298860 DOI: 10.1016/j.conctc.2016.10.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Marsha N. Wittink
- Department of Psychiatry, University of Rochester Medical Center, United States
- Department of Family Medicine, University of Rochester Medical Center, United States
- Corresponding author. Department of Psychiatry, University of Rochester School of Medicine, Rochester, NY, 14642, United States.
| | - Sule Yilmaz
- Warner School for Education, University of Rochester, United States
| | - Patrick Walsh
- Department of Psychiatry, University of Rochester Medical Center, United States
- Department of Public Health Sciences, University of Rochester Medical Center, United States
| | - Ben Chapman
- Department of Psychiatry, University of Rochester Medical Center, United States
- Department of Public Health Sciences, University of Rochester Medical Center, United States
| | - Paul Duberstein
- Department of Psychiatry, University of Rochester Medical Center, United States
- Department of Family Medicine, University of Rochester Medical Center, United States
- Department of Medicine, University of Rochester Medical Center, United States
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Are care plans suitable for the management of multiple conditions? JOURNAL OF COMORBIDITY 2016; 6:103-113. [PMID: 29090181 PMCID: PMC5556452 DOI: 10.15256/joc.2016.6.79] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Accepted: 10/03/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Care plans have been part of the primary care landscape in Australia for almost two decades. With an increasing number of patients presenting with multiple chronic conditions, it is timely to consider whether care plans meet the needs of patients and clinicians. OBJECTIVES To review and benchmark existing care plan templates that include recommendations for comorbid conditions, against four key criteria: (i) patient preferences, (ii) setting priorities, (iii) identifying conflicts and synergies between conditions, and (iv) setting dates for reviewing the care plan. DESIGN Document analysis of Australian care plan templates published from 2006 to 2014 that incorporated recommendations for managing comorbid conditions in primary care. RESULTS Sixteen templates were reviewed. All of the care plan templates addressed patient preference, but this was not done comprehensively. Only three templates included setting priorities. None assisted in identifying conflicts and synergies between conditions. Fifteen templates included setting a date for reviewing the care plan. CONCLUSIONS Care plans are a well-used tool in primary care practice, but their current format perpetuates a single-disease approach to care, which works contrary to their intended purpose. Restructuring care plans to incorporate shared decision-making and attention to patient preferences may assist in shifting the focus back to the patient and their care needs.
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Priority topics for European multidisciplinary guidelines on the management of chronic kidney disease in older adults. Int Urol Nephrol 2016; 48:859-69. [DOI: 10.1007/s11255-016-1257-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2015] [Accepted: 02/26/2016] [Indexed: 12/16/2022]
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Afshar K, Bokhof B, Wiese B, Dierks ML, Junius-Walker U. [Patients' need for consultation after a geriatric assessment in family practice : Survey]. Z Gerontol Geriatr 2015; 49:632-638. [PMID: 26419481 DOI: 10.1007/s00391-015-0956-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 08/26/2015] [Accepted: 09/02/2015] [Indexed: 11/24/2022]
Abstract
BACKGROUND During a doctor-patient consultation patients usually seek information by disclosing their reasons for requesting the encounter. Geriatric assessment allows a proactive examination of patients' overall health and function and provides an opportunity to broach issues beyond the initial purposes of the consultation. OBJECTIVES The study aimed at investigating older patients' information seeking behavior following a geriatric assessment and the kind of topics they wished to discuss, taking a variety of patient and health-related factors into account. MATERIAL AND METHODS A total of 317 patients (≥ 70 years) underwent a geriatric assessment in 40 general practices. Subsequently they obtained a list of the problems uncovered and rated the relevance and information needs for each problem. Analyses consisted of determining the prevalence of information need for each health topic and identifying predictors in a mixed model (multilevel regression analysis). RESULTS The 317 patients presented with a median of 11 health problems (interquartile range, IQR 8-14) and 80 % of the patients had information needs concerning only a few of the problems. High information needs were present for physical complaints and for vaccination issues. Little information seeking behavior was evident for unhealthy lifestyles, falls, limitations in daily activities and psychosocial problems. In the mixed model the personal relevance and the type of health problem both had a significant and independent effect on information seeking behavior. CONCLUSION A geriatric assessment generates a moderate need for information. It provides physicians with an opportunity to focus on those health problems that are important to older patients but not usually addressed in normal consultations. This particularly applies to limitations in daily activities and psychosocial problems.
