1
|
Van Damme J, Dal Bello-Haas V, Strachan P, Kuspinar A, Kalu M, Zaide M. Client and clinician perspectives about a virtual education and exercise chronic disease management programme for people with hip and knee osteoarthritis. Musculoskeletal Care 2024; 22:e1881. [PMID: 38588022 DOI: 10.1002/msc.1881] [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: 02/26/2024] [Revised: 03/25/2024] [Accepted: 03/28/2024] [Indexed: 04/10/2024]
Abstract
INTRODUCTION Osteoarthritis (OA) is one of the most prevalent chronic conditions in Canada. Despite the established benefits of non-pharmacological management (education, exercise) for people with OA, many do not receive treatment, resulting in pain, decreased physical function, and poorer quality of life. Virtual programme options grew significantly during the recent pandemic and may provide longer-term opportunities for increased uptake by reaching individuals otherwise unable to participate. This study explored the experiences and perspectives of clients participating in and clinicians providing the Good Life with osteoArthritis: Denmark (GLA:DTM) Canada remote programme. METHODS This qualitative descriptive study recruited 10 clients with hip and/or knee OA and 11 clinicians across Canada using purposive sampling. An online pre-interview survey was completed, and individual interviews were conducted, audio-recorded, transcribed verbatim and analysed independently by two researchers using inductive thematic analysis. Coding and analyses were initially conducted separately by group and then compared and combined. RESULTS Four overarching themes (and 11 subthemes) were identified: (1) Expected and unexpected benefits of virtual programs; (2) Drawbacks to virtual programs; (3) Programme delivery in a virtual world; (4) Shifting and non-shifting perspectives. Although initially sceptical, after completion of the programme, clients were in favour of virtual delivery with many benefits described. Clinicians' perspectives varied about feedback aimed to correct client movement patterns. CONCLUSIONS Clients and clinicians identified important experiential and procedural elements for virtual chronic disease management programs that include education and exercise. Additional work is needed to understand if the GLA:DTM remote outcomes are equivalent to the in-person programme.
Collapse
Affiliation(s)
- Jill Van Damme
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Michael Kalu
- School of Kinesiology and Health Sciences, York University, Toronto, Ontario, Canada
| | - Mashal Zaide
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
2
|
Jäger M, Zangger G, Bricca A, Dideriksen M, Smith SM, Midtgaard J, Taylor RS, Skou ST. Mapping interventional components and behavior change techniques used to promote self-management in people with multimorbidity: a scoping review. Health Psychol Rev 2024; 18:165-188. [PMID: 36811829 PMCID: PMC7615688 DOI: 10.1080/17437199.2023.2182813] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 02/15/2023] [Indexed: 02/24/2023]
Abstract
Ageing populations and improved survival, have contributed to a rise in the number of people living with multimorbidity, raising issues related to polypharmacy, treatment burden, competing priorities and poor coordination of care. Self-management programs are increasingly included as an essential component of interventions to improve outcomes in this population. However, an overview of how interventions supporting self-management in patients with multimorbidity is missing. This scoping review focused on mapping the literature on patient-centered interventions for people living with multimorbidity. We searched several databases, clinical registries, and grey literature for RCTs published between 1990-2019 describing interventions that supported self-management in people with multimorbidity. We included 72 studies that were found to be very heterogeneous when it comes to the population, delivery modes and modalities, intervention elements and facilitators. The results pointed to an extensive use of cognitive behavioral therapy as a basis for interventions, as well as behavior change theories and disease management frameworks. The most coded behavior change techniques stemmed from the categories Social Support, Feedback and monitoring and Goals and Planning. To allow for implementation of effective interventions in clinical practice, improved reporting of intervention mechanisms in RCTs is warranted.
Collapse
Affiliation(s)
- Madalina Jäger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- Danish Centre for Motivation and Behaviour Science, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Graziella Zangger
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Alessio Bricca
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Mette Dideriksen
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Susan M. Smith
- HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Julie Midtgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Centre for Applied Research in Mental Health Care (CARMEN), Mental Health Centre Glostrup, Mental Health Services in the Capital Region of Denmark, University of Copenhagen, Copenhagen, Denmark
| | - Rod S. Taylor
- MRC/CSO Social and Public Health Sciences Unit & Robertson Centre for Biostatistics, Institute of Health and Well Being, University of Glasgow, Glasgow, Scotland
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| |
Collapse
|
3
|
Van Damme J, Dal Bello-Haas V, Kuspinar A, Strachan P, Peters N, Nguyen KT, Bolger G. Guiding Documents for Engaging with Remote Chronic Disease Management Programs as a Healthcare Provider: A Scoping Review. Int J Telerehabil 2023; 15:e6583. [PMID: 38162933 PMCID: PMC10754241 DOI: 10.5195/ijt.2023.6583] [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] [Indexed: 01/03/2024] Open
Abstract
Introduction Chronic disease management programs (CDMP) that include education and exercise enhance outcomes and reduce healthcare costs. Remote CDMP have the potential to provide convenient, cost-effective, and accessible options for individuals, but it is unclear how to best implement programs that include education and exercise. This review identified and synthesized resources for implementing remote CDMP programs that incorporate education and exercise. Methods Peer-reviewed and grey literature were systematically searched from January 1998 to May 2022. Covidence software was used for screening and extraction. The data were synthesized and presented in a narrative and tabular format. Results Six peer-reviewed manuscripts and six grey literature documents published between 2006-2022 were included. All resources described individual programs targeting various chronic conditions. Provider training, consent, participant screening, and safety considerations were identified. Conclusions Guidelines for remote CFMP programs are lacking. Additional work is needed to design remote CDMP guidelines incorporating education and exercise.
Collapse
Affiliation(s)
- Jill Van Damme
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario
| | | | - Ayse Kuspinar
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario
| | | | - Nicole Peters
- School of Rehabilitation Science, Western University, London, Ontario
| | - Khang Trong Nguyen
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario
| | | |
Collapse
|
4
|
Younas A, Shahzad S, Tejada-Garrido CI, Monari EN, Durante A. Sociocultural and patient-health care professional related factors influencing self-management of multiethnic patients with multimorbidities: A thematic synthesis. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0002132. [PMID: 37733662 PMCID: PMC10513255 DOI: 10.1371/journal.pgph.0002132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 08/23/2023] [Indexed: 09/23/2023]
Abstract
Self-management is critical for the general well-being and disease management of individuals with multimorbidities. A better understanding of sociocultural and patient-professional level factors affecting self-management can be valuable for designing individual and community-based strategies to promote optimal self-management. The purpose of this review was to explore sociocultural and patient-health care professional related factors affecting self-management among patients with multimorbidities. A metasynthesis was conducted. Literature was searched in PubMed, CINAHL, Scopus, Web of Science, and OVID databases. In total, 21 qualitative studies published from January 2010-March 2023 were critically appraised and reviewed. Thematic synthesis was used for analysis and eight descriptive and three analytical themes were generated. The analytical themes illustrated that personal and structural vulnerabilities, social and family struggles, and fragmented interpersonal relationships with health care professionals affect health care access, navigation, and self-management of individuals with multimorbidities. Engagement in self-management for individuals with multiple chronic conditions is hampered by under-resourced community and health care environments, structural vulnerabilities, familial and interpersonal conflicts, and disjointed relationships. There is a dire need to ensure optimal community resources to support individuals to address and navigate complexities associated with accessing care and effectively managing their illnesses.
