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Hafiz N, Hyun K, Knight A, Hespe C, Chow CK, Briffa T, Gallagher R, Reid CM, Hare DL, Zwar N, Woodward M, Jan S, Atkins ER, Laba TL, Halcomb E, Usherwood T, Redfern J. Gender Comparison of Receipt of Government-Funded Health Services and Medication Prescriptions for the Management of Patients With Cardiovascular Disease in Primary Care. Heart Lung Circ 2021; 30:1516-1524. [PMID: 33933363 DOI: 10.1016/j.hlc.2021.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Revised: 01/11/2021] [Accepted: 04/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cardiovascular disease (CVD) and risk factors remains a major burden in terms of disease, disability, and death in the Australian population and mental health is considered as an important risk factor affecting cardiovascular disease. A multidisciplinary collaborative approach in primary care is required to ensure an optimal outcome for managing cardiovascular patients with mental health issues. Medicare introduced numerous primary care health services and medications that are subsidised by the Australian government in order to provide a more structured approach to reduce and manage CVD. However, the utilisation of these services nor gender comparison for CVD management in primary care has been explored. Therefore, the aim is to compare the provision of subsidised chronic disease management plans (CDMPs), mental health care and prescription of guideline-indicated medications to men and women with CVD in primary care practices for secondary prevention. METHODS De-identified data for all active patients with CVD were extracted from 50 Australian primary care practices. Outcomes included the frequency of receipt of CDMPs, mental health care and prescription of evidence-based medications. Analyses adjusted for demography and clinical characteristics, stratified by gender, were performed using logistic regression and accounted for clustering effects by practices. RESULTS Data for 14,601 patients with CVD (39.4% women) were collected. The odds of receiving the CDMPs was significantly greater amongst women than men (preparation of general practice management plan [GPMP]: (46% vs 43%; adjusted OR [95% CI]: 1.22 [1.12, 1.34]). Women were more likely to have diagnosed with mental health issues (32% vs 20%, p<0.0001), however, the adjusted odds of men and women receiving any government-subsidised mental health care were similar. Women were less often prescribed blood pressure, lipid-lowering and antiplatelet medications. After adjustment, only an antiplatelet medication or agent was less likely to be prescribed to women than men (44% vs 51%; adjusted OR [95% CI]: 0.84 [0.76, 0.94]). CONCLUSION Women were more likely to receive CDMPs but less likely to receive antiplatelet medications than men, no gender difference was observed in the receipt of mental health care. However, the receipt of the CDMPs and the mental health treatment consultations were suboptimal and better use of these existing services could improve ongoing CVD management.
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Affiliation(s)
- Nashid Hafiz
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia. https://twitter.com/HafizNashid
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Andrew Knight
- Primary and Integrated Care Unit, South Western Sydney Local Health District, Sydney, NSW, Australia; University of New South Wales, Sydney, NSW, Australia
| | - Charlotte Hespe
- The University of Notre Dame, School of Medicine, Sydney, NSW, Australia
| | - Clara K Chow
- Western Sydney Local Health District, Sydney, NSW, Australia; Westmead Applied Research Centre, The University of Sydney, Sydney, NSW, Australia
| | - Tom Briffa
- School of Population and Global Health, Faculty of Health and Medical Sciences, The University of Western Australia, Sydney, NSW, Australia
| | - Robyn Gallagher
- Sydney Nursing School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Christopher M Reid
- School of Public Health, Curtin University, Perth, WA, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, Vic, Australia
| | - David L Hare
- Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Melbourne, Vic, Australia; Austin Health, Melbourne, Vic, Australia
| | - Nicholas Zwar
- Faculty of Health Sciences & Medicine, Bond University, Brisbane, Qld, Australia
| | - Mark Woodward
- University of New South Wales, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia
| | - Stephen Jan
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Emily R Atkins
- The George Institute for Global Health, Sydney, NSW, Australia
| | - Tracey-Lea Laba
- University of Technology Sydney Centre for Health Economics Research and Evaluation, Sydney, NSW, Australia
| | - Elizabeth Halcomb
- School of Nursing, University of Wollongong, Wollongong, NSW, Australia
| | - Timothy Usherwood
- The George Institute for Global Health, Sydney, NSW, Australia; The University of Sydney, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Julie Redfern
- School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia; The George Institute for Global Health, Sydney, NSW, Australia.
