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Koehn S, Jones CA, Barber C, Jasper L, Pham A, Lindeman C, Drummond N. Candidacy 2.0 (CC) - an enhanced theory of access to healthcare for chronic conditions: lessons from a critical interpretive synthesis on access to rheumatoid arthritis care. BMC Health Serv Res 2024; 24:986. [PMID: 39187885 PMCID: PMC11348652 DOI: 10.1186/s12913-024-11438-6] [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: 12/01/2023] [Accepted: 08/14/2024] [Indexed: 08/28/2024] Open
Abstract
BACKGROUND The Dixon-Woods et al. Candidacy Framework, a valuable tool since its 2006 introduction, has been widely utilized to analyze access to various services in diverse contexts, including healthcare. This social constructionist approach examines micro, meso, and macro influences on access, offering concrete explanations for access challenges rooted in socially patterned influences. This study employed the Candidacy Framework to explore the experiences of individuals living with rheumatoid arthritis (RA) and their formal care providers. The investigation extended to assessing supports and innovations in RA diagnosis and management, particularly in primary care. METHODS This systematic review is a Critical Interpretive Synthesis (CIS) of qualitative and mixed methods literature. The CIS aimed to generate theory from identified constructs across the reviewed literature. The study found alignment between the seven dimensions of the Candidacy Framework and key themes emerging from the data. Notably absent from the framework was an eighth dimension, identified as the "embodied relational self." This dimension, central to the model, prompted the proposal of a revised framework specific to healthcare for chronic conditions. RESULTS The CIS revealed that the eight dimensions, including the embodied relational self, provided a comprehensive understanding of the experiences and perspectives of individuals with RA and their care providers. The proposed Candidacy 2.0 (Chronic Condition (CC)) model demonstrated how integrating approaches like Intersectionality, concordance, and recursivity enhanced the framework when the embodied self was central. CONCLUSIONS The study concludes that while the original Candidacy Framework serves as a robust foundation, a revised version, Candidacy 2.0 (CC), is warranted for chronic conditions. The addition of the embodied relational self dimension enriches the model, accommodating the complexities of accessing healthcare for chronic conditions. TRIAL REGISTRATION This study did not involve a health care intervention on human participants, and as such, trial registration is not applicable. However, our review is registered with the Open Science Framework at https://doi.org/10.17605/OSF.IO/ASX5C .
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Affiliation(s)
- Sharon Koehn
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Claire Barber
- Division of Rheumatology, Cumming School of Medicine, Health Sciences Center, University of Calgary, Room #B130Z 3300, Hospital Drive NW, Calgary, AB, T2N 4N1, Canada
| | - Lisa Jasper
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - Anh Pham
- Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 Street, 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - Cliff Lindeman
- Prescribing, Analytics & Tracked Prescription Program Alberta, College of Physicians & Surgeons, 2700 - 10020 100 Street NW, Edmonton, AB, T5J 0N3, Canada
| | - Neil Drummond
- Faculty of Medicine and Dentistry - Family Medicine Department, University of Alberta, 6- 10L4 University Terrace, 8303 - 112 Street NW, Edmonton, AB, T6G 2T4, Canada
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Khadour FA, Khadour YA, Ebrahem BM. A qualitative survey on factors affecting depression and anxiety in patients with rheumatoid arthritis: a cross-sectional study in Syria. Sci Rep 2024; 14:11513. [PMID: 38769092 PMCID: PMC11106252 DOI: 10.1038/s41598-024-61523-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 05/07/2024] [Indexed: 05/22/2024] Open
Abstract
Depression and anxiety often coexist with rheumatoid arthritis (RA) and affect the course of the disease. These mental health conditions can be overlooked or underdiagnosed in people with RA. There is conflicting evidence in previous studies regarding this topic, indicating that further research is necessary to provide a thorough understanding of the relationship between anxiety, depression, and RA. This study aims to determine the factors correlated with depression and anxiety symptoms in RA patients by evaluating disease activity at the same time. This cross-sectional study was conducted at four outpatient rehabilitation centers in four Syrian provinces: Damascus, Homs, Hama, and Latakia. The study included RA patients who attended the RA department of rehabilitation centers from January 1 to June 31, 2023. RA patients who presented at a rheumatology clinic were selected consecutively. RA patients were included in the study in accordance with the ACR/EULAR classification criteria, disease activity was assessed by disease activity score based on the 28-joint count (DAS28), and patients with DAS28 > 2.6 were considered to have active RA. The demographic data, as well as disease duration, educational status, Disease Activity Score with 28-joint counts (DAS28), health assessment questionnaire (HAQ) score, and the hospital anxiety and depression scale (HADS), were the parameters used in the analysis. Two hundred and twelve patients (female, 75%) with a mean age of 49.3 ± 13.1 years and a mean disease duration of 8.3 ± 6.9 years were studied. Depression was diagnosed in 79 (37.3%) patients and anxiety in 36 (16.9%) patients. Patients with depression and/or anxiety had higher HAQ and DAS28 scores compared to other RA patients. Blue-collar workers exhibited a higher prevalence of anxiety, whereas females, housewives, and individuals with lower educational attainment demonstrated a higher prevalence of depression. The current study found high rates of anxiety and depression in RA patients, highlighting the significant burden of these mental health conditions compared to the general population. It is essential for healthcare providers not to overlook the importance of psychiatric evaluations, mental health assessments, and physical examinations of RA patients.