Collapse
|
5
|
Poitras ME, Couturier Y, Doucet E, T. Vaillancourt V, Poirier MD, Gauthier G, Hudon C, Delli-Colli N, Gagnon D, Careau E, Duhoux A, Gaboury I, Charif AB, Ashcroft R, Lukewich J, Ramond-Roquin A, Massé S. Co-design, implementation, and evaluation of an expanded train-the-trainer strategy to support the sustainability of evidence-based practice guides for registered nurses and social workers in primary care clinics: a developmental evaluation protocol. BMC PRIMARY CARE 2022; 23:84. [PMID: 35436845 PMCID: PMC9016936 DOI: 10.1186/s12875-022-01684-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 03/31/2022] [Indexed: 11/12/2022]
Abstract
Background The implementation of evidence-based innovations is incentivized as part of primary care reform in Canada. In the Province of Québec, it generated the creation of interprofessional care models involving registered nurses and social workers as members of primary care clinics. However, the scope of practice for these professionals remains variable and suboptimal. In 2019, expert committees co-designed and published two evidence-based practice guides, but no clear strategy has been identified to support their assimilation. This project’s goal is to support the implementation and deployment of practice guides for both social workers and registered nurses using a train-the-trainer educational intervention. Methods/design This three-phase project is a developmental evaluation using a multiple case study design across 17 primary care clinics. It will involve trainers in healthcare centers, patients, registered nurses and social workers. The development and implementation of an expanded train-the-trainer strategy will be informed by a patient-oriented research approach, the Kirkpatrick learning model, and evidence-based practice guides. For each case and phase, the qualitative and quantitative data will be analyzed using a convergent design method and will be integrated through assimilation. Discussion This educational intervention model will allow us to better understand the complex context of primary care clinics, involving different settings and services offered. This study protocol, based on reflective practice, patient-centered research and focused on the needs of the community in collaboration with partners and patients, may serve as an evidence based educational intervention model for further study in primary care.
Collapse
|
6
|
Ismail FF, Md Redzuan A, Wen CW. Patient-centered education in dyslipidemia management: a systematic review. ASIAN BIOMED 2022; 16:214-236. [PMID: 37551316 PMCID: PMC10321189 DOI: 10.2478/abm-2022-0026] [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] [Indexed: 08/09/2023]
Abstract
Background Dyslipidemia management is crucial to reduce mortality and morbidity from cardiovascular diseases (CVDs). Patients must be educated and empowered to enable them to manage their own diseases. Various methods of patient education, such as patient-centered education (PCE) or non-PCE (such as didactic education or any traditional form of education), have been implemented. Objective To review and determine the effectiveness of PCE for dyslipidemia management compared with usual care. The primary outcome chosen was cholesterol level. Other measures, such as psychosocial or cognitive, behavioral, and other relevant outcomes, were also extracted. Additionally, underlying theories and other contributing factors that may have led to the success of the intervention were also reviewed and discussed. Methods We conducted searches in PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Scopus, and Google Scholar from inception until April 2021. All studies involving randomized controlled trials were included. Study quality was assessed using the Critical Appraisal Skills Program (CASP) checklist specifically for randomized controlled trials. Results The search identified 8,847 records. Of these, 20 studies were eligible for inclusion. Interventions using a PCE approach were largely successful. Contributing factors extracted from the included studies were underlying theories, instant reward system, dietary education, collaborative care, duration of intervention with systematic follow-ups, social support, adherence assessment method, and usage of e-health. Conclusions PCE is successful in achieving the desired outcomes in dyslipidemia management. Future studies may incorporate the elements of PCE to improve the management of dyslipidemia in hospital or community settings where appropriate.
Collapse
Affiliation(s)
- Farhana Fakhira Ismail
- Centre for Quality Management of Medicine, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur50300, Malaysia
- Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, Puncak Alam, Selangor42300, Malaysia
| | - Adyani Md Redzuan
- Centre for Quality Management of Medicine, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur50300, Malaysia
| | - Chong Wei Wen
- Centre for Quality Management of Medicine, Faculty of Pharmacy, Universiti Kebangsaan Malaysia, Kuala Lumpur50300, Malaysia
| |
Collapse
|
7
|
Nicholson K, Makovski TT, Nagyova I, van den Akker M, Stranges S. Strategies to improve health status among adults with multimorbidity: A scoping review. Maturitas 2022; 167:24-31. [DOI: 10.1016/j.maturitas.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Revised: 08/09/2022] [Accepted: 09/04/2022] [Indexed: 10/14/2022]
|
8
|
Improvement Strategies for the Challenging Collaboration of General Practitioners and Specialists for Patients with Complex Chronic Conditions: A Scoping Review. Int J Integr Care 2022; 22:4. [PMID: 36043030 PMCID: PMC9374013 DOI: 10.5334/ijic.5970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 07/26/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction: Coordination of healthcare professionals seems to be particularly important for patients with complex chronic disease, as they present a challenging interplay of conditions and symptoms. As one solution, to counteract or prevent this, improving collaboration between general practitioners (GPs) and specialists has been the aim of studies by linking or coordinating their services along the continuum of care. This scoping review summarises role distributions and components of this collaboration that have potential for improvement for the care of patients with complex chronic conditions. Methods: Scoping review as a knowledge synthesis for components of collaboration and role distributions between medical specialists and GPs in intervention studies. The PubMed database was searched for literature from 2010–2020. Results: Literature search and reference screening generated 2,174 articles. 30 articles originating from 22 unique projects were included in our synthesis. In the interventions to improve collaboration, the GP is most commonly in charge of patient management and extends the scope of practice. The specialist provides support when needed. Clear definition of roles, resources for knowledge transfer and education from specialists are commonly utilised interventions. Typically, combinations of process and system changes addressing communication and coordination issues are applied. Most interventions improve provider and patient satisfaction, health outcomes, and reduce care fragmentation. Conclusion: This review showed that interventions to improve collaboration between GPs and medical specialists seem promising. Further efforts should be made to test and apply the findings systematically in broad clinical practice.
Collapse
|
9
|
Community-based intervention of chronic disease management program in rural areas of Indonesia †. FRONTIERS OF NURSING 2022. [DOI: 10.2478/fon-2022-0021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Objective
This study evaluates the community-based intervention of chronic disease management (CDM) through the Integrated Non-Communicable Diseases Health Post (Posbindu-NCD) conducted by a community of health workers (CHWs) in Indonesia's rural areas.
Methods
A cohort retrospective study evaluated 577 participants from Posbindu-NCD in 7 public health centers (PHCs) in 2019. Activities of intervention of CDM for Posbindu-NCD was included, identified risk factors to NCDs, and provided counselling education and other follow-ups based on interviews and measurement results from the five Desk systems that recorded in a medical record as a form of the monthly activity report each the first month, the 6 months, and the 12th month.
Results
There were statistically significant differences for alcohol consumed and diabetes mellites (χ2
= 10.455; P = 0.001). There were significant differences on gender (χ2
= 3.963; P = 0.047), on ethnicity (χ2
= 19.873; P < 0.001), and hypertension. In addition, there were also significant differences on ethnicity (χ2
= 15.307; P < 0.001), vegetable consumption (χ2
= 4.435; P = 0.035), physical exercise (χ2
= 6.328; P = 0.012), and the current diseases of hypercholesterolemia of participants. Furthermore, the survival rate among patients who have overweight, abdominal overweight, hypertension, diabetes mellitus, and hypercholesterolemia increased among participants who regularly visited Posbindu-NCD compared with the non-regularly one.
