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Holm NN, Frølich A, Andersen O, Juul-Larsen HG, Stockmarr A. Correction: Longitudinal models for the progression of disease portfolios in a nationwide chronic heart disease population. PLoS One 2024; 19:e0304245. [PMID: 38758811 PMCID: PMC11101091 DOI: 10.1371/journal.pone.0304245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2024] Open
Abstract
[This corrects the article DOI: 10.1371/journal.pone.0284496.].
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Stockmarr A, Frølich A. Clusters from chronic conditions in the Danish adult population. PLoS One 2024; 19:e0302535. [PMID: 38687772 PMCID: PMC11060538 DOI: 10.1371/journal.pone.0302535] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 04/09/2024] [Indexed: 05/02/2024] Open
Abstract
Multimorbidity, the presence of 2 or more chronic conditions in a person at the same time, is an increasing public health concern, which affects individuals through reduced health related quality of life, and society through increased need for healthcare services. Yet the structure of chronic conditions in individuals with multimorbidity, viewed as a population, is largely unmapped. We use algorithmic diagnoses and the K-means algorithm to cluster the entire 2015 Danish multimorbidity population into 5 clusters. The study introduces the concept of rim data as an additional tool for determining the number of clusters. We label the 5 clusters the Allergies, Chronic Heart Conditions, Diabetes, Hypercholesterolemia, and Musculoskeletal and Psychiatric Conditions clusters, and demonstrate that for 99.32% of the population, the cluster allocation can be determined from the diagnoses of 4-5 conditions. Clusters are characterized through most prevalent conditions, absent conditions, over- or under-represented conditions, and co-occurrence of conditions. Clusters are further characterized through socioeconomic variables and healthcare service utilizations. Additionally, geographical variations throughout Denmark are studied at the regional and municipality level. We find that subdivision into municipality levels suggests that the Allergies cluster frequency is positively associated with socioeconomic status, while the subdivision suggests that frequencies for clusters Diabetes and Hypercholesterolemia are negatively correlated with socioeconomic status. We detect no indication of association to socioeconomic status for the Chronic Heart Conditions cluster and the Musculoskeletal and Psychiatric Conditions cluster. Additional spatial variation is revealed, some of which may be related to urban/rural populations. Our work constitutes a step in the process of characterizing multimorbidity populations, leading to increased comprehension of the nature of multimorbidity, and towards potential applications to individual-based care, prevention, the development of clinical guidelines, and population management.
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Affiliation(s)
- Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Lyngby, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
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Bell C, Appel CW, Prior A, Frølich A, Pedersen AR, Vedsted P. The Effect of Coordinating the Outpatient Treatment across Medical Specialities for Patients With Multimorbidity. Int J Integr Care 2024; 24:4. [PMID: 38618047 PMCID: PMC11011960 DOI: 10.5334/ijic.7535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 03/19/2024] [Indexed: 04/16/2024] Open
Abstract
Introduction Patients with multimorbidity attend multiple outpatient clinics. We assessed the effects on hospital use of scheduling several outpatient appointments to same-day visits in a multidisciplinary outpatient pathway (MOP). Methods This study used a quasi-experimental design. Eligible patients had multimorbidity, were aged ≥18 years and attended ≥2 outpatient clinics in five different specialties. Patients were identified through forthcoming appointments from August 2018 to March 2020 and divided into intervention group (alignment of appointments) and comparison group (no alignment). We used patient questionnaires and paired analyses to study care integration and treatment burden. Using negative binomial regression, we estimated healthcare utilisation as incidence rates ratios (IRRs) at one year before and one year after baseline for both groups and compared IRR ratios (IRRRs). Results Intervention patients had a 19% reduction in hospital visits (IRRR: 0.81, 95% CI: 0.70-0.96) and a 17% reduction in blood samples (IRRR: 0.83, 0.73-0.96) compared to comparison patients. No effects were found for care integration, treatment burden, outpatient contacts, terminated outpatient trajectories, hospital admissions, days of admission or GP contacts. Conclusion The MOP seemed to reduce the number of hospital visits and blood samples. These results should be further investigated in studies exploring the coordination of outpatient care for multimorbidity. Research question Can an intervention of coordinating outpatient appointments to same-day visits combined with a multidisciplinary conference influence the utilisation of healthcare services and the patient-assessed integration of healthcare services and treatment burden among patients with multimorbidity?
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Affiliation(s)
- Cathrine Bell
- Medical Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Regional Hospital Central Jutland, Department of Clinical Medicine, Central Denmark Region, Denmark
| | - Charlotte Weiling Appel
- Medical Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Regional Hospital Central Jutland, Department of Clinical Medicine, Central Denmark Region, Denmark
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Centre for General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Asger Roer Pedersen
- Medical Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Regional Hospital Central Jutland, Department of Clinical Medicine, Central Denmark Region, Denmark
| | - Peter Vedsted
- Medical Diagnostic Centre, University Research Clinic for Innovative Patient Pathways, Regional Hospital Central Jutland, Department of Clinical Medicine, Central Denmark Region, Denmark
- Centre for General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
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Thomsen MK, Løppenthin KB, Bidstrup PE, Andersen EW, Dalton S, Petersen LN, Pappot H, Mortensen CE, Christensen MB, Frølich A, Lassen U, Johansen C. Impact of multimorbidity and polypharmacy on mortality after cancer: a nationwide registry-based cohort study in Denmark 2005-2017. Acta Oncol 2023; 62:1653-1660. [PMID: 37874076 DOI: 10.1080/0284186x.2023.2270145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 10/04/2023] [Indexed: 10/25/2023]
Abstract
BACKGROUND Concurrent chronic diseases and treatment hereof in patients with cancer may increase mortality. In this population-based study we examined the individual and combined impact of multimorbidity and polypharmacy on mortality, across 20 cancers and with 13-years follow-up in Denmark. MATERIALS AND METHODS This nationwide study included all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015, and followed until the end of 2017. We defined multimorbidity as having one or more of 20 chronic conditions in addition to cancer, registered in the five years preceding diagnosis, and polypharmacy as five or more redeemed medications 2-12 months prior to cancer diagnosis. Cox regression analyses were used to estimate the effects of multimorbidity and polypharmacy, as well as the combined effect on mortality. RESULTS A total of 261,745 cancer patients were included. We found that patients diagnosed with breast, prostate, colon, rectal, oropharynx, bladder, uterine and cervical cancer, malignant melanoma, Non-Hodgkin lymphoma, and leukemia had higher mortality when the cancer diagnosis was accompanied by multimorbidity and polypharmacy, while in patients with cancer of the lung, esophagus, stomach, liver, pancreas, kidney, ovarian and brain & central nervous system, these factors had less impact on mortality. CONCLUSION We found that multimorbidity and polypharmacy was associated with higher mortality in patients diagnosed with cancer types that typically have a favorable prognosis compared with patients without multimorbidity and polypharmacy. Multimorbidity and polypharmacy had less impact on mortality in cancers that typically have a poor prognosis.
