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Springgate B, Tang L, Ong M, Aoki W, Chung B, Dixon E, Johnson MD, Jones F, Landry C, Lizaola E, Mtume N, Ngo VK, Pulido E, Sherbourne C, Wright AL, Whittington Y, Williams P, Zhang L, Miranda J, Belin T, Gilmore J, Jones L, Wells KB. Comparative Effectiveness of Coalitions Versus Technical Assistance for Depression Quality Improvement in Persons with Multiple Chronic Conditions. Ethn Dis 2018. [PMID: 30202185 DOI: 10.18865/ed.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/30/2023] Open
Abstract
SIGNIFICANCE Prior research suggests that Community Engagement and Planning (CEP) for coalition support compared with Resources for Services (RS) for program technical assistance to implement depression quality improvement programs improves 6- and 12-month client mental-health related quality of life (MHRQL); however, effects for clients with multiple chronic medical conditions (MCC) are unknown. OBJECTIVE To explore effectiveness of CEP vs RS in MCC and non-MCC subgroups. DESIGN Secondary analyses of a cluster-randomized trial. SETTING 93 health care and community-based programs in two neighborhoods. PARTICIPANTS Of 4,440 clients screened, 1,322 depressed (Patient Health Questionnaire, PHQ8) provided contact information, 1,246 enrolled and 1,018 (548 with ≥3 MCC) completed baseline, 6- or 12-month surveys. INTERVENTION CEP or RS for implementing depression quality improvement programs. OUTCOMES AND ANALYSES Primary: depression (PHQ9 <10), poor MHRQL (Short Form Health Survey, SF-12<40); Secondary: mental wellness, good physical health, behavioral health hospitalization, chronic homelessness risk, work/workloss days, services use at 6 and 12 months. End-point regressions were used to estimate intervention effects on outcomes for subgroups with ≥3 MCC, non-MCC, and intervention-by-MCC interactions (exploratory). RESULTS Among MCC clients at 6 months, CEP vs RS lowered likelihoods of depression and poor MHRQL; increased likelihood of mental wellness; reduced work-loss days among employed and likelihoods of ≥4 behavioral-health hospitalization nights and chronic homelessness risk, while increasing faith-based and park community center depression services; and at 12 months, likelihood of good physical health and park community center depression services use (each P<.05). There were no significant interactions or primary outcome effects for non-MCC. CONCLUSIONS CEP was more effective than RS in improving 6-month primary outcomes among depressed MCC clients, without significant interactions.
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Affiliation(s)
- Benjamin Springgate
- Louisiana State University, Department of Medicine, School of Medicine, New Orleans, LA
| | - Lingqi Tang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Michael Ong
- David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Wayne Aoki
- Los Angeles Christian Health Centers, Los Angeles CA
| | - Bowen Chung
- Los Angeles County Department of Mental Health Services, UCLA-Harbor General Hospital, David Geffen School of Medicine and Semel Institute at UCLA, RAND Health Program, Los Angeles CA
| | - Elizabeth Dixon
- School of Nursing, University of California, Los Angeles, Los Angeles CA
| | - Megan Dwight Johnson
- Greater Los Angeles Veteran Affairs Health Care System, Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at UCLA, Los Angeles CA
| | - Felica Jones
- Healthy African American Families II, Los Angeles, CA
| | - Craig Landry
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Elizabeth Lizaola
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | | | | | | | | | - Aziza Lucas Wright
- The RAND Corporation, Healthy African American Families II, New Vision Church of Jesus Christ, Los Angeles CA
| | | | - Pluscedia Williams
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles, CA
| | - Lily Zhang
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute at UCLA, Los Angeles CA
| | - Jeanne Miranda
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine and Semel Institute, Los Angeles CA
| | - Thomas Belin
- Department of Biostatistics, Fielding School of Public Health, South Los Angeles CA
| | | | - Loretta Jones
- Healthy African American Families II, Charles R Drew University of Medicine and Science, Los Angeles CA
| | - Kenneth B Wells
- Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, Semel Institute, Department of Health Policy and Management, Fielding School of Public Health at UCLA; RAND Health Program, Los Angeles CA
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Tayer-Shifman OE, Bar-On Y, Pereg D, Hershko AY. Physical Training in a Medical Fitness Room for Patients with Chronic Diseases: Functional and Metabolic Outcomes. Isr Med Assoc J 2018; 20:20-24. [PMID: 29658202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND Physical inactivity is a pivotal factor in the development and progression of various chronic diseases. However, most fitness facilities exclude unhealthy individuals. Therefore, an exercise program that admits such patients is imperative. OBJECTIVES To evaluate the effectiveness of a fitness facility that admits adult subjects with multiple chronic diseases. METHODS We conducted a retrospective screening of patient records from the Medical Fitness Facility at Meir Medical Center, Israel. Intake of subjects was done by a multidisciplinary team. For each individual, personalized diet and exercise plans were developed and patients attended the facility twice a week. Each participant was evaluated at enrolment and after 4 months for well-being, metabolic parameters, exercise capacity, and laboratory blood tests. RESULTS A total of 838 individuals were enrolled, mean age 57 years. Their medical conditions included dyslipidemia (48.8%), hypertension (37.6%), and diabetes mellitus (24.9%), followed by musculoskeletal problems (arthropathy 19%, lower back pain 16.1%) and ischemic heart disease (13.4%). Less common diagnoses were vascular diseases, pulmonary diseases, and malignancy. Only 40.5% of participants adhered to the regimen with advanced age being the best predictor for adherence. At the follow-up visit, body mass index was lower (31.2 vs. 30.2 kg/m2, P <0.0001), exercise capacity increased (measured as maximal MET; 7.1 vs. 8.1, P < 0.0001), and well-being improved (measured by Short Form Survey [SF-36]; 69.3 vs. 76.0, P <0.0001). CONCLUSIONS We show that a fitness program for patients with multiple chronic diseases is feasible and effective in improving prognostic parameters, albeit significantly challenged by adherence limitations.