Conclusions
The CDM program's community-based intervention through Posbindu-NCD conducted by CHWs improved survival rates in Indonesia's rural areas. Therefore, this program can be further developed in conducting CDM in the community with the active involvement of CHWs so that the community becomes active regularly in participating in Posbindu-NCD activities in rural areas of Indonesia.
Collapse
|
10
|
Cross AJ, Thomas D, Liang J, Abramson MJ, George J, Zairina E. Educational interventions for health professionals managing chronic obstructive pulmonary disease in primary care. Cochrane Database Syst Rev 2022; 5:CD012652. [PMID: 35514131 PMCID: PMC9073270 DOI: 10.1002/14651858.cd012652.pub2] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Chronic obstructive pulmonary disease (COPD) is a common, preventable and treatable health condition. COPD is associated with substantial burden on morbidity, mortality and healthcare resources. OBJECTIVES To review existing evidence for educational interventions delivered to health professionals managing COPD in the primary care setting. SEARCH METHODS We searched the Cochrane Airways Trials Register from inception to May 2021. The Register includes records from the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Allied and Complementary Medicine Database (AMED) and PsycINFO. We also searched online trial registries and reference lists of included studies. SELECTION CRITERIA We included randomised controlled trials (RCTs) and cluster-RCTs. Eligible studies tested educational interventions aimed at any health professionals involved in the management of COPD in primary care. Educational interventions were defined as interventions aimed at upskilling, improving or refreshing existing knowledge of health professionals in the diagnosis and management of COPD. DATA COLLECTION AND ANALYSIS Two review authors independently reviewed abstracts and full texts of eligible studies, extracted data and assessed the risk of bias of included studies. We conducted meta-analyses where possible and used random-effects models to yield summary estimates of effect (mean differences (MDs) with 95% confidence intervals (CIs)). We performed narrative synthesis when meta-analysis was not possible. We assessed the overall certainty of evidence for each outcome using Grades of Recommendation, Assessment, Development and Evaluation (GRADE). Primary outcomes were: 1) proportion of COPD diagnoses confirmed with spirometry; 2) proportion of patients with COPD referred to, participating in or completing pulmonary rehabilitation; and 3) proportion of patients with COPD prescribed respiratory medication consistent with guideline recommendations. MAIN RESULTS We identified 38 studies(22 cluster-RCTs and 16 RCTs) involving 4936 health professionals (reported in 19/38 studies) and 71,085 patient participants (reported in 25/38 studies). Thirty-six included studies evaluated interventions versus usual care; seven studies also reported a comparison between two or more interventions as part of a three- to five-arm RCT design. A range of simple to complex interventions were used across the studies, with common intervention features including education provided to health professionals via training sessions, workshops or online modules (31 studies), provision of practice support tools, tool kits and/or algorithms (10 studies), provision of guidelines (nine studies) and training on spirometry (five studies). Health professionals targeted by the interventions were most commonly general practitioners alone (20 studies) or in combination with nurses or allied health professionals (eight studies), and the majority of studies were conducted in general practice clinics. We identified performance bias as high risk for 33 studies. We also noted risk of selection, detection, attrition and reporting biases, although to a varying extent across studies. The evidence of efficacy was equivocal for all the three primary endpoints evaluated: 1) proportion of COPD diagnoses confirmed with spirometry (of the four studies that reported this outcome, two supported the intervention); 2) proportion of patients with COPD who are referred to, participate in or complete pulmonary rehabilitation (of the four studies that reported this outcome, two supported the intervention); and 3) proportion of patients with COPD prescribed respiratory medications consistent with guideline recommendations (12 studies reported this outcome, the majority evaluated multiple drug classes and reported a mixed effect). Additionally, the low quality of evidence and potential risk of bias make the interpretation more difficult. Moderate-quality evidence (downgraded due to risk of bias concerns) suggests that educational interventions for health professionals probably improve the proportion of patients with COPD vaccinated against influenza (three studies) and probably have little impact on the proportion of patients vaccinated against pneumococcal infection (two studies). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on the frequency of COPD exacerbations (10 studies). There was a high degree of heterogeneity in the reporting of health-related quality of life (HRQoL). Low-quality evidence suggests that educational interventions for health professionals may have little or no impact on HRQoL overall, and when using the COPD-specific HRQoL instrument, the St George's Respiratory Questionnaire (at six months MD 0.87, 95% CI -2.51 to 4.26; 2 studies, 406 participants, and at 12 months MD -0.43, 95% CI -1.52 to 0.67, 4 studies, 1646 participants; reduction in score indicates better health). Moderate-quality evidence suggests that educational interventions for health professionals may improve patient satisfaction with care (one study). We identified no studies that reported adverse outcomes. AUTHORS' CONCLUSIONS The evidence of efficacy was equivocal for educational interventions for health professionals in primary care on the proportion of COPD diagnoses confirmed with spirometry, the proportion of patients with COPD who participate in pulmonary rehabilitation, and the proportion of patients prescribed guideline-recommended COPD respiratory medications. Educational interventions for health professionals may improve influenza vaccination rates among patients with COPD and patient satisfaction with care. The quality of evidence for most outcomes was low or very low due to heterogeneity and methodological limitations of the studies included in the review, which means that there is uncertainty about the benefits of any currently published educational interventions for healthcare professionals to improve COPD management in primary care. Further well-designed RCTs are needed to investigate the effects of educational interventions delivered to health professionals managing COPD in the primary care setting.
Collapse
Affiliation(s)
- Amanda J Cross
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Dennis Thomas
- Priority Research Centre for Healthy Lungs, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Jenifer Liang
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Michael J Abramson
- School of Public Health & Preventive Medicine, Monash University, Melbourne, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Elida Zairina
- Department of Pharmacy Practice, Faculty of Pharmacy, Universitas Airlangga, Surabaya, Indonesia
| |
Collapse
|
11
|
van Zanten R, van Dijk M, van Rosmalen J, Beck D, Zietse R, Van Hecke A, van Staa A, Massey EK. Nurse-led self-management support after organ transplantation-protocol of a multicentre, stepped-wedge randomized controlled trial. Trials 2022; 23:14. [PMID: 34991680 PMCID: PMC8733435 DOI: 10.1186/s13063-021-05896-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 11/30/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recipients of an organ transplantation face a number of challenges and often need to change their health behaviour. Good self-management skills are essential for optimal clinical outcomes. However, few interventions are available to support post-transplant self-management. To fill this gap, we developed a self-management support intervention offered by nurse practitioners. The primary aim of the study is to implement and test the effectiveness of the ZENN intervention in promoting self-management skills among heart, kidney liver and lung transplant recipients in comparison to standard care. The secondary aim is to assess the self-management support skills of nurse practitioners who will deliver the intervention. METHODS This multi-centre stepped-wedge randomized controlled trial will take place from September 2020 until May 2023. All departments will commence with inclusion of patients in the control period. Each department will be randomly assigned to a start date (step in the wedge) to commence the experimental period. Patients in the control period will receive standard care and will be asked to complete questionnaires at baseline (T0), 6 months (T1) and 12 months (T2), to assess self-management, self-regulation, quality of life and adherence. During the experimental period, patients will receive standard care plus the ZENN intervention and receive the same set of questionnaires as participants in the control period. Nurse practitioners will complete a baseline and follow-up questionnaire to assess differences in self-management support skills. Video recordings of outpatient clinic consultations during the control and experimental periods will determine the differences in nurses' needs-thwarting and needs-supporting skills between the control and experimental period. DISCUSSION The ZENN intervention could be a useful approach to support patients' self-management skills after organ transplantation and thus promote clinical outcomes as well as avoid adverse events. TRIAL REGISTRATION Dutch Trial Register NL8469 . Registered on March 19, 2020.