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Affiliation(s)
- Mette K Thomsen
- Department of Oncology, Cancer Survivorship and Treatment Late effects CASTLE group, Copenhagen, Denmark
| | | | | | | | - Susanne Dalton
- Danish Cancer Society Research Center, Copenhagen, Denmark
| | | | | | | | - Mikkel B Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Copenhagen Center for Translational Research, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Innovation and Research Center for Multimorbidity and Chronic Conditions, Slagelse, Denmark
- Section of General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Christoffer Johansen
- Department of Oncology, Cancer Survivorship and Treatment Late effects CASTLE group, Copenhagen, Denmark
- Department of Oncology, Copenhagen, Denmark
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Bamberg C, Ladegaard CT, Aalling M, Jensen DM, Madsen CL, Kamil S, Gudbergsen H, Saxild T, Schiøtz ML, Grew J, Castillo LS, Tousgaard I, Johansen RLR, Bardram JE, Frølich A, Domínguez H. Reaching the Frail Elderly for the Diagnosis and Management of Atrial Fibrillation-REAFEL. Int J Environ Res Public Health 2023; 20:6783. [PMID: 37754642 PMCID: PMC10530387 DOI: 10.3390/ijerph20186783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Revised: 09/13/2023] [Accepted: 09/16/2023] [Indexed: 09/28/2023]
Abstract
BACKGROUND Frail elderly patients are exposed to suffering strokes if they do not receive timely anticoagulation to prevent stroke associated to atrial fibrillation (AF). Evaluation in the cardiological ambulatory can be cumbersome as it often requires repeated visits. AIM To develop and implement CardioShare, a shared-care model where primary care leads patient management, using a compact Holter monitor device with asynchronous remote support from cardiologists. METHODS CardioShare was developed in a feasibility phase, tested in a pragmatic cluster randomization trial (primary care clinics as clusters), and its implementation potential was evaluated with an escalation test. Mixed methods were used to evaluate the impact of this complex intervention, comprising quantitative observations, semi-structured interviews, and workshops. RESULTS Between February 2020 and December 2021, 314 patients (30% frail) were included, of whom 75% had AF diagnosed/not found within 13 days; 80% in both groups avoided referral to cardiologists. Patients felt safe and primary care clinicians satisfied. In an escalation test, 58 primary-care doctors evaluated 93 patients over three months, with remote support from four hospitals in the Capital Region of Denmark. CONCLUSIONS CardioShare was successfully implemented for AF evaluation in primary care.
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Affiliation(s)
- Carsten Bamberg
- Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark; (C.B.); (C.T.L.); (D.M.J.); (C.L.M.); (S.K.)
- Department of Biomedicine, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Caroline Thorup Ladegaard
- Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark; (C.B.); (C.T.L.); (D.M.J.); (C.L.M.); (S.K.)
- Department of Biomedicine, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Mathias Aalling
- VihTek Research Center for Welfare Technology Capital Region, 2600 Copenhagen, Denmark;
| | - Dorthea Marie Jensen
- Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark; (C.B.); (C.T.L.); (D.M.J.); (C.L.M.); (S.K.)
- Department of Biomedicine, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Christoffer Læssøe Madsen
- Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark; (C.B.); (C.T.L.); (D.M.J.); (C.L.M.); (S.K.)
- Department of Biomedicine, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Sadaf Kamil
- Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark; (C.B.); (C.T.L.); (D.M.J.); (C.L.M.); (S.K.)
- Department of Biomedicine, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Henrik Gudbergsen
- Section of General Practice, Department of Public Health, University of Copenhagen, 1165 Copenhagen, Denmark;
| | - Thomas Saxild
- Grøndalslægerne Godthåbsvej 239a, Vanløse, 2720 Copenhagen, Denmark;
| | - Michaela Louise Schiøtz
- Center for Clinical Research and Prevention Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark; (M.L.S.); (J.G.)
| | - Julie Grew
- Center for Clinical Research and Prevention Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark; (M.L.S.); (J.G.)
| | | | - Iben Tousgaard
- Department of Quality and Education, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark; (I.T.); (R.L.R.J.)
| | - Rie Laurine Rosenthal Johansen
- Department of Quality and Education, Bispebjerg and Frederiksberg Hospital, 2400 Copenhagen, Denmark; (I.T.); (R.L.R.J.)
| | - Jakob Eyvind Bardram
- Department of Health Technology, Digital Health, Personalized Health Technology, Technical University of Denmark, 2800 Copenhagen, Denmark;
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, 4180 Sorø, Denmark;
- Section of General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, 1165 Copenhagen, Denmark
| | - Helena Domínguez
- Cardiology Department Y Bispebjerg and Frederiksberg Hospital, Capital Region, 2000 Frederiksberg, Denmark; (C.B.); (C.T.L.); (D.M.J.); (C.L.M.); (S.K.)
- Department of Biomedicine, University of Copenhagen, 1165 Copenhagen, Denmark
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Lobo EH, Abdelrazek M, Frølich A, Rasmussen LJ, Livingston PM, Islam SMS, Kensing F, Grundy J. Detecting user experience issues from mHealth apps that support stroke caregiver needs: an analysis of user reviews. Front Public Health 2023; 11:1027667. [PMID: 37304084 PMCID: PMC10247988 DOI: 10.3389/fpubh.2023.1027667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Accepted: 05/05/2023] [Indexed: 06/13/2023] Open
Abstract
Background Existing research has demonstrated the potential of mHealth apps in improving the caregiving outcomes of stroke. Since most of the apps were published in commercially available app stores without explaining their design and evaluation processes, it is necessary to identify the user experience issues to promote long-term adherence and usage. Objective The purpose of this study was to utilize published user reviews of commercially available apps to determine the user experience issues to guide future app development in stroke caregiving. Methods User reviews were extracted from the previously identified 46 apps that support stroke caregiving needs using a python-scraper. The reviews were pre-processed and filtered using python scripts to consider English reviews that described issues faced by the user. The final corpus was categorized based on TF-IDF vectorization and k-means clustering technique, and the issues extracted from the various topics were classified based on the seven dimensions of user experience to highlight factors that may affect the usage of the app. Results A total of 117,364 were extracted from the two app stores. After filtration, 13,368 reviews were included and classified based on the user experience dimensions. Findings highlight critical issues that affect the usability, usefulness, desirability, findability, accessibility, credibility, and value of the app that contribute to decreased satisfaction and increased frustration. Conclusion The study identified several user experience issues due to the inability of the app developers to understand the needs of the user. Further, the study describes the inclusion of a participatory design approach to promote an improved understanding of user needs; therefore, limiting any issues and ensuring continued use.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
| | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - John Grundy
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
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Graever L, Issa AFC, da Fonseca VBP, Melo MM, da Silva GPDC, da Nóbrega ICP, Savassi LCM, Dias MB, Gomes MK, Lapa e Silva JR, Guimarães RM, Seródio RC, Frølich A, Gudbergsen H, Jakobsen JC, Dominguez H. Telemedicine Support for Primary Care Providers versus Usual Care in Patients with Heart Failure: Protocol of a Pragmatic Cluster Randomised Trial within the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) Study. Int J Environ Res Public Health 2023; 20:5933. [PMID: 37297537 PMCID: PMC10253100 DOI: 10.3390/ijerph20115933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 04/27/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023]
Abstract
Heart failure is a prevalent condition and a frequent cause of hospital readmissions and poor quality of life. Teleconsultation support from cardiologists to primary care physicians managing patients with heart failure may improve care, but the effect on patient-relevant outcomes is unclear. We aim to evaluate whether collaboration through a novel teleconsultation platform in the Brazilian Heart Insufficiency with Telemedicine (BRAHIT) project, tested on a previous feasibility study, can improve patient-relevant outcomes. We will conduct a parallel-group, two-arm, cluster-randomised superiority trial with a 1:1 allocation ratio, with primary care practices from Rio de Janeiro as clusters. Physicians from the intervention group practices will receive teleconsultation support from a cardiologist to assist patients discharged from hospitals after admission for heart failure. In contrast, physicians from the control group practices will perform usual care. We will include 10 patients per each of the 80 enrolled practices (n = 800). The primary outcome will be a composite of mortality and hospital admissions after six months. Secondary outcomes will be adverse events, symptoms frequency, quality of life, and primary care physicians' compliance with treatment guidelines. We hypothesise that teleconsulting support will improve patient outcomes.
