Gender differences in chronic pain related health care utilization

Aims

To investigate predictors for health-care utilization for chronic pain and whether there are gender differences in variables predicting chronic pain-related health care utilization.

Methods

A postal questionnaire measuring socio-demographic variables, pain characteristics, health related quality of life (HRQoL) and pain related health care utilization, was sent to a sample of 4500 individuals randomly drawn from the national population of Iceland. The relationships between socio-demographic and pain related variables and pain related health care utilization among participants reporting chronic pain (≥3 months) were tested by using bivariate and multivariate statistical analysis.

Results

The prevalence of chronic pain among respondents was 47.5%. Among participants reporting chronic pain, 53.2% had consulted a health care provider for pain during the previous six months.Predictors for pain related health care utilization were pain interference with daily life and pain pattern (daily pain) as well as physical components of HRQoL. Even though health care utilization was not related to gender, there were gender differences in pain-related predictors for health care utilization. Interference with daily life and pain pattern were the strongest predictors among women, but interference with life and the physical components of HRQoL were the strongest predictors for men. Pain related health care utilization was not related to socio-demographic variables.

Conclusions

Pain related variables are better predictors of chronic pain related health care utilization than socio-demographics. Even though gender does not predict chronic pain-related health care utilization, there are gender differences in the relationships between pain-related variables and health care utilization. These gender differences warrant further exploration.

Chronic pain-related patient-provider communication: The significance of health related quality of life and satisfaction

Aims

To investigate patients’ perception of chronic pain related patient-provider communication in relation to socio-demographic and pain-related variables.

Methods

Apostal questionnaire measuring socio-demographic variables, pain characteristics, health-related quality of life (HRQoL), pain-related health care utilization and perceived patient provider communication, was sent to a sample of 4500 individuals randomly drawn from the national population of Iceland. Relationships between patient perceived patient-provider communication and perceived outcome, satisfaction with care as well as sociodemographic and pain-related variables were tested by using bivariate and multivariate statistical analysis.

Results

The prevalence of chronic pain (≥3months) among respondents was 47.5%. Among participants reporting chronic pain, 53.2% had consulted a health care provider for pain during the previous six months. Patients’ perception of providers’ behaviour and control in the communication was mostly related to pain impact on daily life and physical components of HRQoL as well as to patients’ satisfaction with health care providers. The more pain interfered with daily life and impaired patients’ physical health, the more they felt that the provider did not spend time to listen to their concerns and discuss symptoms and treatment options. Patients’ perception of own activity and control in the patient-provider communication and participation in care was related to socio-demographic variables but not with pain related variables.

Conclusions

To be understood as an individual and having their concerns legitimized by the health care provider is crucial for patients when consulting health care for chronic pain. The more pain interferes with daily life and impairs HRQoL, the more important this is. Patients’ perception of own control in patient-provider communication and participation in care is more related to socio-demographics than pain related variables.

Does physical exercise in addition to a multicomponent smoking cessation program increase abstinence rate and suppress weight gain? An intervention study

Does physical exercise in addition to a multicomponent smoking cessation program increase abstinence rate and suppress weight gain? An intervention study Tobacco use is considered the single most preventable cause of premature morbidity and mortality. Smoking cessation programs aim at two interrelated purposes, to help people to give up smoking and to prevent relapse. A multicomponent intervention consisting of nicotine replacement therapy, health education, behaviour modification therapy and counselling is widely recommended in the health care literature. Smoking cessation studies from a nursing perspective are few. The purpose of this quasi-experimental study was to compare outcomes of two nurse-managed 1-year group smoking cessation interventions. Intervention 1 (n=34) was provided at a health care centre and consisted of nicotine replacement therapy, health education, behavioural modification and individual and group counselling. In intervention 2 (n=33), provided in a health club, physical exercise was added to the intervention provided in 1. Participants were self-referred with equal numbers in both interventions. A nonsignificant difference in lapse free abstinence time (LFAT) at 1 year was demonstrated between intervention 1 (20.6%, n=7) and intervention 2 (39.4%, n=13) (p=0.16, odds ratio=2.5). The difference in weight gain between intervention groups was also nonsignificant. Within intervention comparison between abstinent participants and smokers showed that abstinent participants had gained significantly more weight than smokers in intervention 2 (p=0.001), but in intervention 1 the difference was nonsignificant (p=0.2). The small sample size in the study detracts from the significance of the findings. However, a trend is observed showing that physical exercise increases the abstinence rate of participants. The conclusion is drawn that a multicomponent smoking cessation program that includes physical exercise might be an effective intervention, but further studies with a larger sample size are needed.