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Astutik E, Hidajah AC, Tama TD, Efendi F, Li CY. Prevalence and determinants of depressive symptoms among adults in Indonesia: A cross-sectional population-based national survey. Nurs Forum 2020; 56:37-44. [PMID: 32964484 DOI: 10.1111/nuf.12508] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2019] [Revised: 07/30/2020] [Accepted: 09/07/2020] [Indexed: 11/30/2022]
Abstract
AIMS To analyze the association between personal health conditions (self-rated health, physical function, and chronic conditions) and symptoms of depression in Indonesia. METHODS Data were collected from the Indonesian family life survey 5. This study used a cross-sectional study design with a sample size of 17,734 respondents. We included depressive symptoms, self-rated health, physical function, chronic conditions, demographics and socioeconomic variables. The center for epidemiologic studies depression scale was used to measure symptoms of depression. Multivariate logistic regression analysis was used to analyze the data. RESULTS The results showed that 23.47% of respondents had depressive symptoms, 20.04% had poor self-rated health, 55.93% had a poor physical function, and 32.37% had at least one chronic disease. Respondents who had poor self-rated health, had poor physical function, or had a chronic condition were all had a significantly higher odds of experiencing symptoms of depression after controlling for demographic variables (age, sex, married, and education level), social-economic, and smoking status. CONCLUSION Depressive symptoms were significantly associated with personal health conditions including self-rated health, physical functioning, and chronic conditions among community residents. Strategies that can improve personal health conditions needed to be studied at the community level to improve the level of mental health.
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Affiliation(s)
- Erni Astutik
- Research Group for Health and Wellbeing of Women and Children, Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Atik Choirul Hidajah
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia
| | - Tika Dwi Tama
- Department of Public Health, Faculty of Sport Science, Universitas Negeri Malang, Malang, East Java, Indonesia
| | - Ferry Efendi
- Department of Community Health and Mental Health Nursing, Faculty of Nursing, Universitas Airlangga, Surabaya, East Java, Indonesia.,Visiting Fellow, School of Nursing and Midwifery, La Trobe University, Melbourne, Australia
| | - Chung-Yi Li
- Department of Epidemiology, Faculty of Public Health, Universitas Airlangga, Surabaya, East Java, Indonesia.,Department and Graduate Institute of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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Cal SF, Sá LRD, Glustak ME, Santiago MB. Resilience in chronic diseases: A systematic review. COGENT PSYCHOLOGY 2015. [DOI: 10.1080/23311908.2015.1024928] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Affiliation(s)
- Sílvia Fernanda Cal
- Rheumatology Ambulatory, Bahian School of Medicine and Public Health-EBMSP (Escola Bahiana de Medicina e Saúde Pública), Av. Dom João VI, n°. 275, Brotas, Salvador, Bahia, Brazil
| | - Lis Ribeiro de Sá
- Course in Medicine, Centro Universitário Serra dos Órgãos – UNIFESO, Rua Alberto Torres 111 Alto, Teresópolis, Rio de Janeiro 25964-004, Brazil
| | - Maria Eugênia Glustak
- Course in Psychology, Federal University of Paraná (UFPR), Praça Santos Andrade n° 50-Centro, Curitiba, Paraná 81531-900, Brazil
| | - Mittermayer Barreto Santiago
- Rheumatology Service, Bahian School of Medicine and Public Health-EBMSP (Escola Bahiana de Medicina e Saúde Pública), Av. Dom João VI, n° 275, Brotas, Salvador, Bahia 40290-000, Brazil
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Esposito M, Marotta R, Roccella M, Gallai B, Parisi L, Lavano SM, Carotenuto M. Pediatric neurofibromatosis 1 and parental stress: a multicenter study. Neuropsychiatr Dis Treat 2014; 10:141-6. [PMID: 24489471 PMCID: PMC3904813 DOI: 10.2147/ndt.s55518] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Neurofibromatosis 1 (NF1) is a complex and multifaceted neurocutaneous syndrome with many and varied comorbidities. The literature about the prevalence and degree of maternal stress and the impact of NF1 in the parent-child interaction is still scant. The aim of this study was to evaluate the prevalence of maternal stress in a large pediatric sample of individuals affected by NF1. METHODS Thirty-seven children (19 boys, 18 girls) of mean age 7.86±2.94 (range 5-11) years affected by typical NF1 and a control group comprising 405 typically developing children (207 boys, 198 girls; mean age 8.54±2.47 years) were included in this study. To assess parental stress, the mothers of all individuals (NF1 and comparisons) filled out the Parenting Stress Index-Short Form test. RESULTS The two