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Affiliation(s)
- Leonardo Graever
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
| | - Aurora Felice Castro Issa
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Brazil; (A.F.C.I.); (V.B.P.d.F.); (M.M.M.); (I.C.P.d.N.)
| | | | - Marcelo Machado Melo
- Instituto Nacional de Cardiologia, Rio de Janeiro 22240-006, Brazil; (A.F.C.I.); (V.B.P.d.F.); (M.M.M.); (I.C.P.d.N.)
| | | | | | | | | | - Maria Kátia Gomes
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
| | - Jose Roberto Lapa e Silva
- Departamento de Clínica Médica, Faculdade de Medicina, Universidade Federal do Rio de Janeiro, Rio de Janeiro 21044-020, Brazil
| | | | | | - Anne Frølich
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1353 Copenhagen, Denmark; (A.F.); (H.G.)
| | - Henrik Gudbergsen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, 1353 Copenhagen, Denmark; (A.F.); (H.G.)
| | - Janus Christian Jakobsen
- Copenhagen Trial Unit, Centre for Clinical Intervention Research, Capital Region of Denmark & Department of Regional Health Research, The Faculty of Health Sciences, University of Southern Denmark, 2200 Copenhagen, Denmark;
| | - Helena Dominguez
- Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, 2200 Copenhagen, Denmark;
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Bell C, Prior A, Appel CW, Frølich A, Pedersen AR, Vedsted P. Multimorbidity and determinants for initiating outpatient trajectories: A population-based study. BMC Public Health 2023; 23:739. [PMID: 37085788 PMCID: PMC10120141 DOI: 10.1186/s12889-023-15453-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 03/15/2023] [Indexed: 04/23/2023] Open
Abstract
INTRODUCTION Individuals with multimorbidity often receive high numbers of hospital outpatient services in concurrent trajectories. Nevertheless, little is known about factors associated with initiating new hospital outpatient trajectories; identified as the continued use of outpatient contacts for the same medical condition. PURPOSE To investigate whether the number of chronic conditions and sociodemographic characteristics in adults with multimorbidity is associated with entering a hospital outpatient trajectory in this population. METHODS This population-based register study included all adults in Denmark with multimorbidity on January 1, 2018. The exposures were number of chronic conditions and sociodemographic characteristics, and the outcome was the rate of starting a new outpatient trajectory during 2018. Analyses were stratified by the number of existing outpatient trajectories. We used Poisson regression analysis, and results were expressed as incidence rates and incidence rate ratios with 95% confidence intervals. We followed the individuals during the entire year of 2018, accounting for person-time by hospitalization, emigration, and death. RESULTS Incidence rates for new outpatient trajectories were highest for individuals with low household income and ≥3 existing trajectories and for individuals with ≥3 chronic conditions and in no already established outpatient trajectory. A high number of chronic conditions and male gender were found to be determinants for initiating a new outpatient trajectory, regardless of the number of existing trajectories. Low educational level was a determinant when combined with 1, 2, and ≥3 existing trajectories, and increasing age, western ethnicity, and unemployment when combined with 0, 1, and 2 existing trajectories. CONCLUSION A high number of chronic conditions, male gender, high age, low educational level and unemployment were determinants for initiation of an outpatient trajectory. The rate was modified by the existing number of outpatient trajectories. The results may help identify those with multimorbidity at greatest risk of having a new hospital outpatient trajectory initiated.
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Affiliation(s)
- Cathrine Bell
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark.
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Denmark
| | - Charlotte Weiling Appel
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Centre for General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Asger Roer Pedersen
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark
| | - Peter Vedsted
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Central Denmark Region, Silkeborg, Danmark
- Research Unit for General Practice, Aarhus, Denmark
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Holm NN, Frølich A, Andersen O, Juul-Larsen HG, Stockmarr A. Longitudinal models for the progression of disease portfolios in a nationwide chronic heart disease population. PLoS One 2023; 18:e0284496. [PMID: 37079591 PMCID: PMC10118194 DOI: 10.1371/journal.pone.0284496] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Accepted: 03/30/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND AND AIM With multimorbidity becoming increasingly prevalent in the ageing population, addressing the epidemiology and development of multimorbidity at a population level is needed. Individuals subject to chronic heart disease are widely multimorbid, and population-wide longitudinal studies on their chronic disease trajectories are few. METHODS Disease trajectory networks of expected disease portfolio development and chronic condition prevalences were used to map sex and socioeconomic multimorbidity patterns among chronic heart disease patients. Our data source was all Danish individuals aged 18 years and older at some point in 1995-2015, consisting of 6,048,700 individuals. We used algorithmic diagnoses to obtain chronic disease diagnoses and included individuals who received a heart disease diagnosis. We utilized a general Markov framework considering combinations of chronic diagnoses as multimorbidity states. We analyzed the time until a possible new diagnosis, termed the diagnosis postponement time, in addition to transitions to new diagnoses. We modelled the postponement times by exponential models and transition probabilities by logistic regression models. FINDINGS Among the cohort of 766,596 chronic heart disease diagnosed individuals, the prevalence of multimorbidity was 84.36% and 88.47% for males and females, respectively. We found sex-related differences within the chronic heart disease trajectories. Female trajectories were dominated by osteoporosis and male trajectories by cancer. We found sex important in developing most conditions, especially osteoporosis, chronic obstructive pulmonary disease and diabetes. A socioeconomic gradient was observed where diagnosis postponement time increases with educational attainment. Contrasts in disease portfolio development based on educational attainment were found for both sexes, with chronic obstructive pulmonary disease and diabetes more prevalent at lower education levels, compared to higher. CONCLUSIONS Disease trajectories of chronic heart disease diagnosed individuals are heavily complicated by multimorbidity. Therefore, it is essential to consider and study chronic heart disease, taking into account the individuals' entire disease portfolio.