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Affiliation(s)
- Fater A Khadour
- Department of Rehabilitation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China.
| | - Younes A Khadour
- Department of Physical Therapy, Cairo University, Cairo, 11835, Egypt
| | - Bashar M Ebrahem
- Department of Rehabilitation, Faculty of Medicine, Al Baath University, Homs, Syria
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Tunks A, Berry C, Strauss C, Nyikavaranda P, Ford E. Patients' perspectives of barriers and facilitators to accessing support through primary care for common mental health problems in England: A systematic review. J Affect Disord 2023; 338:329-340. [PMID: 37348656 DOI: 10.1016/j.jad.2023.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/16/2023] [Accepted: 06/17/2023] [Indexed: 06/24/2023]
Abstract
BACKGROUND Common mental disorders (CMDs) are prevalent throughout the population. Psychological therapy is often sought via primary care; however, equitable access is not commonplace. This review aims to investigate the barriers and facilitators adults experiencing CMDs perceive when accessing evidence-based psychological treatment in England. METHODS A qualitative systematic review with meta-synthesis was conducted (PROSPERO CRD42020227039). Seven electronic databases were searched for papers from 2008 to October 2022. RESULTS Searches identified 30 studies from which three themes were developed with seven subthemes. Stigma and patients' perceptions and understandings of CMDs impacted their help-seeking decision-making and engagement with services. This meant that services were not used as a first resort for help-seeking. Upon reaching services, patients appeared to perceive primary care as not prioritising mental health problems, nor as being the place where they would be supported, particularly as healthcare professionals did not appear to know about CMDs and therapy was seen as difficult to access. The interaction between healthcare professional and patients was seen as pivotal to whether patients accessed support or not. LIMITATIONS The review is limited to research conducted within England. Additionally, it only explores access barriers prior to treatment experiences. CONCLUSION Knowledge, attitudinal, systemic and relational barriers and facilitators were identified. Future research should focus on developing stigma reduction initiatives. Clinical implications include provision of standardised training across primary care HCP (healthcare professionals).
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Affiliation(s)
- Alice Tunks
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Clio Berry
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Clara Strauss
- School of Psychology, University of Sussex, United Kingdom; Sussex Partnership NHS Foundation Trust, United Kingdom.
| | - Patrick Nyikavaranda
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
| | - Elizabeth Ford
- Primary Care and Public Health Department, Brighton and Sussex Medical School, United Kingdom.
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Islam ST, Descallar J, Martens D, Hassett G, Gibson KA. Screening for Anxiety in Patients With Inflammatory Arthritis Using the Multidimensional Health Assessment Questionnaire. J Rheumatol 2023; 50:1273-1278. [PMID: 37399467 DOI: 10.3899/jrheum.2022-1261] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/06/2023] [Indexed: 07/05/2023]
Abstract
OBJECTIVE To analyze the Multidimensional Health Assessment Questionnaire (MDHAQ) in screening for anxiety in patients with rheumatoid arthritis (RA) and psoriatic arthritis (PsA), compared to the Hospital Anxiety and Depression Scale (HADS) as the reference standard. METHODS Patients with a physician diagnosis of RA or PsA were invited to complete the MDHAQ and HADS at their routine rheumatology clinic visit. Sensitivity, specificity, percent agreement, and [Formula: see text] statistics were used to evaluate agreement between 2 MDHAQ items for anxiety and HADS subscale for Anxiety (HADS-A) score of ≥ 8. The first item is a question asked on a 4-point scale (0-3.3), and the second is a yes or no (blank) question asked within a 60-item review of symptoms (ROS) checklist. RESULTS The study included 183 participants, of whom 126 (68.9%) had RA and 57 (31.1%) had PsA. The mean age was 57.3 years and 66.7% were female. Positive screening for anxiety according to a HADS-A score of ≥ 8 was seen in 39.3% of patients. Compared to those with a HADS-A score of ≥ 8, patients with an MDHAQ score of ≥ 2.2 or a positive on ROS had a sensitivity of 69.9%, specificity of 73.6% and substantial agreement (agreement 80.9%, [Formula: see text] 0.59). CONCLUSION The MDHAQ provides information similar to the HADS in screening for anxiety in patients with RA and PsA. The use of this single questionnaire, which can also be used to monitor clinical status and to screen for fibromyalgia and depression without requiring multiple questionnaires, may prove a valuable tool in routine clinical practice.
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Affiliation(s)
- Sadia Tasnim Islam
- S.T. Islam, MD, Department of Rheumatology, Liverpool Hospital, Liverpool;
| | - Joseph Descallar
- J. Descallar, MBiostat, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, University of New South Wales (UNSW Sydney), Liverpool
| | - David Martens
- D. Martens, MBBS, Department of Rheumatology, Liverpool Hospital, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool
| | - Geraldine Hassett
- G. Hassett, PhD, K.A. Gibson, PhD, Department of Rheumatology, Liverpool Hospital, Liverpool, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool, Australia
| | - Kathryn Alleyne Gibson
- G. Hassett, PhD, K.A. Gibson, PhD, Department of Rheumatology, Liverpool Hospital, Liverpool, Ingham Institute for Applied Medical Research, Liverpool, and South West Sydney Clinical Campuses, School of Clinical Medicine, UNSW Sydney, Liverpool, Australia
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Moudi S, Heidari B, Yousefghahari B, Gholami R, Gholinia H, Babaei M. The prevalence and correlation of depression and anxiety with disease activity in rheumatoid arthritis. Reumatologia 2023; 61:86-91. [PMID: 37223374 PMCID: PMC10201383 DOI: 10.5114/reum/154905] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2022] [Accepted: 09/23/2022] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Depression and anxiety share similar symptoms with rheumatoid arthritis (RA) and these conditions are often not diagnosed or overlooked in RA. This study aimed to determine the prevalence of depression/anxiety in RA and their correlation with RA activity. MATERIAL AND METHODS Rheumatoid arthritis patients who presented at a rheumatology clinic were selected consecutively. The diagnosis of RA was confirmed by the ACR/EULAR criteria, disease activity was assessed by Disease Activity Score based on the 28-joint count (DAS28) and patients with DAS28 > 2.6 were considered to have active RA. The diagnosis of depression and anxiety was made by the Hospital Anxiety and Depression Scale (HADS). The Pearson test was used to determine the correlation between DAS28 and HADS scores. RESULTS Two-hundred patients (female, 82%) with a mean age of 53.5 ±10.1 years and mean disease duration of 6.6 ±6.8 years were studied. Depression was diagnosed in 27 (13.5%) patients and anxiety in 38 (19%) patients. The DAS28 score correlated positively with depression (r = 0.173, p = 0.014) and anxiety score (r = 0.229, p = 0.001). In multiple logistic regression analysis after adjustment for all covariates, age < 40 years and female sex were independently associated with RA activity in patients with depression, with OR = 4.21 (p = 0.002) and OR = 3.56 (p = 0.028) respectively. CONCLUSIONS These findings indicate that depression and anxiety are prevalent in RA and correlate positively with active disease in particular in depressive female patients aged < 40 years.