Collapse
Affiliation(s)
- Regina van Zanten
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands.
| | - Monique van Dijk
- Department of Internal Medicine, Nursing Studies, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joost van Rosmalen
- Department of Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Denise Beck
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Robert Zietse
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | - Ann Van Hecke
- Department of Public Health and Primary Care, University Centre for Nursing and Midwifery, Ghent University Hospital, Ghent, Belgium.,Department of Nursing Director, Ghent University Hospital, Ghent, Belgium
| | | | - Emma K Massey
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, The Netherlands
| | | |
Collapse
|
12
|
Abstract
Background: Chronic diseases have significant impacts on health systems worldwide and are a leading cause of death. Early diagnosis and treatment of chronic diseases are the best ways to reduce mortality and morbidity. Objectives: The aim of this study was to evaluate public access to preventive services for chronic diseases in Jeddah, Saudi Arabia. Methods: A survey of university hospital visitors was conducted in 2019. Participants were randomly selected and asked to fill a 16-question survey, including demographics, health care utilization, and type of preventive services. The chi-square test (SPSS) was used to identify any significant association between age and gender using the variable of preventive screening or counseling. Results: The majority of individuals who completed the survey (250 participants) were young, married, and male bachelor’s degree holders. About 71% of the participants received counseling services for either smoking, physical activity, weight, diet, or sleeping. More than half (58%) had undergone screening services, including breast cancer, colon cancer, diabetes, hypertension, or weight management. Chi-square analysis showed that females had a significant (P < 0.01) positive statistical relationship with the utilization of diabetes and breast cancer screening services, while males were more associated (P < 0.01) with smoking and weight-related counseling than females. Conclusions: The study demonstrated an insufficient use of preventive services and that sociodemographic differences (such as age and gender) could influence the utilization of various preventive services. Females were significantly positively associated with breast cancer and diabetes-related preventive services as these diseases are highly prevalent among females. Public education and awareness campaigns are needed to broadcast the importance of preventive services and promote better understanding and management of chronic diseases.
Collapse
|
13
|
Patient-centred innovation for multimorbidity care: a mixed-methods, randomised trial and qualitative study of the patients' experience. Br J Gen Pract 2021; 71:e320-e330. [PMID: 33753349 PMCID: PMC7997674 DOI: 10.3399/bjgp21x714293] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 10/15/2020] [Indexed: 11/06/2022] Open
Abstract
Background Patient-centred interventions to help patients with multimorbidity have had mixed results. Aim To assess the effectiveness of a provider-created, patient-centred, multi-provider case conference with follow-up, and understand under what circumstances it worked, and did not work. Design and setting Mixed-methods design with a pragmatic randomised trial and qualitative study, involving nine urban primary care sites in Ontario, Canada. Method Patients aged 18–80 years with ≥3 chronic conditions were referred to the Telemedicine IMPACT Plus intervention; a nurse and patient planned a multi-provider case conference during which a care plan could be created. The patients were randomised into an intervention or control group. Two subgroup analyses and a fidelity assessment were conducted, with the primary outcomes at 4 months being self-management and self-efficacy. Secondary outcomes were mental and physical health status, quality of life, and health behaviours. A thematic analysis explored the patients’ experiences of the intervention. Results A total of 86 patients in the intervention group and 77 in the control group showed no differences, except that the intervention improved mental health status in the subgroup with an annual income of ≥C$50 000 (β-coefficient 11.003, P = 0.006). More providers and follow-up hours were associated with poorer outcomes. Five themes were identified in the qualitative study: valuing the team, patients feeling supported, receiving a follow-up plan, being offered new and helpful additions to their treatment regimen, and experiencing positive outcomes. Conclusion Overall, the intervention showed improvements only for patients who had an annual income of ≥C$50 000, implying a need to address the costs of intervention components not covered by existing health policies. Findings suggest a need to optimise team composition by revising the number and type of providers according to patient preferences and to enhance the hours of nurse follow-up to better support the patient in carrying out the case conference’s recommendations.
Collapse
|
14
|
Fortin M, Stewart M, Ngangue P, Almirall J, Bélanger M, Brown JB, Couture M, Gallagher F, Katz A, Loignon C, Ryan BL, Sampalli T, Wong ST, Zwarenstein M. Scaling Up Patient-Centered Interdisciplinary Care for Multimorbidity: A Pragmatic Mixed-Methods Randomized Controlled Trial. Ann Fam Med 2021; 19:126-134. [PMID: 33685874 PMCID: PMC7939717 DOI: 10.1370/afm.2650] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 07/07/2020] [Accepted: 07/15/2020] [Indexed: 12/12/2022] Open
Abstract
PURPOSE To measure the effectiveness of a 4-month interdisciplinary multifaceted intervention based on a change in care delivery for patients with multimorbidity in primary care practices. METHODS A pragmatic randomized controlled trial with a mixed-methods design in patients aged 18 to 80 years with 3 or more chronic conditions from 7 family medicine groups (FMGs) in Quebec, Canada. Health care professionals (nurses, nutritionists, kinesiologists) from the FMGs were trained to deliver the patient-centered intervention based on a motivational approach and self-management support. Primary outcomes: self-management (Health Education Impact Questionnaire); and self-efficacy. SECONDARY OUTCOMES health status, quality of life, and health behaviors. Quantitative analyses used multi-level mixed effects and generalized linear mixed models controlling for clustering within FMGs. We also conducted in-depth interviews with patients, family members, and health care professionals. RESULTS The trial randomized 284 patients (144 in intervention group, 140 in control group). The groups were comparable. After 4 months, the intervention showed a neutral effect for the primary outcomes. There was significant improvement in 2 health behaviors (healthy eating with odds ratios [OR] 4.36; P = .006, and physical activity with OR 3.43; P = .023). The descriptive qualitative evaluation revealed that the patients reinforced their self-efficacy and improved their self-management which was divergent from the quantitative results. CONCLUSIONS Quantitatively, this intervention showed a neutral effect on the primary outcomes and substantial improvement in 2 health behaviors as secondary outcomes. Qualitatively, the intervention was evaluated as positive. The combination of qualitative and quantitative designs proved to be a good design for evaluating this complex intervention.