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Affiliation(s)
| | - Yigal Bar-On
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba, Israel
- Rehabilitation Center, Meir Medical Center, Kfar Saba, Israel
| | - David Pereg
- Department of Cardiology, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Alon Y Hershko
- Department of Internal Medicine B, Meir Medical Center, Kfar Saba, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Lim CY, Berry ABL, Hirsch T, Hartzler AL, Wagner EH, Ludman EJ, Ralston JD. Understanding What Is Most Important to Individuals with Multiple Chronic Conditions: A Qualitative Study of Patients' Perspectives. J Gen Intern Med 2017; 32:1278-1284. [PMID: 28849368 PMCID: PMC5698221 DOI: 10.1007/s11606-017-4154-3] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 07/19/2017] [Accepted: 07/28/2017] [Indexed: 11/24/2022]
Abstract
BACKGROUND To improve care for individuals living with multiple chronic conditions, patients and providers must align care planning with what is most important to patients in their daily lives. We have a limited understanding of how to effectively encourage communication about patients' personal values during clinical care. OBJECTIVE To identify what patients with multiple chronic conditions describe as most important to their well-being and health. DESIGN We interviewed individuals with multiple chronic conditions in their homes and analyzed results qualitatively, guided by grounded theory. PARTICIPANTS A total of 31 patients (mean age 68.7 years) participated in the study, 19 of which included the participation of family members. Participants were from Kaiser Permanente Washington, an integrated health care system in Washington state. APPROACH Qualitative analysis of home visits, which consisted of semi-structured interviews aided by photo elicitation. KEY RESULTS Analysis revealed six domains of what patients described as most important for their well-being and health: principles, relationships, emotions, activities, abilities, and possessions. Personal values were interrelated and rarely expressed as individual values in isolation. CONCLUSIONS The domains describe the range and types of personal values multimorbid older adults deem important to well-being and health. Understanding patients' personal values across these domains may be useful for providers when developing, sharing, and following up on care plans.
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Affiliation(s)
- Catherine Y Lim
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA.
| | | | - Tad Hirsch
- University of Washington, Seattle, WA, USA
| | - Andrea L Hartzler
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | - Edward H Wagner
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | - Evette J Ludman
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
- University of Washington, Seattle, WA, USA
| | - James D Ralston
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
- University of Washington, Seattle, WA, USA
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Henchoz Y, Büla C, Guessous I, Rodondi N, Goy R, Demont M, Santos-Eggimann B. Chronic symptoms in a representative sample of community-dwelling older people: a cross-sectional study in Switzerland. BMJ Open 2017; 7:e014485. [PMID: 28096256 PMCID: PMC5253546 DOI: 10.1136/bmjopen-2016-014485] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVES The burden of multiple diagnoses is well documented in older people, but less is known about chronic symptoms, many of which are even not brought to medical attention. This study aimed to determine the prevalence of chronic symptoms, their relationships with disability in basic activities of daily living (BADL) and quality of life (QoL), and their public health impact. DESIGN A large cross-sectional population-based study. SETTING Community in 2 regions of French-speaking Switzerland. PARTICIPANTS Community-dwelling older adults aged 68 years and older in 2011 (N=5300). OUTCOMES Disability in BADL defined as difficulty or help needed with any of dressing, bathing, eating, getting in/out of bed or an arm chair, and using the toilet. Overall QoL dichotomised as favourable (ie, excellent or very good) or unfavourable (ie, good, fair or poor). Disturbance by any of the following 14 chronic symptoms for at least 6 months: joint pain, back pain, chest pain, dyspnoea, persistent cough, swollen legs, memory gaps, difficulty concentrating, difficulty making decisions, dizziness/vertigo, skin problems, stomach/intestine problems, urinary incontinence and impaired sexual life. RESULTS Only 17.1% of participants did not report being disturbed by any of these chronic symptoms. Weighted prevalence ranged from 3.1% (chest pain) to 47.7% (joint pain). Most chronic symptoms were significantly associated with disability in BADL or unfavourable QoL, with substantial gender differences. The number of chronic symptoms was significantly associated with disability in BADL and unfavourable QoL, with gradients suggesting dose-response relationships. Joint pain and back pain had the highest population attributable fractions. CONCLUSIONS Chronic symptoms are highly prevalent in older people, and are associated with disability in BADL and unfavourable QoL, particularly when multiple chronic symptoms co-occur. Owing to their high public health impact, musculoskeletal chronic symptoms represent good targets for preventive interventions.
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Affiliation(s)
- Yves Henchoz
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
| | - Christophe Büla
- Service of Geriatric Medicine and Geriatric Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | - Idris Guessous
- Unit of Population Epidemiology, Geneva University Hospitals, Geneva, Switzerland
- Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne, Switzerland
| | - Nicolas Rodondi
- Department of General Internal Medicine, University Hospital of Bern, Bern, Switzerland
- Institute of Primary Health Care (BIHAM), University of Bern, Bern, Switzerland
| | - René Goy
- Pro Senectute Vaud, Lausanne, Switzerland
| | | | - Brigitte Santos-Eggimann
- Institute of Social and Preventive Medicine, University of Lausanne Hospital Centre, Lausanne, Switzerland
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