Group reminiscence among people with end-stage chronic lung diseases

BACKGROUND

Reminiscence is a process of recalling long-forgotten memorable experiences and events through verbal interaction between the person eliciting memories and one or more persons. Reminiscence is considered an effective treatment for various groups of people, particularly the elderly.

AIM

This paper describes an intervention study on group reminiscence intervention for people with end-stage chronic lung diseases. The following hypotheses were proposed: (1) Depression in people with end-stage chronic lung diseases will decrease after participating in a reminiscence group. (2) Self-esteem in people with end-stage chronic lung diseases will increase after participating in a reminiscence group. (3) People with end-stage chronic lung diseases will report increased well-being after participating in a reminiscence group.

METHODS

The research design was quasi-experimental, using Beck Depression Inventory and Rosenberg's Self-Esteem Survey pre- and posttreatment, in addition to conducting semistructured interviews after the treatment was finished and qualitatively evaluating outcomes of selected nursing diagnosis. A total of 12 patients participated, 10 women (mean age 70 years) and two men (mean age 86 years). The treatment was provided by two nurses to a group of patients dwelling at a long-term unit for people with end-stage lung diseases located in Iceland. A total of 13 group meetings were held, with 5-8 participants each time. Each group meeting had a preselected focus. It started with a short period of relaxation followed by a selected reading from a biography or from Icelandic literature and then the group discussion started, focusing on the topic of the day.

RESULTS

The first two hypotheses were not supported. The following themes support the third hypothesis: (a) enjoyment, (b) feeling well and (c) closeness and affirmation of self and others.

CONCLUSIONS

The purpose of the study was partly achieved. Although hypotheses one and two were not supported, the third was supported by the qualitative results, which clearly demonstrated that participation in the intervention increased well-being.

Outcomes of implementing primary nursing in the care of people with chronic lung diseases: the nurses' experience

AIM

This study describes the outcomes of an action research project carried out to implement primary nursing in the care of people with chronic lung diseases at two hospital units in Iceland.

METHODS

The methodological approach was the interpretative perspective. Data from transcribed interviews with 21 nurses and a research journal written by the author were analysed. Themes were generated according to dialectical procedures of interpretation.

FINDINGS

The following themes were identified: close relationships with patients, continuity of care, reports of satisfied and secure patients, centrality of individual patient's needs, constant refinement of the system, sensitivity to staffing load and ambitious and responsible nurses.

CONCLUSIONS

The nurses participating in this study clearly valued the possibilities that primary nursing brought in terms of higher quality of care for their patients. One of the most important components of high quality care is to know and understand patients' experiences, which is the main outcome of this study. This indicates that implementing primary nursing in the care of people with chronic lung diseases was beneficial from the point of view of the nurses. However, concerns were raised that primary nursing is more sensitive to low staffing than the system it was meant to replace.

Life patterns of people with chronic obstructive pulmonary disease: isolation and being closed in

This study is based on Newman's theory of health as expanding consciousness and applies Newman's hermeneutic dialectic method and hermeneutic phenomenology in describing the experience of people with chronic obstructive pulmonary disease. The researcher engaged in five in-depth interviews with 10 people. Results demonstrate the participants' life pattern of isolation and being closed in. Core themes characterizing the life pattern are resignation to the situation as it is, unsuccessful solutions to traumatic events, and difficulties in expressing oneself and relating to others. None of the participants had experienced the turning point central to the process of expanding consciousness.