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Affiliation(s)
- Nikolaj Normann Holm
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Ove Andersen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Emergency Department, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Helle Gybel Juul-Larsen
- Department of Clinical Research, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
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10
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Lobo EH, Frølich A, Abdelrazek M, Rasmussen LJ, Grundy J, Livingston PM, Islam SMS, Kensing F. Information, involvement, self-care and support-The needs of caregivers of people with stroke: A grounded theory approach. PLoS One 2023; 18:e0281198. [PMID: 36719929 PMCID: PMC9888718 DOI: 10.1371/journal.pone.0281198] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 01/17/2023] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Globally, stroke is a leading cause of death and disability, with most care undertaken by caregivers who are generally family and friends without prior experience of care. The lack of experience or unpreparedness results in feelings of uncertainty, burnout, anxiety, burden, etc. Hence, it is necessary to identify the needs of caregivers to better support them in their caregiving journey and improve the quality of care delivered. METHODS The study employed a grounded theory methodology that utilizes information gathered from literature reviews and social media to represent the needs and create a storyline visually. The storyline is further refined and evaluated using an online survey of 72 participants recruited through online stroke caregiving communities. RESULTS The study identified four core categories of needs: (i) Information: sufficient information delivered in layman's terms based on the individual situation of the caregiver and survivor through oral and hands-on demonstrations, (ii) Involvement: inclusion in the decision-making processes at different stages of recovery through face-to-face communication at the hospital, (iii) Self-care: ability to engage in work and leisure activities, (iv) Support: receive support in the form of resources, services and finances from different other stakeholders. CONCLUSIONS There is a need to create a caregiver-centered approach in stroke recovery to ensure limited obstruction to care and reduced uncertainty in stroke recovery. Moreover, through the inclusion of caregivers in stroke recovery, it may be possible to reduce the burden of care to the caregiver and ensure the satisfaction of the healthcare system throughout stroke recovery.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | - John Grundy
- Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | | | | | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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11
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Hvidberg MF, Petersen KD, Davidsen M, Witt Udsen F, Frølich A, Ehlers L, Alava MH. Catalog of EQ-5D-3L Health-Related Quality-of-Life Scores for 199 Chronic Conditions and Health Risks in Denmark. MDM Policy Pract 2023; 8:23814683231159023. [PMID: 37056295 PMCID: PMC10088414 DOI: 10.1177/23814683231159023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/27/2023] [Indexed: 04/15/2023] Open
Abstract
Background. Assessments of health-related quality of life (HRQoL) are essential in estimating quality-adjusted life-years. It is sometimes not feasible to collect primary HRQoL data, and reliable secondary sources are necessary. Current "off-the-shelf" HRQoL catalogs are based on older diagnosis classifications and include a limited number of diseases. This article aims to provide 1) a Danish EQ-5D-3L-based HRQoL catalog for 199 nationally representative chronic conditions based on ICD-10 codes and 2) a complementary model-based catalog controlling for age, sex, comorbidities, lifestyle, and health risks. Design. A total of 55,616 respondents from 3 national health survey samples were pooled and combined with 7 national registers containing patient-level information on diagnoses, health care activity, and sociodemographics. EQ-5D-3L data were converted to utility scores using the Danish EQ-5D-3L value set to estimate the mean utility for each chronic disease population. Adjusted limited dependent variable mixture models were estimated and used to provide a regression-based catalog of utilities/disutilities. Results. Diseases with the lowest mean EQ-5D score in the Danish population were systemic sclerosis (M34; score = 0.432), fibromyalgia (M797; score = 0.490), rheumatism (M790; score = 0.515), dementia (F00, G30; score = 0.546), posttraumatic stress syndrome (F431; score = 0.557), and systemic atrophies (G10-G14; score = 0.583. Based on the estimated models, the largest estimated disutilities were cystic fibrosis, cerebral palsy, depression, dorsalgia, sclerosis, and fibromyalgia. Lifestyle factors, including perceived stress, loneliness, and body mass index, were also significantly associated with low HRQoL. Conclusions. This study provides a comprehensive nationally representative catalog and a model-based catalog of EQ-5D-3L-based HRQoL scores for Denmark that can be used to describe aspects of disease burden and allocate resources within health care. Additional Stata programs are also provided to facilitate predictions in other populations. Highlights A Danish national representative catalog of health-related quality-of-life scores for 199 chronic conditions is presented, which provides population estimates for chronic conditions subgroups that can be used for health economic evaluation.Two separate regression models of EQ-5D-3L utility scores with different sets of control variables are estimated to allow researchers to adjust for differences in the composition of the subgroups and provide a tool that can be used in other settings.Results indicate that health-related quality of life varies across disease groups but is lowest for renal disease, mental and behavioral disorders, benign neoplasms and diseases of the blood, digestive systems, and nervous systems.Health risks and lifestyle factors such as perceived stress, loneliness, and a large body mass index are highly correlated with health-related quality of life, and, in many cases, the correlation is higher than with individual diseases.