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Affiliation(s)
- Sousan Moudi
- Health Research Center, Master of Biostatistics and Epidemiology, Babol University of Medical Science, Iran
| | - Behzad Heidari
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Behnaz Yousefghahari
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Reza Gholami
- Student Research Committee, Babol University of Medical Sciences, Iran
| | - Hemmat Gholinia
- Clinical Research Development Unit of Rouhani, Babol University of Medical Sciences, Iran
| | - Mansour Babaei
- Clinical Research Development Unit of Rouhani Hospital, Babol University of Medical Sciences, Iran
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Bergmans RS, Loewenstein E, Aboul-Hassan D, Chowdhury T, Schaefer G, Wegryn-Jones R, Xiao LZ, Yu C, Moore MN, Kahlenberg JM. Social determinants of depression in systemic lupus erythematosus: A systematic scoping review. Lupus 2023; 32:23-41. [PMID: 36274579 PMCID: PMC9812916 DOI: 10.1177/09612033221135145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Social determinants of health (SDOH) influence inequities in systemic lupus erythematosus (SLE). While these inequities contribute to overall disease experience, there is little consensus guiding our understanding of the psychological implications of SDOH in SLE. Given the paucity of evidence in this area, the aim of this scoping review was to systematically assess the volume and features of available research literature on associations of SDOH with depression in SLE over the past 20 years, from 1 January 2000 to 16 November 2021. We developed a search strategy for PubMed and EMBASE that included keywords for depression and lupus. After screening 2188 articles, we identified 22 original articles that met our inclusion criteria. At least one SDOH was associated with depression in two of the six studies with unadjusted estimates and 13 of the 16 studies with adjusted estimates. Results provide consistent but sparse evidence that SDOH are associated with depression in SLE. Additionally, depression epidemiology in SLE may differ from the general population such that depression risk is more similar across genders and racial/ethnic groups. More work is needed to identify the SDOH that have the greatest impact on depression and mental health among SLE patients, as well as how and when to intervene.
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Affiliation(s)
- Rachel S. Bergmans
- University of Michigan, Medical School, Department of Anesthesiology, Chronic Pain & Fatigue Research Center, Ann Arbor, Michigan
| | - Emma Loewenstein
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Deena Aboul-Hassan
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Tasfia Chowdhury
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Grace Schaefer
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Riley Wegryn-Jones
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Lillian Z. Xiao
- University of Michigan, College of Pharmacy, Ann Arbor, Michigan
| | - Christine Yu
- University of Michigan, College of Literature, Science, and the Arts, Ann Arbor, Michigan
| | - Meriah N. Moore
- University of Michigan, Medical School, Department of Internal Medicine, Division of Rheumatology, Ann Arbor, Michigan
| | - J. Michelle Kahlenberg
- University of Michigan, Medical School, Department of Internal Medicine, Division of Rheumatology, Ann Arbor, Michigan
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Zhang C, Wu X, Yuan Y, Xiao H, Li E, Ke H, Yang M, Zhu X, Zhang Z. Effect of solution-focused approach on anxiety and depression in patients with rheumatoid arthritis: A quasi-experimental study. Front Psychol 2022; 13:939586. [PMID: 36582330 PMCID: PMC9792673 DOI: 10.3389/fpsyg.2022.939586] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 11/22/2022] [Indexed: 12/15/2022] Open
Abstract
Introduction Anxiety and depression are common psychological problems in rheumatoid arthritis (RA) patients. However, few effective nursing intervention models have been designed specifically to improve anxiety and depression in RA patients. Solution-focused approach (SFA) is an effective intervention method for psychosocial issues. There have been no studies involving SFA yet in RA patients. This study investigated the effects of SFA-based nursing intervention on anxiety and depression in RA patients. Methods A quasi-experimental study using a convenience sampling of RA patients was conducted. The 48 RA patients were divided into the control group (n = 24) and the experimental group (n = 24). The control group received routine nursing intervention, while the experimental group received SFA-based nursing intervention. The scores on the self-rating anxiety scale (SAS), self-rating depression scale (SDS), arthritis self-efficacy scale-8 (ASES-8), and questionnaire on patient satisfaction with nursing care were collected before and after nursing interventions. Results Between-Group Comparison: Before the nursing intervention, there was no statistically significant difference in the SDS, SAS, and ASES-8 scores between the two groups (p > 0.05). However, after the nursing intervention, the SDS and SAS scores of the experimental group were statistically significantly lower than those of the control group (p < 0.05). In contrast, the ASES-8 score of the experimental group was statistically significantly higher than that of the control group (p < 0.05). In addition, patient satisfaction with nursing care of the experimental group was better than that of the control group (p > 0.05). Within-Group Comparison: There was no statistically significant difference in the SDS, SAS, and ASES-8 scores in the control group before and after routine nursing intervention (p > 0.05). However, in the experimental group, the SDS and SAS scores before SFA-based nursing intervention were statistically significantly higher than those after SFA nursing intervention (p < 0.05), and the ASES-8 score before SFA-based nursing intervention was considerably lower than that after SFA nursing intervention (p < 0.05). Discussion SFA-based nursing intervention can effectively improve anxiety, depression, and arthritis self-efficacy of RA patients. This study broadens clinical psychological nursing intervention models for RA patients. SFA may be an effective nursing model for various psychosocial problems in the current medical context.