Collapse
Affiliation(s)
- Martin Fortin
- CORRESPONDING AUTHOR Martin Fortin Department of Family Medicine and Emergency Medicine Université de Sherbrooke 3001 12e Ave N Quebec, Canada, J1H 5N4
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
15
|
Murtagh S, McCombe G, Broughan J, Carroll Á, Casey M, Harrold Á, Dennehy T, Fawsitt R, Cullen W. Integrating Primary and Secondary Care to Enhance Chronic Disease Management: A Scoping Review. Int J Integr Care 2021; 21:4. [PMID: 33613136 PMCID: PMC7880002 DOI: 10.5334/ijic.5508] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 10/28/2020] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND In Ireland, as in many healthcare systems, health policy has committed to delivering an integrated model of care to address the increasing burden of chronic disease. Integrated care is an approach to healthcare systems delivery that aims to minimise fragmentation of patient services and improve care continuity. To this end, how best to integrate primary and secondary care is a challenge. This paper aims to undertake a scoping review of empirical work on the integration of primary and secondary care in relation to chronic disease management. METHODS A search was conducted of 'PubMed', 'Cochrane Library' and 'Google Scholar' for papers published between 2009-2019 using Arksey and O'Malley's framework for conducing scoping reviews. RESULTS Twenty-two studies were included. These reported research from a wide range of healthcare systems (most commonly UK, Australia, the Netherlands), adopted a range of methodologies (most commonly randomised/non-randomised controlled trials, case studies, qualitative studies) and among patients with a range of chronic conditions (most commonly diabetes, COPD, Parkinson's disease). No studies reported on interventions to address the needs of whole populations. Interventions to enhance integration included multidisciplinary teams, education of healthcare professionals, and e-health interventions. Among the effectiveness measures reported were improved disease specific outcomes, and cost effectiveness. CONCLUSION With healthcare systems increasingly recognising that integrated approaches to patient care can enhance chronic disease management, considerable literature now informs how this can be done. However, most of the research published has focussed on specific diseases and their clinical outcomes. Future research should focus on how such approaches may improve health outcomes for populations as a whole.
Collapse
Affiliation(s)
- Sara Murtagh
- School of Medicine, University College Dublin, Ireland
| | - Geoff McCombe
- School of Medicine, University College Dublin, Ireland
| | - John Broughan
- School of Medicine, University College Dublin, Ireland
| | - Áine Carroll
- School of Medicine, University College Dublin, Ireland
| | - Mary Casey
- School of Nursing Midwifery and Health Systems, University College Dublin, Ireland
| | - Áine Harrold
- School of Medicine, University College Dublin, Ireland
| | | | - Ronan Fawsitt
- School of Medicine, University College Dublin, Ireland
- Ireland East Hospital Group, Dublin, Ireland
| | - Walter Cullen
- School of Medicine, University College Dublin, Ireland
| |
Collapse
|
16
|
Ngangue PA, Forgues C, Nguyen T, Sasseville M, Gallagher F, Loignon C, Stewart M, Belle Brown J, Chouinard MC, Fortin M. Patients, caregivers and health-care professionals' experience with an interdisciplinary intervention for people with multimorbidity in primary care: A qualitative study. Health Expect 2020; 23:318-327. [PMID: 32035012 PMCID: PMC7104629 DOI: 10.1111/hex.13035] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 01/16/2020] [Accepted: 01/23/2020] [Indexed: 12/13/2022] Open
Abstract
Background Multimorbidity challenges the health‐care system and requires innovative approaches. In 2015, a 4‐month patient‐centred interdisciplinary pragmatic intervention was implemented in primary care with the aim of supporting self‐management for patients with multimorbidity. Objective To explore the perceptions and experiences of health‐care professionals, patients and their caregivers with a 4‐month patient‐centred interdisciplinary pragmatic intervention in primary care. Design A descriptive, qualitative study using semi‐structured interviews was conducted. Setting and participants A purposive sample of 30 participants was recruited from seven family medicine groups including patients, caregivers and health‐care professionals (HCPs). Interviews were analysed using Thorne's interpretive description approach. Results Findings were grouped into the benefits and challenges of participating in the intervention. The programme allowed patients to adopt realistic and adapted objectives; to customize interventions to the patient's reality; and to help patients gain confidence, improve their knowledge, skills and motivation to manage their condition. Interprofessional collaboration eased the exchange of information via team meetings and electronic medical records. Challenges were related to collaboration, communication, coordination of work and integration of newly relocated HCPs mainly due to part‐time assignments and staff turnover. HCPs part‐time schedules limited their availability and hindered patients’ follow‐up. Discussion and conclusion This intervention was useful and rewarding from the HCPs, patients and caregivers’ perspective. However, to ensure the success of this complex interdisciplinary intervention, implementers and managers should anticipate organizational barriers such as availability and time management of relocated HCPs.
Collapse
Affiliation(s)
- Patrice Alain Ngangue
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Catherine Forgues
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Tu Nguyen
- Westmead Applied Research Centre, The University of Sydney, Camperdown, NSW, Australia
| | - Maxime Sasseville
- Department of health sciences, Université du Québec à Chicoutimi, Chicoutimi, Québec, Canada
| | - Frances Gallagher
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Christine Loignon
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Moira Stewart
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Judith Belle Brown
- Centre for Studies in Family Medicine, Department of Family Medicine, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | | | - Martin Fortin
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, QC, Canada
| |
Collapse
|
17
|
Butterworth JE, Hays R, McDonagh STJ, Richards SH, Bower P, Campbell J. Interventions for involving older patients with multi-morbidity in decision-making during primary care consultations. Cochrane Database Syst Rev 2019; 2019:CD013124. [PMID: 31684697 PMCID: PMC6815935 DOI: 10.1002/14651858.cd013124.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Older patients with multiple health problems (multi-morbidity) value being involved in decision-making about their health care. However, they are less frequently involved than younger patients. To maximise quality of life, day-to-day function, and patient safety, older patients require support to identify unmet healthcare needs and to prioritise treatment options. OBJECTIVES To assess the effects of interventions for older patients with multi-morbidity aiming to involve them in decision-making about their health care during primary care consultations. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; all years to August 2018), in the Cochrane Library; MEDLINE (OvidSP) (1966 to August 2018); Embase (OvidSP) (1988 to August 2018); PsycINFO (OvidSP) (1806 to August 2018); the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (Ovid) (1982 to September 2008), then in Ebsco (2009 to August 2018); Centre for Reviews and Dissemination Databases (Database of Abstracts and Reviews of Effects (DARE)) (all years to August 2018); the Health Technology Assessment (HTA) Database (all years to August 2018); the Ongoing Reviews Database (all years to August 2018); and Dissertation Abstracts International (1861 to August 2018). SELECTION CRITERIA We sought randomised controlled trials (RCTs), cluster-RCTs, and quasi-RCTs of interventions to involve patients in decision-making about their health care versus usual care/control/another intervention, for patients aged 65 years and older with multi-morbidity in primary care. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological procedures. Meta-analysis was not possible; therefore we prepared a narrative synthesis. MAIN RESULTS We included three studies involving 1879 participants: two RCTs and one cluster-RCT. Interventions consisted of: · patient workshop and individual coaching using behaviour change techniques; · individual patient coaching utilising cognitive-behavioural therapy and motivational interviewing; and · holistic patient review, multi-disciplinary practitioner training, and organisational change. No studies reported the primary outcome 'patient involvement in decision-making' or the primary adverse outcome 'less patient involvement as a result of the intervention'. Comparing interventions (patient workshop and individual coaching, holistic patient review plus practitioner training, and organisational change) to usual care: we are uncertain whether interventions had any effect on patient reports of high self-rated health (risk ratio (RR) 1.40, 95% confidence interval (CI) 0.36 to 5.49; very low-certainty evidence) or on patient enablement (mean difference (MD) 0.60, 95% CI -9.23 to 10.43; very low-certainty evidence) compared with usual care. Interventions probably had no effect on health-related quality of life (adjusted difference in means 0.00, 95% CI -0.02 to 0.02; moderate-certainty evidence) or on medication adherence (MD 0.06, 95% CI -0.05 to 0.17; moderate-certainty evidence) but probably improved the number of patients discussing their priorities (adjusted odds ratio 1.85, 95% CI 1.44 to 2.38; moderate-certainty evidence) and probably increased the number of nurse consultations (incident rate ratio from adjusted multi-level Poisson model 1.37, 95% CI 1.17 to 1.61; moderate-certainty evidence) compared with usual care. Practitioner outcomes were not measured. Interventions were not reported to adversely affect rates of participant death or anxiety, emergency department attendance, or hospital admission compared with usual care. Comparing interventions (patient workshop and coaching, individual patient coaching) to attention-control conditions: we are uncertain whether interventions affect patient-reported high self-rated health (RR 0.38, 95% CI 0.15 to 1.00, favouring attention control, with very low-certainty evidence; RR 2.17, 95% CI 0.85 to 5.52, favouring the intervention, with very low-certainty evidence). We are uncertain whether interventions affect patient enablement and engagement by increasing either patient activation (MD 1.20, 95% CI -8.21 to 10.61; very low-certainty evidence) or self-efficacy (MD 0.29, 95% CI -0.21 to 0.79; very low-certainty evidence); or whether interventions affect the number of general practice visits (MD 0.51, 95% CI -0.34 to 1.36; very low-certainty evidence), compared to attention-control conditions. The intervention may however lead to more patient-reported changes in management of their health conditions (RR 1.82, 95% CI 1.35 to 2.44; low-certainty evidence). Practitioner outcomes were not measured. Interventions were not reported to adversely affect emergency department attendance nor hospital admission when compared with attention control. Comparing one form of intervention with another: not measured. There was 'unclear' risk across studies for performance bias, detection bias, and reporting bias; however, no aspects were 'high' risk. Evidence was downgraded via GRADE, most often because of 'small sample size' and 'evidence from a single study'. AUTHORS' CONCLUSIONS Limited available evidence does not allow a robust conclusion regarding the objectives of this review. Whilst patient involvement in decision-making is seen as a key mechanism for improving care, it is rarely examined as an intervention and was not measured by included studies. Consistency in design, analysis, and evaluation of interventions would enable a greater likelihood of robust conclusions in future reviews.