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Affiliation(s)
- Michael Falk Hvidberg
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Department of Psychology, University of York, UK
| | | | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Institute of Public Health, University of Copenhagen, Denmark
| | - Lars Ehlers
- Department of Clinical Medicine, Aalborg University, Denmark
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12
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Hvidberg MF, Petersen KD, Davidsen M, Witt Udsen F, Frølich A, Ehlers L, Alava MH. Catalog of EQ-5D-3L Health-Related Quality-of-Life Scores for 199 Chronic Conditions and Health Risks in Denmark. MDM Policy Pract 2023; 8:23814683231159023. [PMID: 37056295 PMCID: PMC10088414 DOI: 10.1177/23814683231159023#supplementary-materials] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 01/27/2023] [Indexed: 06/20/2023] Open
Abstract
UNLABELLED Background. Assessments of health-related quality of life (HRQoL) are essential in estimating quality-adjusted life-years. It is sometimes not feasible to collect primary HRQoL data, and reliable secondary sources are necessary. Current "off-the-shelf" HRQoL catalogs are based on older diagnosis classifications and include a limited number of diseases. This article aims to provide 1) a Danish EQ-5D-3L-based HRQoL catalog for 199 nationally representative chronic conditions based on ICD-10 codes and 2) a complementary model-based catalog controlling for age, sex, comorbidities, lifestyle, and health risks. Design. A total of 55,616 respondents from 3 national health survey samples were pooled and combined with 7 national registers containing patient-level information on diagnoses, health care activity, and sociodemographics. EQ-5D-3L data were converted to utility scores using the Danish EQ-5D-3L value set to estimate the mean utility for each chronic disease population. Adjusted limited dependent variable mixture models were estimated and used to provide a regression-based catalog of utilities/disutilities. Results. Diseases with the lowest mean EQ-5D score in the Danish population were systemic sclerosis (M34; score = 0.432), fibromyalgia (M797; score = 0.490), rheumatism (M790; score = 0.515), dementia (F00, G30; score = 0.546), posttraumatic stress syndrome (F431; score = 0.557), and systemic atrophies (G10-G14; score = 0.583. Based on the estimated models, the largest estimated disutilities were cystic fibrosis, cerebral palsy, depression, dorsalgia, sclerosis, and fibromyalgia. Lifestyle factors, including perceived stress, loneliness, and body mass index, were also significantly associated with low HRQoL. Conclusions. This study provides a comprehensive nationally representative catalog and a model-based catalog of EQ-5D-3L-based HRQoL scores for Denmark that can be used to describe aspects of disease burden and allocate resources within health care. Additional Stata programs are also provided to facilitate predictions in other populations. HIGHLIGHTS A Danish national representative catalog of health-related quality-of-life scores for 199 chronic conditions is presented, which provides population estimates for chronic conditions subgroups that can be used for health economic evaluation.Two separate regression models of EQ-5D-3L utility scores with different sets of control variables are estimated to allow researchers to adjust for differences in the composition of the subgroups and provide a tool that can be used in other settings.Results indicate that health-related quality of life varies across disease groups but is lowest for renal disease, mental and behavioral disorders, benign neoplasms and diseases of the blood, digestive systems, and nervous systems.Health risks and lifestyle factors such as perceived stress, loneliness, and a large body mass index are highly correlated with health-related quality of life, and, in many cases, the correlation is higher than with individual diseases.
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Affiliation(s)
- Michael Falk Hvidberg
- Michael Falk Hvidberg, Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Ingemannsvej 18, St, Region Zealand, Slagelse, 4200, Denmark; ()
| | | | - Michael Davidsen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | | | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Institute of Public Health, University of Copenhagen, Denmark
| | - Lars Ehlers
- Department of Clinical Medicine, Aalborg University, Denmark
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13
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Eriksen CU, Kamstrup–Larsen N, Birke H, Helding SAL, Ghith N, Andersen JS, Frølich A. Commentary on the systematic review: Models of care for improving health-related quality of life, mental health, or mortality in persons with multimorbidity: A systematic review of randomized controlled trials. J Multimorb Comorb 2023; 13:26335565231220204. [PMID: 38116067 PMCID: PMC10729638 DOI: 10.1177/26335565231220204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 11/27/2023] [Indexed: 12/21/2023]
Affiliation(s)
- Christian U Eriksen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Nina Kamstrup–Larsen
- Department of Public Health, University of Copenhagen, and Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Juliane Marie Centre,Bispebjerg and Frederiksberg Hospital, Kobenhavn, Denmark
| | - Hanne Birke
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Frederiksberg, Denmark
| | - Sofie A L Helding
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Denmark
| | - Nermin Ghith
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - John S Andersen
- Department of Public Health, University of Copenhagen, and Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, and Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Juliane Marie Centre,Bispebjerg and Frederiksberg Hospital, Kobenhavn, Denmark
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14
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Hvidberg MF, Frølich A, Lundstrøm SL. Catalogue of socioeconomic disparities and characteristics of 199+ chronic conditions-A nationwide register-based population study. PLoS One 2022; 17:e0278380. [PMID: 36584039 PMCID: PMC9803180 DOI: 10.1371/journal.pone.0278380] [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] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 11/15/2022] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Real-world information on socioeconomic differences within and between chronic conditions represents an important data source for treatments and decision-makers executing and prioritising healthcare resources. AIMS The aim of this study was to estimate the prevalence and mean of socioeconomic disparities from educational, income, and socioeconomic positions of 199 chronic conditions and disease groups, including sex and age group estimates, for use in planning of care services and prioritisation, by healthcare professionals, decision-makers and researchers. METHODS The study population includes all Danish residents 16 years and above, alive on 1 January 2013 (n = 4,555,439). The data was established by linking seven national registers encompassing educational achievements, incomes, socioeconomic positions, hospital- and general practice services, and filled-in out-of-hospital prescriptions. The health register data were used to identify the 199+ chronic conditions. Socioeconomic differences were primarily measured as differences in educational prevalence levels from low to high educational achievements using a ratio. Furthermore, multiple binary logistic regression models were carried out to control for potential confounding and residual correlations of the crude estimates. RESULTS The prevalence of having one or more chronic conditions for patients with no educational achievement was 768 per thousand compared to 601.3 for patients with higher educational achievement (ratio 1.3). Across disease groups, the highest educational differences were found within disease group F-mental and behavioural (ratio 2.5), E-endocrine, nutritional and metabolic disease (ratio 2.4), I-diseases of the circulatory system (ratio 2.1) and, K-diseases of the digestive system (ratio 2.1). The highest educational differences among the 29 common diseases were found among schizophrenia (ratio 5.9), hyperkinetic disorders (ratio 5.2), dementia (ratio 4.9), osteoporosis (ratio 3.9), type 2 diabetes (ratio 3.8), chronic obstructive pulmonary disease COPD (ratio 3.3), heart conditions and stroke (ratios ranging from 2.3-3.1). CONCLUSIONS A nationwide catalogue of socioeconomic disparities for 199+ chronic conditions and disease groups is catalogued and provided. The catalogue findings underline a large scope of socioeconomic disparities that exist across most chronic conditions. The data offer essential information on the socioeconomic disparities to inform future socially differentiated treatments, healthcare planning, etiological, economic, and other research areas.