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Affiliation(s)
- Kambiz Afshar
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland.
| | - Beate Bokhof
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Birgitt Wiese
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
| | - Marie-Luise Dierks
- Institut für Epidemiologie, Sozialmedizin und Gesundheitssystemforschung, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - Ulrike Junius-Walker
- Institut für Allgemeinmedizin, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland
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Hansen H, Pohontsch N, van den Bussche H, Scherer M, Schäfer I. Reasons for disagreement regarding illnesses between older patients with multimorbidity and their GPs - a qualitative study. BMC FAMILY PRACTICE 2015; 16:68. [PMID: 26032949 PMCID: PMC4450605 DOI: 10.1186/s12875-015-0286-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/22/2015] [Indexed: 11/16/2022]
Abstract
Background Chronic conditions are the most common themes in doctor-patient communication, especially for older patients with multimorbidity and their GPs. Former quantitative studies identified a variety of socio-demographic and health-related factors which were associated with the (dis-)agreement between medical records and patient self-reported diseases. The aim of this qualitative study was to identify reasons for disagreement regarding illnesses between patients and their GPs. Methods We conducted three focus groups with GPs (n = 15) and three focus groups with multimorbid patients aged 65 to 85 (n = 21). The participants were recruited from the MultiCare Cohort Study. Focus groups were audiotaped and transcribed verbatim. The transcripts of the focus groups were analysed using the qualitative content analysis according to Mayring. Categories were determined deductively and inductively. Results The analysis revealed seven themes concerning reasons for disagreement regarding illnesses between patients and their GPs: problems with communication and cooperation between health care professionals, disease management by the GP and the patient, the documentation behaviour of the GP, communication challenges between GP and patient, differences in the understanding of a disease between GP and patient, the prioritization and rating of diseases by GP and patient and obliviousness, repression and avoidance by the patient. Conclusions For older patients with multimorbidity, our study demonstrated that there is a need to enhance the cooperation between GPs, specialists and outpatient care, a demand to improve doctor-patient communication and a need for interventions to increase patients’ knowledge of diseases. Electronic supplementary material The online version of this article (doi:10.1186/s12875-015-0286-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Heike Hansen
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Nadine Pohontsch
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Hendrik van den Bussche
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Martin Scherer
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
| | - Ingmar Schäfer
- Department of Primary Medical Care, Center of Psychosocial Medicine, University Medical Center Hamburg-Eppendorf, Martinistrasse 52, 20246, Hamburg, Germany.
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Waller A, Carey M, Mazza D, Yoong S, Grady A, Sanson-Fisher R. Patient-reported areas for quality improvement in general practice: a cross-sectional survey. Br J Gen Pract 2015; 65:e312-8. [PMID: 25918336 PMCID: PMC4408502 DOI: 10.3399/bjgp15x684841] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Accepted: 02/02/2015] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND GPs are often a patient's first point of contact with the health system. The increasing demands imposed on GPs may have an impact on the quality of care delivered. Patients are well placed to make judgements about aspects of care that need to be improved. AIM To determine whether general practice patients perceive that the care they receive is 'patient-centred' across eight domains of care, and to determine the association between sociodemographic, GP and practice characteristics, detection of preventive health risks, and receipt of patient-centred care. DESIGN AND SETTING Cross-sectional survey of patients attending Australian general practice clinics. METHOD Patients completed a touchscreen survey in the waiting room to rate the care received from their GP across eight domains of patient-centred care. Patients also completed the Patient Health Questionnaire (PHQ-9) and self-reported health risk factors. GPs completed a checklist for each patient asking about the presence of health risk factors. RESULTS In total 1486 patients and 51 GPs participated. Overall, 83% of patients perceived that the care they received was patient-centred across all eight domains. Patients most frequently perceived the 'access to health care when needed' domain as requiring improvement (8.3%). Not having private health insurance and attending a practice located in a disadvantaged area were significantly associated with perceived need for improvements in care (P<0.05). CONCLUSION Patients in general practice report that accessibility is an aspect of care that could be improved. Further investigation of how indicators of lower socioeconomic status interact with the provision of patient-centred care and health outcomes is required.