Collapse
Affiliation(s)
- Joanne E Butterworth
- University of Exeter Medical SchoolUniversity of Exeter Collaboration for Academic Primary Care (APEx)Smeall BuildingSt Luke's CampusExeterDevonUKEX1 2LU
| | - Rebecca Hays
- University of ManchesterNIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care5th Floor, Williamson BuildingOxford RoadManchesterUKM13 9PL
| | - Sinead TJ McDonagh
- University of Exeter Medical SchoolUniversity of Exeter Collaboration for Academic Primary Care (APEx)Smeall BuildingSt Luke's CampusExeterDevonUKEX1 2LU
| | - Suzanne H Richards
- University of LeedsLeeds Institute of Health SciencesCharles Thackrah Building101 Clarendon RoadLeedsUKLS2 9LJ
| | - Peter Bower
- University of ManchesterNIHR School for Primary Care Research, Manchester Academic Health Science Centre, Division of Population Health, Health Services Research and Primary Care5th Floor, Williamson BuildingOxford RoadManchesterUKM13 9PL
| | - John Campbell
- University of Exeter Medical SchoolUniversity of Exeter Collaboration for Academic Primary Care (APEx)Smeall BuildingSt Luke's CampusExeterDevonUKEX1 2LU
| | | |
Collapse
|
18
|
Dineen-Griffin S, Garcia-Cardenas V, Williams K, Benrimoj SI. Helping patients help themselves: A systematic review of self-management support strategies in primary health care practice. PLoS One 2019; 14:e0220116. [PMID: 31369582 PMCID: PMC6675068 DOI: 10.1371/journal.pone.0220116] [Citation(s) in RCA: 225] [Impact Index Per Article: 45.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2018] [Accepted: 07/09/2019] [Indexed: 12/11/2022] Open
Abstract
Background Primary health professionals are well positioned to support the delivery of patient self-management in an evidence-based, structured capacity. A need exists to better understand the active components required for effective self-management support, how these might be delivered within primary care, and the training and system changes that would subsequently be needed. Objectives (1) To examine self-management support interventions in primary care on health outcomes for a wide range of diseases compared to usual standard of care; and (2) To identify the effective strategies that facilitate positive clinical and humanistic outcomes in this setting. Method A systematic review of randomized controlled trials evaluating self-management support interventions was conducted following the Cochrane handbook & PRISMA guidelines. Published literature was systematically searched from inception to June 2019 in PubMed, Scopus and Web of Science. Eligible studies assessed the effectiveness of individualized interventions with follow-up, delivered face-to-face to adult patients with any condition in primary care, compared with usual standard of care. Matrices were developed that mapped the evidence and components for each intervention. The methodological quality of included studies were appraised. Results 6,510 records were retrieved. 58 studies were included in the final qualitative synthesis. Findings reveal a structured patient-provider exchange is required in primary care (including a one-on-one patient-provider consultation, ongoing follow up and provision of self-help materials). Interventions should be tailored to patient needs and may include combinations of strategies to improve a patient’s disease or treatment knowledge; independent monitoring of symptoms, encouraging self-treatment through a personalized action plan in response worsening symptoms or exacerbations, psychological coping and stress management strategies, and enhancing responsibility in medication adherence and lifestyle choices. Follow-up may include tailored feedback, monitoring of progress with respect to patient set healthcare goals, or honing problem-solving and decision-making skills. Theoretical models provided a strong base for effective SMS interventions. Positive outcomes for effective SMS included improvements in clinical indicators, health-related quality of life, self-efficacy (confidence to self-manage), disease knowledge or control. An SMS model has been developed which sets the foundation for the design and evaluation of practical strategies for the construct of self-management support interventions in primary healthcare practice. Conclusions These findings provide primary care professionals with evidence-based strategies and structure to deliver SMS in practice. For this collaborative partnership approach to be more widely applied, future research should build on these findings for optimal SMS service design and upskilling healthcare providers to effectively support patients in this collaborative process.
Collapse
Affiliation(s)
- Sarah Dineen-Griffin
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
- * E-mail:
| | | | - Kylie Williams
- Graduate School of Health, University of Technology Sydney, Sydney, Australia
| | | |
Collapse
|
19
|
Contant É, Loignon C, Bouhali T, Almirall J, Fortin M. A multidisciplinary self-management intervention among patients with multimorbidity and the impact of socioeconomic factors on results. BMC FAMILY PRACTICE 2019; 20:53. [PMID: 31010425 PMCID: PMC6477711 DOI: 10.1186/s12875-019-0943-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2017] [Accepted: 04/04/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Limited studies exist on successful interventions for patients with multimorbidity. Even more limited is the knowledge on how socioeconomic factors have an impact on these interventions. The objective of this study was to analyze the effect of a multidisciplinary self-management intervention among patients with multimorbidity and the impact of socioeconomic factors on the results. METHODS Secondary data analysis limited to multimorbid patients from of a pragmatic randomized trial evaluating an intervention that included patients (18 to 75 yrs.) from eight primary care practices in Quebec, Canada. The intervention included self-management support and patient-centred motivational approaches. Self-management was evaluated using the Health Education Impact Questionnaire (heiQ) which measures eight different domains. Changes in heiQ were analyzed following the three-month intervention with univariate and multivariate logistic regressions. RESULTS Participants with three or more chronic conditions (n = 281), randomized to intervention or control groups, were included in this analysis. The effect of the intervention on the likelihood of an improvement in self-management was significant in six heiQ domains in the univariate analysis (Odd ratio; 95% CI): Health-directed behaviour (2.03; 1.16-3.55), Emotional well-being (1.97; 1.05-3.68), Self-monitoring and insight (2.35; 1.02-5.40), Constructive attitudes and approaches (2.91; 1.45-5.84), Skill and technique acquisition (1.96; 1.13-3.39), and Health services navigation (2.52; 1.21-5.21). After controlling for age and gender the results remained essentially the same. After additional adjustments for family income, education and self-perceived financial status, the likelihood of an improvement was no longer significant in the domains Emotional well-being and Self-monitoring and insight. CONCLUSIONS The intervention produced significant improvements in multimorbid patients for most domains of self-management. Socioeconomic factors had a minor impact on the results. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01319656.