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Affiliation(s)
- Chunli Zhang
- Department of Nursing, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Xuehua Wu
- Department of Nursing, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Ying Yuan
- Department of Hand Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huamei Xiao
- Department of Nursing, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Erhui Li
- Department of Neonatology, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Hongyan Ke
- Department of Neurology, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Mei Yang
- Department of Endocrinology, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China
| | - Xiaodong Zhu
- Department of Oncology, Huanggang Central Hospital of Yangtze University, Huanggang, Hubei, China,Xiaodong Zhu,
| | - Zhicheng Zhang
- Department of Gastroenterology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China,*Correspondence: Zhicheng Zhang,
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Barriers and Enablers to Help-Seeking Behaviour for Mental Health Reasons Among Community Dwelling Older Adults With Anxiety: Mixed-Methods Systematic Review. JOURNAL OF AFFECTIVE DISORDERS REPORTS 2022. [DOI: 10.1016/j.jadr.2022.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Murphy L, Moore S, Swan J, Hehir D, Ryan J. Examining the impact of video-based outpatient education on patient demand for a rheumatology CNS service. BRITISH JOURNAL OF NURSING (MARK ALLEN PUBLISHING) 2021; 30:1056-1064. [PMID: 34645352 DOI: 10.12968/bjon.2021.30.18.1056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Patient demand for education and access to the clinical nurse specialists (CNSs) during the rheumatology clinic at one hospital in Ireland was increasing. Alternative methods of providing patient education had to be examined. AIMS To explore the efficacy of video-based outpatient education, and its impact on demand for the CNSs. METHODS A video was produced to play in a rheumatology outpatient department. A representative sample of 240 patients (120 non-exposed and 120 exposed to the video) attending the clinic was selected to complete a questionnaire exploring the effect of the video. Data were analysed using chi-square tests with Yates' continuity correction. FINDINGS Demand for the CNSs was six times higher in the non-exposed group compared with the exposed group (non-exposed: 25%, exposed: 4.8%) (χ2=15.7, P=0.00007), representing a significant decrease in resource demand. CONCLUSION High-quality educational videos on view in the rheumatology outpatient department provide patients with information sufficient to meet their educational needs, thus releasing CNS resources.
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Affiliation(s)
- Louise Murphy
- Advanced Nurse Practitioner in Rheumatology, Department of Rheumatology, Cork University Hospital, Ireland
| | - Stephen Moore
- Lecturer in Economics, Centre for Policy Studies, University College Cork, Ireland
| | - Joan Swan
- Clinical Nurse Specialist in Rheumatology, Department of Rheumatology, Cork University Hospital, Ireland, when this article was written and has since retired
| | - Davida Hehir
- Clinical Nurse Specialist in Rheumatology, Department of Rheumatology, Cork University Hospital, Ireland
| | - John Ryan
- Consultant Rheumatologist, Department of Rheumatology, Cork University Hospital, Ireland
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Chen SH, Yu KH, Kao YC, Shao JH. It Is Like a Puppet Show-Experiences of Rheumatoid Arthritis Among Adult Chinese: A Qualitative Study. Clin Nurs Res 2021; 31:795-802. [PMID: 34404269 DOI: 10.1177/10547738211037467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Rheumatoid arthritis results in progressive destruction of the joints. However, descriptions of patient's experiences with the disease are limited. This qualitative study aimed to explore patients' personal experiences with rheumatoid arthritis in Taiwan. Face-to-face interviews were conducted with 30 patients from January to May 2019; interview data were analyzed with content analysis. Most participants were female (90%); their mean age was 57 years. Three main categories emerged from analysis of the data: "physical suffering," "limitations of abilities," and "coexisting with the disease." Physical suffering was due to personal lifelong hardships from chronic pain and stiffness. Limitations of abilities occurred from loss of physical function and limited social life, due to participants discomfort with joint deformities and their appearance to others. Participants coexisted with the disease by making changes in their outlook and comparing their lives with others in order to gain a positive perspective.