study groups were comparable for age (P=0.116), gender (P=0.886), and body mass index adjusted for age (P=0.305). Mothers of children affected by NF1 reported higher mean Parenting Stress Index-Short Form scores on the Parental Distress domain (P<0.001), Difficult Child domain (P<0.001), and Total Stress domain than the mothers of typically developing children (controls) (P<0.001). No significant differences between the two groups were found for the Parent-Child Dysfunctional Interaction domain (P=0.566) or Defensive Responding domain scores (P=0.160). CONCLUSION NF1 is considered a multisystemic and complex disease, with many still unrecognized features in pediatric patients and in their families. In this light, our findings about the higher levels of maternal stress highlight the importance of considering the environmental aspects of NF1 management in developmental age.
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Affiliation(s)
- Maria Esposito
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
| | - Rosa Marotta
- Department of Psychiatry, "Magna Graecia" University of Catanzaro, Catanzaro, Italy
| | - Michele Roccella
- Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy
| | - Beatrice Gallai
- Unit of Child and Adolescent Neuropsychiatry, University of Perugia, Perugia, Italy
| | - Lucia Parisi
- Child Neuropsychiatry, Department of Psychology, University of Palermo, Palermo, Italy
| | | | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, Second University of Naples, Naples, Italy
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Carotenuto M, Esposito M, Di Pasquale F, De Stefano S, Santamaria F. Psychological, cognitive and maternal stress assessment in children with primary ciliary dyskinesia. World J Pediatr 2013; 9:312-7. [PMID: 24235065 DOI: 10.1007/s12519-013-0441-1] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2012] [Accepted: 06/05/2013] [Indexed: 01/02/2023]
Abstract
BACKGROUND Primary ciliary dyskinesia (PCD) is a rare disorder due to structure and functional abnormalities of respiratory cilia. There are no reports on the behavioral and psychological aspects of children and adolescents with PCD. This study was undertaken to assess the cognitive and behavioural characteristics, and the parental stress of a population of school-aged children with PCD. METHODS Ten PCD and 34 healthy school-aged children underwent Wechsler Intelligence Scale for Children-III edition, Child Behavior Check-List questionnaire (CBCL), Parenting Stress Index-Short Form tests in order to perform a behavioural and psychological evaluation. RESULTS PCD children showed significant behavioral and social competent problems in CBCL scale than control children, in particular with regard to internalizing problems score (P<0.001). Parental distress, parent-child interaction and total stress in the mothers of PCD patients were higher than those in the controls' parents (P<0.001). CONCLUSION Our findings pinpoint the importance of specific psychological support in the clinical management of children with PCD.
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Affiliation(s)
- Marco Carotenuto
- Clinic, Department of Mental and Physical Health, and Preventive Medicine, Second University of Naples, Naples, Italy
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What are the implications of changing treatment delivery models for patients with inflammatory bowel disease: a discussion paper. Eur J Gastroenterol Hepatol 2013; 25:393-8. [PMID: 23470263 DOI: 10.1097/meg.0b013e32835c07b4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
An integrated model of care has been used effectively to manage chronic diseases; however, there is limited, yet encouraging evidence on its introduction in the management of inflammatory bowel disease (IBD), a chronic gastrointestinal condition. Here, the rationale for and implications of introducing an integrated model of care for patients with IBD are discussed, with a particular focus on psychology input, patient-centred care, efficiency as perceived by patients and doctors, financial implications and the possible means of model introduction. This is a discussion paper on the integrated model of care for IBD against a background of what has been learned from an integrated model of care established in other chronic conditions. Although limited, the emerging data on an integrated model of care in IBD are encouraging with respect to patient outcomes and savings in healthcare costs. In other conditions, the model has been well received by both patients and practitioners, although the loss of autonomy by doctors is listed among its drawbacks. The cost-effectiveness data are now sufficiently convincing to recommend the model's acceptance in principle. The model should be promoted at the policy level rather than by individual practitioners to facilitate equal access for patients with IBD on a larger scale than currently.