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Affiliation(s)
- Amy Waller
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Mariko Carey
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Danielle Mazza
- Department of General Practice, School of Primary Health Care, Monash University, Victoria, Australia
| | - Serene Yoong
- Population Health, Hunter New England Local Health District, Newcastle, New South Wales, Australia
| | - Alice Grady
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
| | - Rob Sanson-Fisher
- Health Behaviour Research Group, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
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Collis D, Waterfield J. The understanding of pain by older adults who consider themselves to have aged successfully. Musculoskeletal Care 2015; 13:19-30. [PMID: 25470469 DOI: 10.1002/msc.1083] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2014] [Indexed: 06/04/2023]
Abstract
OBJECTIVES Despite an ageing population and an increased prevalence of chronic pain, the relationship between chronic pain and the concept of successful ageing is unclear. The aim of the present research was to explore older people's views on past and present experiences of pain, and its management, and how these experiences relate to their perceptions of successful ageing. METHODS Semi-structured interviews with six participants, aged 75 years or older, who considered themselves to have aged successfully, explored what this concept meant to them and their experiences of pain. Data analysis used methods drawn from grounded theory. The themes reported in this article are 'understanding of pain' and 'perceptions of ageing'. RESULTS None of the participants recalled painful experiences that were not attributable to physical trauma. They believed that pain is part of life and a natural consequence of the ageing process. While some accepted this with little resistance, others felt frustration at what they considered a dismissive attitude towards older people experiencing pain from healthcare practitioners. The concept of successful ageing was previously unfamiliar to participants, and their conceptualization of ageing derived from comparing themselves with their peers. CONCLUSIONS The findings of the present study suggest that predictable experiences of pain as one ages may contribute to an acceptance of pain as a biomedical certainty, a belief reinforced both by health professionals and society. However, one may have chronic pain and yet consider oneself to have aged successfully, and it should therefore be recognized that there is a distinction between having pain and having a problem with pain.
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Affiliation(s)
- David Collis
- Mid-Derbyshire Association of Mobile Physiotherapy, Ashbourne, Derbyshire, UK
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Barkhausen T, Junius-Walker U, Hummers-Pradier E, Mueller CA, Theile G. "It's MAGIC"--development of a manageable geriatric assessment for general practice use. BMC FAMILY PRACTICE 2015; 16:4. [PMID: 25608946 PMCID: PMC4320637 DOI: 10.1186/s12875-014-0215-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 12/15/2014] [Indexed: 11/10/2022]
Abstract
Background Geriatric assessments are established tools in institutional care since they enable standardized detection of relevant age-related disorders. Geriatric assessments could also be helpful in general practice. However, they are infrequently used in this setting, mainly due to their lengthy administration. The aim of the study was the development of a “manageable geriatric assessment – MAGIC”, specially tailored to the requirements of daily primary care. Methods MAGIC was developed based on the comprehensive Standardized Assessment for Elderly People in Primary Care (STEP), using four different methodological approaches: We relied on A) the results of the PRISCUS study by assessing the prevalence of health problems uncovered by STEP, the importance of the respective problems rated by patients and general practitioners, as well as the treatment procedures initiated subsequently to the assessment. Moreover, we included findings of B) a literature analysis C) a review of the STEP assessment by experienced general practitioners and D) focus groups with general practitioners. Results The newly created MAGIC assessment consists of 9 items and covers typical geriatric health problems and syndromes: function, falls, incontinence, cognitive impairment, impaired ears and eyes, vaccine coverage, emotional instability and isolation. Conclusions MAGIC promises to be a helpful screening instrument in primary care consultations involving elderly multimorbid patients. Applicable within a minimum of time it still covers health problems highly relevant with regard to a potential loss of autonomy. Feasibility will be tested in the context of a large, still ongoing randomized controlled trial on “reduction of potentially inadequate medication in elderly patients” (RIME study; DRKS-ID: DRKS00003610) in general practice.