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Affiliation(s)
- Su-Hui Chen
- Chang Gung University of Science and Technology, Taoyuan City.,Chang Gung Memorial Hospital, Taoyuan City
| | | | | | - Jung-Hua Shao
- Chang Gung Memorial Hospital, Taoyuan City.,Chang Gung University, Taoyuan City
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Bongomin F, Natukunda B, Sekimpi M, Olum R, Baluku JB, Makhoba A, Kaddumukasa M. High Prevalence of Depressive Symptoms Among Ugandan Patients with Rheumatoid Arthritis. Open Access Rheumatol 2021; 13:93-102. [PMID: 33976574 PMCID: PMC8106476 DOI: 10.2147/oarrr.s306503] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Accepted: 04/20/2021] [Indexed: 12/25/2022] Open
Abstract
Background There is a scarcity of data on the burden of depression among Ugandans with rheumatoid arthritis (RA) patients. We aimed to screen for symptoms of depression, their severity and associated factors among patients with RA in Uganda. Patients and Methods A descriptive, cross-sectional study was conducted between September and December 2020 at Mulago National Referral Hospital (MNRH) and Nsambya Hospital. Patients with RA were enrolled consecutively. Data on demographics, disease course and comorbidities and depression symptomatology were collected through an interviewer administered questionnaire. Symptoms of depression were screened for using the depression/anxiety dimension of the EuroQoL questionnaire. Results Forty-eight patients with a median age of 52 (IQR: 43.5–60.5) years were recruited in the study. The majority of the patients were female (91.7%, n=44). Twenty-nine patients (60.4%) had comorbidities with a median Charlson comorbidity score of 3 (IQR: 2–4). Overall, 70.8% (n=34) had depressive symptoms. Patients attending MNRH were more likely to have depressive symptoms (p=0.025). Significantly, patients with depressive symptoms were younger (p=0.027), had lower health index value (p<0.001), and lower overall self-reported health status (p=0.013). At binary logistic regression, patients at MNRH (crude odds ratio (COR): 4.32, 95% confidence interval (CI): 1.16–16.15, P=0.030), patients aged <52 years (COR: 5.24, 95% CI: 1.23–22.28, P=0.025) and those with mild RA (COR: 5.71, 95% CI: 1.15–28.35, P=0.033) were significantly more likely to have depressive symptoms. Increase in age (COR: 0.94, 95% CI: 0.89–0.99, P=0.025), and high visual analogue score (COR: 0.94, 95% CI: 0.89–0.99, P=0.013) were protective. Conclusion Depressive symptoms were common among RA patients in Uganda. Routine screening, diagnosis and management of depression is recommended among young patients to improve quality of life and patient outcomes.
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Affiliation(s)
- Felix Bongomin
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.,Department of Immunology and Medical Microbiology, Gulu University Medical School, Gulu, Uganda
| | - Barbra Natukunda
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Maria Sekimpi
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ronald Olum
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Joseph Baruch Baluku
- Division of Pulmonology, Mulago National Referral Hospital, Kampala, Uganda.,Directorate of Programs, Mildmay Uganda, Wakiso, Uganda
| | - Anthony Makhoba
- Department of Medicine, St. Francis's Hospital- Nsambya, Kampala, Uganda.,Department of Medicine, Mother Kevin Postgraduate Medical School, Uganda Martyrs University, Kampala, Uganda
| | - Mark Kaddumukasa
- Department of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda
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Herron D, Chew-Graham CA, Hider S, Machin A, Paskins Z, Cooke K, Desilva EE, Jinks C. Acceptability of nurse-led reviews for inflammatory rheumatological conditions: A qualitative study. JOURNAL OF COMORBIDITY 2021; 11:26335565211002402. [PMID: 33912472 PMCID: PMC8047946 DOI: 10.1177/26335565211002402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 12/24/2020] [Accepted: 02/05/2021] [Indexed: 11/17/2022]
Abstract
Background: People with inflammatory rheumatological conditions (IRCs), are at increased risk of comorbidities such as cardiovascular disease, osteoporosis, anxiety and depression. The INCLUDE pilot trial evaluated a nurse-delivered review of people with IRCs which sought to identify and initiate management of comorbid conditions. Aim: A nested qualitative study was undertaken to examine the acceptability of the INCLUDE review. Methods: A qualitative interview-based design in UK primary care settings. A purposive sample of 20 patients who attended an INCLUDE review, were interviewed. Inductive thematic analysis was undertaken. Themes were agreed through multidisciplinary team discussion and mapped onto constructs of the Theoretical Framework of Acceptability (TFA). Results: Six themes mapped onto six of the seven TFA constructs. Patients reported the review to be effective by identifying and initiating management of previously unrecognised comorbid conditions. Some participants reported barriers to following recommendations, such as lifestyle modifications or taking more medication. Conclusion: A nurse-delivered review to identify comorbidities is acceptable to patients with IRCs. The TFA provided a novel analytical lens.
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Affiliation(s)
- Daniel Herron
- School of Life Sciences and Education, Science Centre, Staffordshire University, Stoke-on-Trent, UK
| | - Carolyn A Chew-Graham
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Midlands Partnership NHS Foundation Trust, Stafford, UK
| | - Samantha Hider
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stafford, UK
| | - Annabelle Machin
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK
| | - Zoe Paskins
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stafford, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, School of Medicine, David Weatherall Building, Keele University, Keele, UK
| | - Erandie Ediriweera Desilva
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK.,Family Medicine Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Clare Jinks
- Primary Care Centre Versus Arthritis, School of Medicine, David Weatherall Building, Keele University, Keele, UK
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13
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Polidano K, Chew-Graham CA, Farmer AD, Saunders B. Access to Psychological Support for Young People Following Stoma Surgery: Exploring Patients' and Clinicians' Perspectives. QUALITATIVE HEALTH RESEARCH 2021; 31:535-549. [PMID: 33228473 PMCID: PMC7802047 DOI: 10.1177/1049732320972338] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Psychological problems are common among people with inflammatory bowel disease (IBD) following stoma surgery. However, the ways in which stoma-related psychological needs are identified and addressed in health care settings remain unexplored. In this study, we investigated the perspectives of young people with a stoma and health care professionals about access to psychological support. Semi-structured interviews were conducted with young people with an IBD stoma (18-29 years, n = 13) and health care professionals (n = 15), including colorectal surgeons, gastroenterologists, specialist nurses in IBD and stoma care, and general practitioners in England. Data collection and analysis were informed by constructivist grounded theory. Three analytic categories were developed: "initiating support-seeking," "affirming psychological needs," and "mobilizing psychological support," which capture young peoples' trajectory to access psychological support. Based on the findings, we highlight the need for both patients and health care professionals to assign greater priority to the identification of psychological symptoms post-stoma surgery. More effective care pathways, which include responsive psychological services, would enhance access to psychological support for young people with a stoma.