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Shah S, Toelle BG, Sawyer SM, Roydhouse JK, Edwards P, Usherwood T, Jenkins CR. Feasibility study of a communication and education asthma intervention for general practitioners in Australia. Aust J Prim Health 2011; 16:75-80. [PMID: 21133302 DOI: 10.1071/py09056] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
The Physician Asthma Care Education (PACE) program significantly improved asthma prescribing and communication behaviours of primary care paediatricians in the USA. We tested the feasibility and acceptability of a modified PACE program with Australian general practitioners (GP) and measured its impact on self-reported consulting behaviours in a pilot study. Recruitment took place through a local GP division. Twenty-five GP completed two PACE Australia workshops, which incorporated paediatric asthma management consistent with Australian asthma guidelines and focussed on effective communication strategies. Program feasibility, usefulness and perceived benefit were measured by questionnaires before the workshop and 1 month later, and an evaluation questionnaire after each workshop. GP were universally enthusiastic and supportive of the workshops. The most useful elements they reported were communication skills, case studies, device demonstrations and the toolkit provided. GP self reports of the perceived helpfulness of the key communication strategies and their confidence in their application and reported frequency of use increased significantly after the workshops. The PACE program shows promise in improving the way in which Australian GP manage asthma consultations, particularly with regard to doctor-patient communication. The impact ofthe modified PACE Australia program on the processes and outcomes ofGP care ofchildren with asthma is now being measured in a randomised controlled trial.
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Affiliation(s)
- Smita Shah
- Primary Health Care Education and Research Unit, Primary and Community Health Network, Sydney West Area Health Service, Sydney, NSW 2145, Australia.
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Attitudes, norms and controls influencing lifestyle risk factor management in general practice. BMC FAMILY PRACTICE 2009; 10:59. [PMID: 19706198 PMCID: PMC2746183 DOI: 10.1186/1471-2296-10-59] [Citation(s) in RCA: 133] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 08/26/2009] [Indexed: 11/10/2022]
Abstract
BACKGROUND With increasing rates of chronic disease associated with lifestyle behavioural risk factors, there is urgent need for intervention strategies in primary health care. Currently there is a gap in the knowledge of factors that influence the delivery of preventive strategies by General Practitioners (GPs) around interventions for smoking, nutrition, alcohol consumption and physical activity (SNAP). This qualitative study explores the delivery of lifestyle behavioural risk factor screening and management by GPs within a 45-49 year old health check consultation. The aims of this research are to identify the influences affecting GPs' choosing to screen and choosing to manage SNAP lifestyle risk factors, as well as identify influences on screening and management when multiple SNAP factors exist. METHODS A total of 29 audio-taped interviews were conducted with 15 GPs and one practice nurse over two stages. Transcripts from the interviews were thematically analysed, and a model of influencing factors on preventive care behaviour was developed using the Theory of Planned Behaviour as a structural framework. RESULTS GPs felt that assessing smoking status was straightforward, however some found assessing alcohol intake only possible during a formal health check. Diet and physical activity were often inferred from appearance, only being assessed if the patient was overweight. The frequency and thoroughness of assessment were influenced by the GPs' personal interests and perceived congruence with their role, the level of risk to the patient, the capacity of the practice and availability of time. All GPs considered advising and educating patients part of their professional responsibility. However their attempts to motivate patients were influenced by perceptions of their own effectiveness, with smoking causing the most frustration. Active follow-up and referral of patients appeared to depend on the GPs' orientation to preventive care, the patient's motivation, and cost and accessibility of services to patients. CONCLUSION General practitioner attitudes, normative influences from both patients and the profession, and perceived external control factors (time, cost, availability and practice capacity) all influence management of behavioural risk factors. Provider education, community awareness raising, support and capacity building may improve the uptake of lifestyle modification interventions.
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