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Affiliation(s)
- Michael Falk Hvidberg
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- University of York, York, United Kingdom
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Sanne Lykke Lundstrøm
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, The Capital Region of Denmark
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15
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Lobo EH, Abdelrazek M, Kensing F, Rasmussen LJ, Livingston PM, Grundy J, Islam SMS, Frølich A. Technology-based support for stroke caregiving: A rapid review of evidence. J Nurs Manag 2022; 30:3700-3713. [PMID: 34350650 DOI: 10.1111/jonm.13439] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Revised: 07/14/2021] [Accepted: 08/02/2021] [Indexed: 12/30/2022]
Abstract
AIM This rapid review examines the technology-based interventions for caregivers of stroke proposed in the literature while also identifying the acceptance, effectiveness and satisfaction of the implemented approaches. BACKGROUND The increasing burden of supporting stroke survivors has resulted in caregivers searching for innovative solutions, such as technology-based interventions, to provide better care. Hence, its potential to support caregivers throughout the disease trajectory needs to be assessed. EVALUATION Five electronic databases were systematically searched for articles related to stroke caregiving technologies based on well-defined inclusion and exclusion criteria. KEY ISSUE(S) Fifteen articles met the inclusion criteria that focused on supporting caregivers through functionalities such as education, therapy and support, remote consultations, health assessments and logs and reminders using different devices. The majority of interventions demonstrated positive conclusions for caregiving impact, acceptance, effectiveness and satisfaction. CONCLUSION Findings highlight the influences of technology in improving stroke caregiving and the need to include user-centred design principles to create a meaningful, actionable and feasible system for caregivers. IMPLICATIONS FOR NURSING MANAGEMENT Technology can educate and support stroke caregivers, thereby minimizing uncertainty and ensuring better care for the survivor.
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Affiliation(s)
- Elton H Lobo
- School of Information Technology, Deakin University, Geelong, Victoria, Australia.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, Victoria, Australia
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Lene J Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - John Grundy
- Faculty of Information Technology, Monash University, Victoria, Australia
| | | | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
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16
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Hvidberg MF, Frølich A, Lundstrøm SL, Kamstrup-Larsen N. Catalogue of multimorbidity mean based severity and associational prevalence rates between 199+ chronic conditions-A nationwide register-based population study. PLoS One 2022; 17:e0273850. [PMID: 36103504 PMCID: PMC9473636 DOI: 10.1371/journal.pone.0273850] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/16/2022] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Real-world data on multimorbidity represents an important but underutilised source of evidence for the planning of healthcare services, including prevention, treatments, and health economic modelling. AIMS This study aimed to estimate means of multimorbidity and provide associated prevalence rates and frequencies between 199 x 199 chronic conditions and disease groups based on the total adult Danish population and sex, age, and educational attainment. Thus, this study provides an off-the-shelf catalogue for use in treatments and planning by clinicians, decision-makers and researchers. METHODS The study population contained all Danish residents above 16 years on 1 January 2013 (n = 4,555,439). The data was based on the linkage of six national registers covering hospital contacts, services in general practice, filled-in out-of-hospital prescriptions, and educational attainments. The health registers were used to identify the 199 chronic conditions based on the ICD-10 classification system. RESULTS The mean number of chronic conditions (NCC) was 2.2. The mean increased with age, women had a higher mean than men, and there was a social gradient with the mean increasing with lower educational attainment. The mean NCC varied from 3.3-9.8 among all conditions. Across disease groups, the highest mean NCC were found within disease group N (chronic renal failure, mean = 8.8), D (in situ and benign neoplasms; mean = 6.5), K (diseases of the digestive system; mean = 5.7), and H (diseases of the eye and the ear; mean = 5.6). The highest mean NCC among the 29 common diseases was heart failure, ischemic heart diseases, angina pectoris, stroke, and dementia, with a mean above 6.5. Several prevalent conditions like hypertension, arthritis, chronic lower respiratory diseases, depression, type 2 diabetes, and overweight transcended other conditions regarding the associated prevalence rates. As one of the most frequent, hypertensive diseases were highly associated with arthritis (50.4%), depression (37.4%), type 2 diabetes (75.4%), cancers (49.7%), and being overweight (39.7%)-meaning that 50.4% of people with arthritis, 37.4% of people with depression and so on also had hypertensive diseases. The largest differences in means between individuals with no educational attainment and individuals with high educational attainment were found within disease groups J (diseases of the respiratory system, ratio = 1.8), Q (congenital malformations, deformations, and chromosomal abnormalities, ratio = 1.7), and B (viral hepatitis and human immunodeficiency virus disease, ratio = 1.7). CONCLUSIONS The current study provides a nationwide off-the-shelf catalogue of multimorbidity means and real-world associations estimates of 199+ chronic conditions for future clinical treatments and health care systems planning. The findings described are just one example of numerous results and underline that multimorbidity is highly prevalent in the adult Danish population and that it is a vital condition transcending all future medical treatment. The data offer essential information on the multimorbidity burden of disease in future differentiated treatments, healthcare planning, and economic, aetiological, and other research.
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Affiliation(s)
- Michael Falk Hvidberg
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- University of York, York, United Kingdom
| | - Anne Frølich
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, København, Denmark
| | - Sanne Lykke Lundstrøm
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, København, Denmark
| | - Nina Kamstrup-Larsen
- Innovation and Research Center for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, København, Denmark
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17
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Bell C, Prior A, Frølich A, Appel CW, Vedsted P. Trajectories in Outpatient Care for People with Multimorbidity: A Population-Based Register Study in Denmark. Clin Epidemiol 2022; 14:749-762. [PMID: 35686026 PMCID: PMC9172733 DOI: 10.2147/clep.s363654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/18/2022] [Indexed: 11/23/2022] Open
Abstract
Background Multimorbidity is a global health challenge. Individuals with multimorbidity are frequent users of healthcare services, and many experience fragmented healthcare. We assessed the number of outpatient trajectories and contacts with hospital outpatient clinics for individuals with multimorbidity and explored different time intervals for the occurrence of concurrent outpatient trajectories. Methods A population-based cohort of 1.3 million residents, ≥18 years, with multimorbidity was identified through Danish national health registries. Multimorbidity was defined as having two or more of 39 specific chronic conditions. Nine disease system categories were used to categorize outpatient contacts in 2018 into outpatient trajectories and trajectory-related contacts. We defined an “outpatient trajectory” as two contacts within 12 consecutive months for the same medical condition. All outpatient contacts and trajectories with related contacts were counted for 2018. The impact of different time intervals on the number of concurrent trajectories was analyzed. Results On 1 January 2019, 29% of the adult Danish population was classified as multimorbid. During 2018, 68% of them had ≥1 outpatient contact (median: 2 (IQI: 0–4)). Twenty-six percent had ≥1 outpatient trajectory. The median number of trajectory contacts was 3 (IQI: 2–5). The 4% of individuals with ≥2 outpatient trajectories accounted for 28% of trajectory contacts. During the 6-week period from the latest outpatient contact, 33% of all patients with ≥2 trajectories in 2018 experienced concurrent trajectories with outpatient contact. Conclusion Two-thirds of adult Danes with multimorbidity attended an outpatient clinic in 2018, and one-fourth had at least one outpatient trajectory. Individuals with two or more trajectories represented 4% and comprised 28% of the trajectory contacts; 33% had concurrent trajectories within a 6-week period. It appears that a small proportion place demands on outpatient clinics because of frequent attendance. A more uniform way of organizing outpatient trajectories for these patients merits consideration.