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Affiliation(s)
- Kay Polidano
- School of Medicine, Keele University, Keele, United Kingdom
| | - Carolyn A. Chew-Graham
- School of Medicine, Keele University, Keele, United Kingdom
- Midlands Partnership Foundation Trust, Stafford, United Kingdom
| | - Adam D. Farmer
- School of Medicine, Keele University, Keele, United Kingdom
- University Hospitals of North Midlands NHS Trust, Stoke-on Trent, United Kingdom
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14
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Hider SL, Bucknall M, Jinks C, Cooke K, Cooke K, Desilva EE, Finney AG, Healey EL, Herron D, Machin AR, Mallen CD, Wathall S, Chew-Graham CA. A pilot study of a nurse-led integrated care review (the INCLUDE review) for people with inflammatory rheumatological conditions in primary care: feasibility study findings. Pilot Feasibility Stud 2021; 7:9. [PMID: 33407943 PMCID: PMC7786467 DOI: 10.1186/s40814-020-00750-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 12/15/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND People with inflammatory rheumatological conditions such as rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, polymyalgia rheumatica and giant cell arteritis are at an increased risk of common comorbidities including cardiovascular disease, osteoporosis and mood problems, leading to increased morbidity and mortality. Identifying and treating these problems could lead to improved patient quality of life and outcomes. Despite these risks being well-established, patients currently are not systematically targeted for management interventions for these morbidities. This study aimed to assess the feasibility of conducting a randomised controlled trial (RCT) of a nurse-led integrated care review in primary care to identify and manage these morbidities. METHODS A pilot cluster RCT was delivered across four UK general practices. Patients with a diagnostic Read code for one of the inflammatory rheumatological conditions of interest were recruited by post. In intervention practices (n = 2), eligible patients were invited to attend the INCLUDE review. Outcome measures included health-related quality of life (EQ-5D-5L), patient activation, self-efficacy and treatment burden. A sample (n = 24) of INCLUDE review consultations were audio-recorded and assessed against a fidelity checklist. RESULTS 453/789 (57%) patients responded to the invitation, although 114/453 (25%) were excluded as they either did not fulfil eligibility criteria or failed to provide full written consent. In the intervention practices, uptake of the INCLUDE review was high at 72%. Retention at 3 and 6 months both reached pre-specified success criteria. Participants in intervention practices had more primary care contacts than controls (mean 29 vs 22) over the 12 months, with higher prescribing of all relevant medication classes in participants in intervention practices, particularly so for osteoporosis medication (baseline 29% vs 12 month 46%). The intervention was delivered with fidelity, although potential areas for improvement were identified. CONCLUSIONS The findings of this pilot study suggest it is feasible to deliver an RCT of the nurse-led integrated care (INCLUDE) review in primary care. A significant morbidity burden was identified. Early results suggest the INCLUDE review was associated with changes in practice. Lessons have been learnt around Read codes for patient identification and refining the nurse training. TRIAL REGISTRATION ISRCTN, ISRCTN12765345.
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Affiliation(s)
- Samantha L Hider
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK. .,Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke on Trent, Staffordshire, ST6 7AG, UK.
| | - Milica Bucknall
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Keele Clinical Trials Unit, Keele University, Stoke on Trent, UK
| | - Clare Jinks
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Midlands Partnership Foundation Trust, Stoke on Trent, Staffordshire, ST6 7AG, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, Keele University, Stoke on Trent, UK
| | - Erandie Ediriweera Desilva
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,Family Medicine Unit, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Andrew G Finney
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,School of Nursing and Midwifery, Keele University, Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Royal Stoke University Hospital, Stoke-on-Trent, ST4 6QG, UK
| | - Emma L Healey
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Daniel Herron
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Annabelle R Machin
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Christian D Mallen
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK.,Midlands Partnership Foundation Trust, Stafford, Staffordshire, ST16 3SR, UK
| | - Simon Wathall
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK
| | - Carolyn A Chew-Graham
- School of Primary, Community and Social Care, Keele University, Keele, Staffordshire, ST5 5BG, UK.,National Institute for Health Research (NIHR) Applied Research Collaboration (ARC) West Midlands, Keele, Stoke on Trent, Staffordshire, UK.,Midlands Partnership Foundation Trust, Stafford, Staffordshire, ST16 3SR, UK
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15
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Jetha A, Theis KA, Boring MA, Murphy LB, Guglielmo D. Depressive Symptoms and the Arthritis-Employment Interface: A Population-Level Study. Arthritis Care Res (Hoboken) 2021; 73:65-77. [PMID: 32702187 PMCID: PMC10481427 DOI: 10.1002/acr.24381] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 07/09/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine the relationship between depressive symptoms, arthritis, and employment, and to determine whether this relationship differs across young, middle-age, and older working-age adults with arthritis. METHODS Data from the US National Health Interview Survey from 2013-2017 were analyzed. Analyses were restricted to adults with doctor-diagnosed arthritis of working age (ages 18-64 years) with complete data on depressive symptoms (n = 11,380). Covariates were sociodemographic information, health, and health system utilization variables. Employment prevalence was compared by self-reported depressive symptoms. We estimated percentages, as well as univariable and multivariable logistic regression models, to examine the relationship between depression and employment among young adults (ages 18-34 years), middle-age adults (ages 35-54 years), and older adults (ages 55-64 years). RESULTS Among all working-age US adults with arthritis, the prevalence of depressive symptoms was 13%. Those reporting depressive symptoms had a higher prevalence of fair/worse health (60%) and arthritis-attributable activity limitations (70%) compared to those not reporting depression (23% and 39%, respectively). Respondents with depressive symptoms reported significantly lower employment prevalence (30%) when compared to those not reporting depressive symptoms (66%) and lower multivariable-adjusted association with employment (prevalence ratio 0.88 [95% confidence interval (95% CI) 0.83-0.93]). Middle-age adults reporting depression were significantly less likely to be employed compared to their counterparts without depression (prevalence ratio 0.83 [95% CI 0.77-0.90]); similar but borderline statistically significant relationships were observed for both young adults (prevalence ratio 0.86 [95% CI 0.74-0.99]) and older adults (prevalence ratio 0.94 [95% CI 0.86-1.03]). CONCLUSION For adults with arthritis, depressive symptoms are associated with not participating in employment. Strategies to reduce arthritis-related work disability may be more effective if they simultaneously address mental health.