Collapse
Affiliation(s)
- Éric Contant
- Postgraduate student, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Quebec, Canada
| | - Christine Loignon
- Family Medicine Department, Université de Sherbrooke, Quebec, Canada
| | - Tarek Bouhali
- Family Medicine Department, Université de Sherbrooke, Quebec, Canada
| | - José Almirall
- Family Medicine Department, Université de Sherbrooke, Quebec, Canada
| | - Martin Fortin
- Professor, Family Medicine Department, Université de Sherbrooke, Quebec, Canada. .,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, 305 St-Vallier, Chicoutimi (Québec), G7H 5H6, Canada.
| |
Collapse
|
20
|
Salisbury C, Man MS, Chaplin K, Mann C, Bower P, Brookes S, Duncan P, Fitzpatrick B, Gardner C, Gaunt DM, Guthrie B, Hollinghurst S, Kadir B, Lee V, McLeod J, Mercer SW, Moffat KR, Moody E, Rafi I, Robinson R, Shaw A, Thorn J. A patient-centred intervention to improve the management of multimorbidity in general practice: the 3D RCT. HEALTH SERVICES AND DELIVERY RESEARCH 2019. [DOI: 10.3310/hsdr07050] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background
People with multimorbidity experience impaired quality of life, poor health and a burden from treatment. Their care is often disease-focused rather than patient-centred and tailored to their individual needs.
Objective
To implement and evaluate a patient-centred intervention to improve the management of patients with multimorbidity in general practice.
Design
Pragmatic, cluster randomised controlled trial with parallel process and economic evaluations. Practices were centrally randomised by a statistician blind to practice identifiers, using a computer-generated algorithm.
Setting
Thirty-three general practices in three areas of England and Scotland.
Participants
Practices had at least 4500 patients and two general practitioners (GPs) and used the EMIS (Egton Medical Information Systems) computer system. Patients were aged ≥ 18 years with three or more long-term conditions.
Interventions
The 3D (Dimensions of health, Depression and Drugs) intervention was designed to offer patients continuity of care with a named GP, replacing separate reviews of each long-term condition with comprehensive reviews every 6 months. These focused on individualising care to address patients’ main problems, attention to quality of life, depression and polypharmacy and on disease control and agreeing treatment plans. Control practices provided usual care.
Outcome measures
Primary outcome – health-related quality of life (assessed using the EuroQol-5 Dimensions, five-level version) after 15 months. Secondary outcomes – measures of illness burden, treatment burden and patient-centred care. We assessed cost-effectiveness from a NHS and a social care perspective.
Results
Thirty-three practices (1546 patients) were randomised from May to December 2015 [16 practices (797 patients) to the 3D intervention, 17 practices (749 patients) to usual care]. All participants were included in the primary outcome analysis by imputing missing data. There was no evidence of difference between trial arms in health-related quality of life {adjusted difference in means 0.00 [95% confidence interval (CI) –0.02 to 0.02]; p = 0.93}, illness burden or treatment burden. However, patients reported significant benefits from the 3D intervention in all measures of patient-centred care. Qualitative data suggested that both patients and staff welcomed having more time, continuity of care and the patient-centred approach. The economic analysis found no meaningful differences between the intervention and usual care in either quality-adjusted life-years [(QALYs) adjusted mean QALY difference 0.007, 95% CI –0.009 to 0.023] or costs (adjusted mean difference £126, 95% CI –£739 to £991), with wide uncertainty around point estimates. The cost-effectiveness acceptability curve suggested that the intervention was unlikely to be either more or less cost-effective than usual care. Seventy-eight patients died (46 in the intervention arm and 32 in the usual-care arm), with no evidence of difference between trial arms; no deaths appeared to be associated with the intervention.
Limitations
In this pragmatic trial, the implementation of the intervention was incomplete: 49% of patients received two 3D reviews over 15 months, whereas 75% received at least one review.
Conclusions
The 3D approach reflected international consensus about how to improve care for multimorbidity. Although it achieved the aim of providing more patient-centred care, this was not associated with benefits in quality of life, illness burden or treatment burden. The intervention was no more or less cost-effective than usual care. Modifications to the 3D approach might improve its effectiveness. Evaluation is needed based on whole-system change over a longer period of time.
Trial registration
Current Controlled Trials ISRCTN06180958.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 7, No. 5. See the NIHR Journals Library website for further project information.
Collapse
Affiliation(s)
- Chris Salisbury
- Centre for Academic Primary Care, National Institute for Health Research School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Mei-See Man
- Centre for Academic Primary Care, National Institute for Health Research School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Katherine Chaplin
- Centre for Academic Primary Care, National Institute for Health Research School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cindy Mann
- Centre for Academic Primary Care, National Institute for Health Research School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Bower
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Sara Brookes
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Polly Duncan
- Centre for Academic Primary Care, National Institute for Health Research School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Caroline Gardner
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Daisy M Gaunt
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bruce Guthrie
- Population Health Sciences Division, School of Medicine, University of Dundee, Dundee, UK
| | - Sandra Hollinghurst
- Centre for Academic Primary Care, National Institute for Health Research School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Bryar Kadir
- Bristol Randomised Trials Collaboration, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Victoria Lee
- National Institute for Health Research School for Primary Care Research, Centre for Primary Care, Division of Population of Health, Health Services Research and Primary Care, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - John McLeod
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stewart W Mercer
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Keith R Moffat
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Emma Moody
- Bristol Clinical Commissioning Group, Bristol, UK
| | - Imran Rafi
- Royal College of General Practitioners, London, UK
| | | | - Alison Shaw
- Centre for Academic Primary Care, National Institute for Health Research School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Joanna Thorn
- Centre for Academic Primary Care, National Institute for Health Research School for Primary Care Research, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
21
|
Fortin M, Chouinard MC, Diallo BB, Bouhali T. Integration of chronic disease prevention and management services into primary care (PR1MaC): findings from an embedded qualitative study. BMC FAMILY PRACTICE 2019; 20:7. [PMID: 30626313 PMCID: PMC6325817 DOI: 10.1186/s12875-018-0898-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Accepted: 12/27/2018] [Indexed: 01/08/2023]
Abstract
Background The PR1MaC study was conducted to evaluate the integration of Chronic Disease Prevention and Management services into primary care practices and was reported effective. The aim of this study was to further explore the effects of the PR1MaC intervention on patients and their family. Methods We conducted a qualitative study embedded in a randomized controlled trial. The trial was implemented in eight primary health care practices in the Saguenay region, Quebec, Canada. The interdisciplinary patient-centred team-based intervention included self-management support and a motivational approach. We conducted focus groups and semi-directed individual interviews with patients, family members and healthcare professionals. Results Perceived positive effects can be grouped into six major themes: awareness, improved knowledge, improved motivation and empowerment, adoption of healthy behaviours, improvement of health status and improvement of quality of life. On the negative side, some participants reported lack of sustainability of newly acquired benefits in the months following the intervention. Conclusions Integrating chronic disease prevention and management services into primary care settings had impacts on patients and their family members. These findings are consistent with findings that were reported in the quantitative study. Further studies should address longterm sustainabilility in terms of benefits for the patients. Trial registration ClinicalTrials.gov, no.: NCT01319656. Electronic supplementary material The online version of this article (10.1186/s12875-018-0898-z) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Martin Fortin
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke 3001, 12e avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada. .,Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, Hôpital de Chicoutimi, 305, Saint-Vallier, Chicoutimi, Quebec, G7H 5H6, Canada.