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Affiliation(s)
- Cathrine Bell
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Silkeborg, Denmark
- Correspondence: Cathrine Bell, Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Denmark, Tel +45 7841 7884, Email
| | - Anders Prior
- Research Unit for General Practice, Aarhus, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
- Centre for General Practice, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Charlotte Weiling Appel
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Silkeborg, Denmark
| | - Peter Vedsted
- Diagnostic Centre - University Research Clinic for Innovative Patient Pathways, Silkeborg Regional Hospital, Department of Clinical Medicine, Aarhus University, Silkeborg, Denmark
- Research Unit for General Practice, Aarhus, Denmark
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Kumar D, Maharjan R, Maxhuni A, Dominguez H, Frølich A, Bardram JE. mCardia: A Context-Aware ECG Collection System for Ambulatory Arrhythmia Screening. ACM Trans Comput Healthcare 2022; 3:1-28. [DOI: 10.1145/3494581] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 10/01/2021] [Indexed: 07/25/2023]
Abstract
This article presents the design, technical implementation, and feasibility evaluation of
mCardia
—a context-aware, mobile
electrocardiogram
(ECG) collection system for longitudinal arrhythmia screening under free-living conditions. Along with ECG,
mCardia
also records active and passive contextual data, including patient-reported symptoms and physical activity. This contextual data can provide a more accurate understanding of what happens before, during, and after an arrhythmia event, thereby providing additional information in the diagnosis of arrhythmia. By using a plugin-based architecture for ECG and contextual sensing,
mCardia
is device-agnostic and can integrate with various wireless ECG devices and supports cross-platform deployment. We deployed the
mCardia
system in a feasibility study involving 24 patients who used the system over a two-week period. During the study, we observed high patient acceptance and compliance with a satisfactory yield of collected ECG and contextual data. The results demonstrate the high usability and feasibility of
mCardia
for longitudinal ambulatory monitoring under free-living conditions. The article also reports from two clinical cases, which demonstrate how a cardiologist can utilize the collected contextual data to improve the accuracy of arrhythmia analysis. Finally, the article discusses the lessons learned and the challenges found in the
mCardia
design and the feasibility study.
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Affiliation(s)
- Devender Kumar
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
| | - Raju Maharjan
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
| | - Alban Maxhuni
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
| | - Helena Dominguez
- Bispebjerg-Frederiksberg Hospital, Department of Cardiology, Copenhagen, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob E. Bardram
- Department of Health Technology, Technical University of Denmark, Copenhagen, Denmark
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Lobo EH, Johnson T, Frølich A, Kensing F, Rasmussen LJ, Hosking SM, Page AT, Livingston PM, Islam SMS, Grundy J, Abdelrazek M. Utilization of social media communities for caregiver information support in stroke recovery: An analysis of content and interactions. PLoS One 2022; 17:e0262919. [PMID: 35081150 PMCID: PMC8791510 DOI: 10.1371/journal.pone.0262919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 01/07/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Caregivers often use the internet to access information related to stroke care to improve preparedness, thereby reducing uncertainty and enhancing the quality of care.
Method
Social media communities used by caregivers of people affected by stroke were identified using popular keywords searched for using Google. Communities were filtered based on their ability to provide support to caregivers. Data from the included communities were extracted and analysed to determine the content and level of interaction.
Results
There was a significant rise in the use of social media by caregivers of people affected by stroke. The most popular social media communities were charitable and governmental organizations with the highest user interaction–this was for topics related to stroke prevention, signs and symptoms, and caregiver self-care delivered through video-based resources.
Conclusion
Findings show the ability of social media to support stroke caregiver needs and practices that should be considered to increase their interaction and support.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- * E-mail:
| | - Tara Johnson
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Faculty of Health, Deakin University, Geelong, VIC, Australia
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Region Zealand, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Amy T. Page
- Pharmacy Department, Alfred Health, Melbourne, VIC, Australia
- Centre for Medicine Use and Safety, Monash University, Melbourne, VIC, Australia
| | | | | | - John Grundy
- Faculty of Information Technology, Monash University, Melbourne, VIC, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
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Eriksen CU, Kamstrup–Larsen N, Birke H, Helding SAL, Ghith N, Andersen JS, Frølich A. Models of care for improving health-related quality of life, mental health, or mortality in persons with multimorbidity: A systematic review of randomized controlled trials. J Multimorb Comorb 2022; 12:26335565221134017. [PMID: 36325259 PMCID: PMC9618762 DOI: 10.1177/26335565221134017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVES To categorize and examine the effectiveness regarding health-related quality of life (HRQoL), mental health, and mortality of care models for persons with multimorbidity in primary care, community care, and hospitals through a systematic review. METHODS We searched PubMed, Embase, and Cochrane Central Register of Controlled Trials up to May 2020. One author screened titles and abstracts, and to validate, a second author screened 5% of the studies. Two authors independently extracted data and assessed risk of bias using the tool by the Cochrane Effective Practice and Organisation of Care group. Study inclusion criteria were (1) participants aged ≥ 18 years with multimorbidity; (2) referred to multimorbidity or two or more specific chronic conditions in the title or abstract; (3) randomized controlled design; and (4) HRQoL, mental health, or mortality as primary outcome measures. We used the Foundation Framework to categorize the models and the PRISMA-guideline for reporting. RESULTS In this study, the first to report effectiveness of care models in patients with multimorbidity in hospital settings, we included 30 studies and 9,777 participants with multimorbidity. 12 studies were located in primary care, 9 in community care, and 9 in hospitals. HRQoL was reported as the primary outcome in 12 studies, mental health in 17 studies, and mortality in three studies-with significant improvements in 5, 14, and 2, respectively. The studies are presented according to settings. CONCLUSIONS Although 20 of the care models reported positive effects, the variations in populations, settings, model elements, and outcome measures made it difficult to conclude on which models and model elements were effective.