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Affiliation(s)
- Arif Jetha
- Institute for Work and Health, and Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | | | | | | | - Dana Guglielmo
- Centers for Disease Control and Prevention, Atlanta, Georgia, and Oak Ridge Institute for Science and Education, Oak Ridge, Tennessee
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16
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Park JYE, Howren AM, Davidson E, De Vera MA. Insights on mental health when living with rheumatoid arthritis: a descriptive qualitative study of threads on the Reddit website. BMC Rheumatol 2020; 4:62. [PMID: 33292866 PMCID: PMC7690206 DOI: 10.1186/s41927-020-00163-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 08/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Reddit is a highly visited social news and discussion website where individuals anonymously ask questions, post opinions and share experiences, which provide a valuable pool of publicly available data. Our objective was to systematically search and analyze threads on the social news website, Reddit, to understand experiences of individuals with rheumatoid arthritis (RA) regarding their mental health. METHODS We conducted a patient-oriented descriptive qualitative study. We identified threads from two subreddits, "r/Thritis" and "r/Rheumatoid", using keywords such as "mood", "mental health", "stressed", "depressed", "anxious" over a 1-year period between June 2018 and June 2019. For included threads, we extracted the title, original post, and corresponding comments and responses. We applied thematic analysis using an inductive approach. RESULTS Of 81 threads identified, we included 27. We identified four themes: 1) Navigating the management of RA explores how the physical impacts of the disease, lack of health resources/support and the complexity of medications affect mental health; 2) Experiencing impact on relationships and social isolation includes experiencing misconceptions of RA, feeling misunderstood and feeling guilt; 3) Experiencing loss, touches on the helplessness brought by challenges with performing self-defining activities such as self-care, work, and childbearing/parenting; and finally, 4) Experiencing emotional struggles captures how tension between fighting through and despair has led some to suicide ideation and thoughts of death. CONCLUSIONS Online forums and communities such as Reddit have created opportunities for individuals with RA to share experiences on mental health matters, which they may not necessarily be able to share with others.
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Affiliation(s)
- Jamie Y E Park
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Alyssa M Howren
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada
- Arthritis Research Canada, Vancouver, BC, Canada
| | | | - Mary A De Vera
- Faculty of Pharmaceutical Sciences, University of British Columbia, 2405 Wesbrook Mall, Vancouver, BC, V6T 1Z3, Canada.
- Collaboration for Outcomes Research and Evaluation, Vancouver, BC, Canada.
- Arthritis Research Canada, Vancouver, BC, Canada.
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17
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Barnes MC, Kessler D, Archer C, Wiles N. Prioritising physical and psychological symptoms: what are the barriers and facilitators to the discussion of anxiety in the primary care consultation? BMC FAMILY PRACTICE 2019; 20:106. [PMID: 31351467 PMCID: PMC6660691 DOI: 10.1186/s12875-019-0996-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 07/15/2019] [Indexed: 11/11/2022]
Abstract
Background Anxiety is under-recorded and under-treated in the UK and is under-represented in research compared with depression. Detecting anxiety can be difficult because of co-existing conditions. GPs can be reluctant to medicalise anxiety symptoms and patients can be reluctant to disclose them, for a variety of reasons. This research addresses the gap in evidence of real-life consultations of patients with anxiety and explores how physical and psychological symptoms are discussed and prioritised by patients and GPs in primary care consultations. Methods A mixed methods study using a baseline questionnaire, video-recorded primary care consultations and interview data with patients and GPs. Results Seventeen patients with anxiety symptoms (GAD-7 score ≥ 10) completed a questionnaire, had their consultation video-recorded and took part in a semi-structured interview. Four GPs were interviewed. The main themes that emerged from GP and patients accounts as barriers and facilitators to discussing anxiety mostly mirrored each other. The GP/patient relationship and continuity of care was the main facilitator for the discussion of anxiety in the consultation. The main barriers were: attribution of or unacknowledged symptoms; co-morbidities; and time constraints. GPs overcame these barriers by making repeat appointments and employing prioritising techniques; patients by choosing an empathetic GP. Conclusions The findings add to the evidence base concerning the management of anxiety in primary care. The findings suggest that the discussion around anxiety is a process negotiated between the patient and the GP influenced by a range of barriers and facilitators. Co-existing depression and health anxieties can mask anxiety symptoms in patients. Good practice techniques such as bringing back patients for appointments to foster continuity of care and understanding can help disclosure and detection of anxiety symptoms. Future research could investigate this longitudinally and should include a wider range of GPs practices and GPs. Electronic supplementary material The online version of this article (10.1186/s12875-019-0996-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- M C Barnes
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - D Kessler
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - C Archer
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - N Wiles
- Centre for Academic Mental Health, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
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18
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The extra-articular impacts of rheumatoid arthritis: moving towards holistic care. BMC Rheumatol 2018; 2:32. [PMID: 30886982 PMCID: PMC6390577 DOI: 10.1186/s41927-018-0039-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Accepted: 10/04/2018] [Indexed: 12/16/2022] Open