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Affiliation(s)
- Tanja Barkhausen
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Ulrike Junius-Walker
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany.
| | - Eva Hummers-Pradier
- Department of General Practice, University Medical Centre Goettingen, Humboldtallee 38, 37073, Goettingen, Germany.
| | - Christiane A Mueller
- Department of General Practice, University Medical Centre Goettingen, Humboldtallee 38, 37073, Goettingen, Germany.
| | - Gudrun Theile
- Institute for General Practice, Hannover Medical School, Carl-Neuberg-Strasse 1, 30625, Hannover, Germany. .,Santémed Health Center, Seebahnstrasse 89, 8036, Zuerich-Wiedikon, Switzerland.
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Witt RR, Roos MDO, Carvalho NM, Silva AMD, Rodrigues CDS, Santos MTD. Professional competencies in primary health care for attending to older adults. Rev Esc Enferm USP 2014; 48:1020-5. [DOI: 10.1590/s0080-623420140000700009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2014] [Accepted: 08/26/2014] [Indexed: 11/22/2022] Open
Abstract
Objective To identify and analyze the necessary competencies in primary health care for attending to older adults. Method An exploratory, descriptive, and quali-quantitative study was developed. Three rounds of the Delphi Technique were conducted with participants from primary health care services and a multidisciplinary committee. The first questionnaire asked participants to indicate the competencies needed for attending to older adults in primary health care. They were compiled into a list and added to a Likert Scale (from 1 to 5) for the second and third questionnaires. A consensus criterion of 70% was adopted. Results Twenty eight competencies were reached by consensus and were classified into twelve domains. Conclusion The competencies reflect Brazilian health care policy and constitute a reference for professional health practice and education when caring for the older adult in primary health care.
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Cheraghi-Sohi S, Morden A, Bower P, Kennedy A, Rogers A, Richardson J, Sanders T, Stevenson F, Ong BN. Exploring patient priorities among long-term conditions in multimorbidity: A qualitative secondary analysis. SAGE Open Med 2013; 1:2050312113503955. [PMID: 26770680 PMCID: PMC4687770 DOI: 10.1177/2050312113503955] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE A lack of agreement between health-care providers and patient priorities can impact the health-care provider-patient relationship, treatment concordance and potentially health outcomes. Evidence suggests that people living with multiple morbidities do prioritise among their long-term conditions. However, the evidence revealing the underlying reasons behind this prioritisation remains limited. Given the potential implications for day-to-day self-management activity and ultimately patient outcomes, this study aims to explore how and why people with multimorbidity prioritise some long-term conditions over others and what the potential implications may be for self-management activity, and in turn, suggest how such information may help clinicians negotiate the management of multimorbidity patients. METHODS A secondary analysis of qualitative data was conducted utilising four existing data sets collated from the three research centres involved. Purposive sampling provided a sample of 41 participants who had multimorbidity. The research team collectively coded and analysed the data thematically. RESULTS All participants, except two, identified one 'main' priority long-term condition. Current priorities were arrived at by participants making comparisons between their long-term conditions, specifically by trading off the various attributes, impacts and perceived consequences of their individual long-term conditions. Two main themes emerged as to why participants identified a particular main long-term condition: (a) proximate issues surrounding barriers to functional health and (b) prioritisation of long-term conditions perceived to have a particular future risk. CONCLUSIONS The recent focus on multimorbidity within the medical literature reflects its prevalence. It is therefore important to understand the complexities of the multimorbidity illness experience. We have added to the limited literature on condition prioritisation by revealing some novel understandings of the process of condition prioritisation which can feed into patient-provider consultations in order to allow better communication and treatment planning as well as, ultimately, optimise patient outcomes.