| | - Maud-Christine Chouinard
- Département des sciences de la santé, Université du Québec à Chicoutimi, 555, boulevard de l'Université, Chicoutimi, Québec, G7H 2B1, Canada
| | - Bayero Boubacar Diallo
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke 3001, 12e avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| | - Tarek Bouhali
- Département de médecine de famille et de médecine d'urgence, Université de Sherbrooke, Sherbrooke 3001, 12e avenue Nord, Sherbrooke, Québec, J1H 5N4, Canada
| |
Collapse
|
22
|
Fortin M. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:e512-e513. [PMID: 30541814 PMCID: PMC6371878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Martin Fortin
- Médecin de famille à l'Unité de médecine de famille de l'Hôpital de Chicoutimi et au Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean, au Québec, professeur titulaire au Département de médecine de famille et de médecine d'urgence de l'Université de Sherbrooke, au Québec, et titulaire de la Chaire de recherche sur les maladies chroniques en soins de première ligne.
| |
Collapse
|
23
|
Fortin M. "It-that-must-not-be-named": Addressing patient discomfort with the term multimorbidity. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2018; 64:881-882. [PMID: 30541799 PMCID: PMC6371864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Affiliation(s)
- Martin Fortin
- Family physician in the Family Medicine Unit at the Chicoutimi Hospital and at the Centre intégré universitaire de santé et de services sociaux du Saguenay-Lac-Saint-Jean in Quebec, Full Professor in the Department of Family Medicine and Emergency Medicine at the University of Sherbrooke in Quebec, and Research Chair on Chronic Diseases in Primary Care.
| |
Collapse
|
24
|
Bringsvor HB, Langeland E, Oftedal BF, Skaug K, Assmus J, Bentsen SB. Effects of a COPD self-management support intervention: a randomized controlled trial. Int J Chron Obstruct Pulmon Dis 2018; 13:3677-3688. [PMID: 30510410 PMCID: PMC6231510 DOI: 10.2147/copd.s181005] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND This study examines the effects of the COPD-specific health promoting self-management intervention "Better living with COPD" on different self-management-related domains, self-efficacy, and sense of coherence (SOC). METHODS In a randomized controlled design, 182 people with COPD were allocated to either an intervention group (offered Better living with COPD in addition to usual care) or a control group (usual care). Self-management-related domains were measured by the Health Education Impact Questionnaire (heiQ) before and after intervention. Self-efficacy was measured by the General Self-Efficacy Scale (GSE) and SOC was measured by the 13-item Sense of Coherence Scale (SOC-13). Effects were assessed by ANCOVA, using intention-to-treat (ITT) analysis and per-protocol analysis (PPA). RESULTS The PPA and the ITT analysis showed significant positive changes on Constructive attitudes and approaches (heiQ) (ITT: P=0.0069; PPA: P=0.0021) and Skill and technique acquisition (heiQ) (ITT: P=0.0405; PPA: P=0.0356). Self-monitoring and insight (heiQ) showed significant positive change in the PPA (P=0.0494). No significant changes were found on the other self-management domains (heiQ), self-efficacy (GSE), or SOC (SOC-13). CONCLUSION Better living with COPD had a significant positive short-term effect on some self-management-related domains, and could be an intervention contributing to the support of self-management in people with COPD. However, further work is needed to establish the clinical relevance of the findings and to evaluate the long-term effects.
Collapse
Affiliation(s)
- Heidi B Bringsvor
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway,
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway,
| | - Eva Langeland
- Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Bjørg Frøysland Oftedal
- Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway,
| | - Knut Skaug
- Department of Research and Innovation, Helse Fonna HF, Haugesund, Norway,
| | - Jörg Assmus
- Center for Clinical Research, Department of Reserach and Innovation, Haukeland University Hospital, Bergen, Norway
| | - Signe Berit Bentsen
- SHARE-Centre for Resilience in Health Care, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, Stavanger, Norway
| |
Collapse
|
25
|
Braillard O, Slama-Chaudhry A, Joly C, Perone N, Beran D. The impact of chronic disease management on primary care doctors in Switzerland: a qualitative study. BMC FAMILY PRACTICE 2018; 19:159. [PMID: 30205832 PMCID: PMC6134721 DOI: 10.1186/s12875-018-0833-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Accepted: 08/14/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Patient-centeredness and therapeutic relationship are widely explored as a means to address the challenge of chronic disease and multi-morbidity management, however research focusing on the perspective of doctors is still rare. In this study, we aimed to explore the impact of the patient's chronic disease(s) on their healthcare provider. METHODS A qualitative approach was taken using semi-structured interviews with general practitioners working in outpatient clinics either in individual practices or in a hospital setting in Geneva, Switzerland. Codes were developed through an iterative process and using grounded theory an inductive coding scheme was performed to identify the key themes. Throughout the analysis process the research team reviewed the analysis and refined the coding scheme. RESULTS Twenty interviews, 10 in each practice type, allowed for saturation to be reached. The following themes relevant to the impact of managing chronic diseases emerge around the issue of feeling powerless as a doctor; facing the patient's socio-economic context; guidelines versus the reality of the patient; time; and taking on the patient's burden. Primary care practitioners face an emotional burden linked with their powerlessness and work conditions, but also with the empathetic bond with their patients and their circumstances. Doctors seem poorly prepared for this emotional strain. The health system is also not facilitating this with time constraints and guidelines unsuitable for the patient's reality. CONCLUSIONS Chronic disease and multi-morbidity management is a challenge for healthcare providers. This has its roots in patient characteristics, the overall health system and healthcare providers themselves. Structural changes need to be implemented at different levels: medical education; health systems; adapted guidelines; leading to an overall environment that favors the development of the therapeutic relationship.
Collapse
Affiliation(s)
- Olivia Braillard
- Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals, 1205, Geneva, Switzerland.
| | - Anbreen Slama-Chaudhry
- Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - Catherine Joly
- Department of Community Medicine, Primary and Emergency Care, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - Nicolas Perone
- Department of Community Health and Care, Geneva University Hospitals, 1205, Geneva, Switzerland
| | - David Beran
- Division of Tropical and Humanitarian Medicine, Geneva University Hospitals and University of Geneva, 1205, Geneva, Switzerland
| |
Collapse
|
26
|
de Leeuw S. Courage, relationships, and applicability: Big research from small places. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:708-711. [PMID: 28904040 PMCID: PMC5597019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|
27
|
de Leeuw S. [Not Available]. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:e400-e403. [PMID: 28904051 PMCID: PMC5597031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
|