Abstract
Although treat-to-target has revolutionised the outcomes of patients with rheumatoid arthritis (RA) there is emerging evidence that attaining the target of remission is insufficient to normalise patients’ quality of life, and ameliorate the extra-articular impacts of RA. RA has a broad range of effects on patient’s lives, with four key “extra-articular” impacts being pain, depression and anxiety, fatigue and rheumatoid cachexia. All of these are seen frequently; for example, studies have reported that 1 in 4 patients with RA have high-levels of fatigue. Commonly used drug treatments (including simple analgesics, non-steroidal anti-inflammatory drugs and anti-depressants) have, at most, only modest benefits and often cause adverse events. Psychological strategies and dynamic and aerobic exercise all reduce issues like pain and fatigue, although their effects are also only modest. The aetiologies of these extra-articular impacts are multifactorial, but share overlapping components. Consequently, patients are likely to benefit from management strategies that extend beyond the assessment and treatment of synovitis, and incorporate more broad-based, or “holistic”, assessments of the extra-articular impacts of RA and their management, including non-pharmacological approaches. Innovative digital technologies (including tablet and smartphone “apps” that directly interface with hospital systems) are increasingly available that can directly capture patient-reported outcomes during and between clinic visits, and include them within electronic patient records. These are likely to play an important future role in delivering such approaches.
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19
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Hider SL, Bucknall M, Cooke K, Cooke K, Finney AG, Goddin D, Healey EL, Hennings S, Herron D, Jinks C, Lewis M, Machin A, Mallen C, Wathall S, Chew-Graham CA. The INCLUDE study: INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community; identifying multimorbidity: Protocol for a pilot randomized controlled trial. JOURNAL OF COMORBIDITY 2018; 8:2235042X18792373. [PMID: 30191145 PMCID: PMC6088485 DOI: 10.1177/2235042x18792373] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Patients with inflammatory rheumatic conditions such as rheumatoid arthritis, polymyalgia rheumatica and ankylosing spondylitis are at increased risk of common comorbidities such as cardiovascular disease, osteoporosis and anxiety and depression which lead to increased morbidity and mortality. These associated morbidities are often un-recognized and under-treated. While patients with other long-term conditions such as diabetes are invited for routine reviews in primary care, which may include identification and management of co-morbidities, at present this does not occur for patients with inflammatory conditions, and thus, opportunities to diagnose and optimally manage these comorbidities are missed. Objective To evaluate the feasibility and acceptability of a nurse-led integrated care review (the INtegrating and improving Care for patients with infLammatory rheUmatological DisordErs in the community (INCLUDE) review) for people with inflammatory rheumatological conditions in primary care. Design A pilot cluster randomized controlled trial will be undertaken to test the feasibility and acceptability of a nurse-led integrated primary care review for identification, assessment and initial management of common comorbidities including cardiovascular disease, osteoporosis and anxiety and depression. A process evaluation will be undertaken using a mixed methods approach including participant self-reported questionnaires, a medical record review, an INCLUDE EMIS template, intervention fidelity checking using audio-recordings of the INCLUDE review consultation and qualitative interviews with patient participants, study nurses and study general practitioners (GPs). Discussion Success of the pilot study will be measured against the engagement, recruitment and study retention rates of both general practices and participants. Acceptability of the INCLUDE review to patients and practitioners and treatment fidelity will be explored using a parallel process evaluation. Trial Registration ISRCTN12765345.
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Affiliation(s)
- Samantha L Hider
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Milica Bucknall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Kelly Cooke
- Haywood Academic Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, UK
| | - Kendra Cooke
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Andrew G Finney
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,School of Nursing and Midwifery, Keele University, Keele UK.,Clinical Education Centre, University Hospitals of North Midlands NHS Trust, Stoke on Trent UK
| | - Dave Goddin
- Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Emma L Healey
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | | | - Daniel Herron
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Clare Jinks
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | - Martyn Lewis
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,Keele Clinical Trials Unit, Keele University, Keele, UK
| | - Annabelle Machin
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Christian Mallen
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
| | - Simon Wathall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK
| | - Carolyn A Chew-Graham
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, UK.,WM CLAHRC National Institute of Health Research Collaborations for Leadership in Applied Health Research and Care West Midlands, UK
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20
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Turner P, Newbigging K. Reimagining mental health in primary care: a blueprint for STPs. Br J Gen Pract 2017; 67:342-343. [PMID: 28751329 PMCID: PMC5519099 DOI: 10.3399/bjgp17x691769] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Affiliation(s)
- Paul Turner
- Karis Medical Centre, Edgbaston, Birmingham; Primary Care Mental Health Lead, West Midlands Mental Health Commission, Birmingham
| | - Karen Newbigging
- Health Services Management Centre, School of Social Policy, the University of Birmingham, Birmingham
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