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Affiliation(s)
- Sudeh Cheraghi-Sohi
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Andrew Morden
- Arthritis Research UK, Primary Care Centre, Keele University, Staffordshire, UK
| | - Peter Bower
- NIHR School for Primary Care Research, Manchester Academic Health Science Centre, The University of Manchester, Manchester, UK
| | - Anne Kennedy
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Anne Rogers
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Jane Richardson
- Arthritis Research UK, Primary Care Centre, Keele University, Staffordshire, UK
| | - Tom Sanders
- Arthritis Research UK, Primary Care Centre, Keele University, Staffordshire, UK
| | - Fiona Stevenson
- Research Department of Primary Care and Population Health, University College London, London, UK
| | - Bie N Ong
- Arthritis Research UK, Primary Care Centre, Keele University, Staffordshire, UK
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Priorities of Health Care Outcomes for the Elderly. J Am Med Dir Assoc 2013; 14:479-84. [DOI: 10.1016/j.jamda.2013.01.009] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Accepted: 01/15/2013] [Indexed: 11/17/2022]
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Patient Priorities in Osteoarthritis and Comorbid Conditions: A Secondary Analysis of Qualitative Data. Arthritis Care Res (Hoboken) 2013. [DOI: 10.1002/acr.21897] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
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Frese T, Hein S, Sandholzer H. Feasibility, understandability, and usefulness of the STEP self-rating questionnaire: results of a cross-sectional study. Clin Interv Aging 2013; 8:515-21. [PMID: 23671388 PMCID: PMC3649857 DOI: 10.2147/cia.s41826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
The study was designed to evaluate the acceptance of the self-rated version of the Standardized Assessment of Elderly People in primary care in Europe (STEP) by patients and general practitioners, as well as the feasibility, comprehensibility, and usefulness in gaining new information. In all, 1007 of 1540 patients aged 65 and above, from 28 different Saxon general practices took part. We recognized that 96% of the patients were able to fill in the questionnaire by themselves. It took them an average of approximately 20 minutes to do so. Further analysis of 257 randomly selected patients identified 281 previously unknown problems (1.1 per patient). In the practitioners' opinion, 16% of these problems, particularly physiological and mental ones, could lead to immediate consequences. Remarkably, newly identified psychosocial problems were not followed by any consequences. Fourteen of the 75 questionnaire items were not answered by more than 9% of the participants. Eight of the 14 frequently unanswered items were marked as difficult to understand by the patients. Altogether the self-rating version of the STEP was found to be feasible and useful. It was well accepted among patients; however, some questions need further review to improve their comprehensibility. Furthermore, it should be investigated why some identified problems do not have consequences and whether there is a need to record these issues at all.
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Affiliation(s)
- Thomas Frese
- Department of Primary Care of the Leipzig Medical School, Leipzig, Germany.
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Abstract
BACKGROUND In Sweden three key criteria are used for priority setting: severity of the health condition; patient benefit; and cost-effectiveness. They are derived from the ethical principles established by the Swedish parliament 1997 but have been used only to a limited extent in primary care. The aim of this study was to describe and analyse: 1) GPs', nurses', and patients' prioritising in routine primary care 2) The association between the three key priority setting criteria and the overall priority assigned by the GPs and nurses to individual patients. METHODS Paired questionnaires were distributed to all patients and the GPs or nurses they had contact with during a 2-week period at four health centres in Sweden. The staff registered the health conditions or health problem, and the planned intervention. Then they estimated the severity of the health condition, the expected patient benefit, and the cost-effectiveness of the planned intervention. Both the staff and the patients reported their overall prioritisation of the patient. In total, 1851 paired questionnaires were collected. RESULTS Compared to the medical staff, the patients assigned relatively higher priority to acute/minor conditions than to preventive check-ups for chronic conditions. Severity of the health condition was the priority setting criterion that had the strongest association with the overall priority for the staff as a whole, but for the GPs it was cost-effectiveness. CONCLUSIONS The challenge for primary care providers is to balance the patients' demands with medical needs and cost-effectiveness. Transparent priority setting in primary care might contribute to a greater consensus between GPs and nurses on how to use the key priority setting criteria.
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