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Affiliation(s)
- Christian U Eriksen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Nina Kamstrup–Larsen
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; AND Innovation and Research Center for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Hanne Birke
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Sofie A L Helding
- Rigshospitalet and DanTrials ApS, Juliane Marie Centre, Kobenhavn, Denmark; Zero Phase 1 Unit, Bispebjerg and Frederiksberg Hospital, The Capital Region of Denmark, Denmark
| | - Nermin Ghith
- Research Group for Genomic Epidemiology, National Food Institute, Technical University of Denmark, Denmark
| | - John S Andersen
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Denmark
| | - Anne Frølich
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark; AND Innovation and Research Center for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
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21
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Bagge-Petersen CM, Langstrup H, Larsen JE, Frølich A. Critical user-configurations in mHealth design: How mHealth-app design practices come to bias design against chronically ill children and young people as mHealth users. Digit Health 2022; 8:20552076221109531. [PMID: 35733878 PMCID: PMC9208037 DOI: 10.1177/20552076221109531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 06/08/2022] [Indexed: 11/16/2022] Open
Abstract
Mobile health smartphone applications (mHealth-apps) are increasingly emerging to assist children's and young people's management of chronic conditions. However, difficulties persist in applying design approaches in mHealth projects that return apps that are useful to this group. In this article, we explore ethnographically two self-proclaimed ‘user-driven’ projects designing mHealth apps for Danish patients below the age of 18 living with, respectively, haemophilia and rheumatoid arthritis. These projects initially included the perspectives of children and young people to inform the designs, however, eventually launched the final apps for adult patients only. Through a concept of ‘critical user-configuration’, we examine the projects’ challenges with attuning the designs to children and young people and how these drove their exclusion as users of the emerging mHealth apps. Critical user-configuration draws attention to critical moments in design practices where significant shifts in user-configurations take place, shaping who can become a user. More specifically, we uncover three critical moments: where mHealth projects expand the group of prospective users; where test subjects are selected; and where data governance systems and digital health infrastructures are mobilised in the design process. Throughout these critical moments, there is a drift from user-driven to data-driven design approaches which increasingly exclude groups of users who are less datafiable – in our case children and young people. We argue that besides giving voice to minors in mHealth design processes, we need to be mindful of the design practices that become decisive for – often implicitly – who can be configured as a user.
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Affiliation(s)
- Claudia M Bagge-Petersen
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Henriette Langstrup
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Jakob E Larsen
- Department of Applied Mathematics and Computer Science, Section for Cognitive Systems, Technical University of Denmark, Lyngby, Denmark
| | - Anne Frølich
- Department of Public Health, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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22
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Lobo EH, Kensing F, Frølich A, Rasmussen LJ, Livingston PM, Islam SMS, Grundy J, Abdelrazek M. mHealth intervention for carers of individuals with a history of stroke: Heuristic evaluation and user perspectives. Digit Health 2022; 8:20552076221089070. [PMID: 35371533 PMCID: PMC8968995 DOI: 10.1177/20552076221089070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 02/11/2022] [Accepted: 03/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Caregiving in stroke is complex, with most carers having little to no preparation to care for individuals with a history of stroke, leading to emotional impact. Technologies such as Mobile Health can provide the carer with real-time support and prepare the carer to assume their new roles and responsibilities. Objectives To perform a heuristic evaluation of mHealth interventions designed to support carers of individuals with a history of stroke and determine the user preferences in stroke caregiving technology to inform future researchers and developers regarding the best practices to support these individuals. Methods Twenty adults (i.e. 10 usability experts and 10 carers) participated in an iterative user-centred design study that focused on developing and modifying the mHealth intervention (StrokeCaregiver (SeCr)) created to support stroke caregiving. The intervention was repeated in four cycles, including two cycles with five usability experts each and five carers each. Results SeCr was iteratively improved to develop a highly usable product in multiple cycles. Participants demonstrated critical needs in personalized information support, communication with their healthcare needs, and the trust of the user, content, and developer. These critical needs are required to be met to promote long-term acceptance and adherence. Conclusions While SeCr was developed to address the needs of carers of individuals with a history of stroke, several considerations must be made to ensure it can be used in a real-world setting. Researchers and developers can use co-design or living lab approaches to further meet the needs and expectations of the carer and enable these individuals to be better prepared for stroke caregiving.
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Affiliation(s)
- Elton H Lobo
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Lene J Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | | | - John Grundy
- Faculty of Information Technology, Monash University, Victoria, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia
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23
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Lobo EH, Abdelrazek M, Grundy J, Kensing F, Livingston PM, Rasmussen LJ, Islam SMS, Frølich A. Caregiver Engagement in Stroke Care: Opportunities and Challenges in Australia and Denmark. Front Public Health 2021; 9:758808. [PMID: 34900907 PMCID: PMC8661098 DOI: 10.3389/fpubh.2021.758808] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 11/04/2021] [Indexed: 01/01/2023] Open
Abstract
Globally, there is a rise in incident cases of stroke, particularly in low- and middle-income countries, due to obesity-related and lifestyle risk factors, including health issues such as high cholesterol, diabetes and hypertension. Since the early 20th century, stroke mortality has declined due to proper management of the risk factors and improved treatment practices. However, despite the decline in mortality, there is an increase in the levels of disability that requires long-term support. In countries such as Australia and Denmark, where most care is provided within the community; family members, generally spouses, assume the role of caregiver, with little to no preparation that affects the quality of care provided to the person living with stroke. While past research has highlighted aspects to improve caregiver preparedness of stroke and its impact on care; health planning, recovery, and public health policies rarely consider these factors, reducing engagement and increasing uncertainty. Hence, there is a need to focus on improving strategies during recovery to promote caregiver engagement. In this study, we, therefore, try to understand the needs of the caregiver in stroke that limit engagement, and processes employed in countries such as Australia and Denmark to provide care for the person with stroke. Based on our understanding of these factors, we highlight the potential opportunities and challenges to promote caregiving engagement in these countries.
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Affiliation(s)
- Elton H. Lobo
- School of Information Technology, Deakin University, Geelong, VIC, Australia
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Mohamed Abdelrazek
- School of Information Technology, Deakin University, Geelong, VIC, Australia
| | - John Grundy
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | | | - Lene J. Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark
- Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
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24
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Frølich A, Nielsen A, Glümer C, Eriksen CU, Maindal HT, Kleist BH, Birke H, Stockmarr A. Patients' assessment of care for type 2 diabetes: Results of the Patient Assessment of Chronic Illness Care scale in a Danish population. BMC Health Serv Res 2021; 21:1069. [PMID: 34627257 PMCID: PMC8501600 DOI: 10.1186/s12913-021-07051-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 09/17/2021] [Indexed: 12/02/2022] Open
Abstract
Background The Patient Assessment of Chronic Illness Care (PACIC) scale is the most appropriate for assessing self-reported experience in chronic care. We aimed to validate the PACIC questionnaire by (1) assess patients’ perception of the quality of care for Danish patients with type 2 diabetes, (2) identify which factors are most important to the quality of care designated by the five subscales in PACIC, and (3) the validity of the questionnaire. Methods A survey of 7,745 individuals randomly selected from the National Diabetes Registry. Descriptive statistics inter-item and item-rest correlations and factor analysis assessed the PACIC properties. Quality of care was analysed with descriptive statistics; linear and multiple regression assessed the effect of forty-nine covariates on total and subscale scores. Results In total, 2,696 individuals with type 2 diabetes completed ≥ 50 % of items. The floor effect for individual items was 8.5–74.5 %; the ceiling effect was 4.1–47.8 %. Cronbach’s alpha was 0.73–0.86 for the five subscales. The comparative fit index (CFI) and the Tucker–Lewis index (TLI) were 0,87, and 0,84, respectively. Mean PACIC score was 2.44 (± 0.04). Respondents, who receive diabetes care primarily at general practice and outpatient clinics had higher scores compared to those receiving care at a private specialist. Receiving rehabilitation was followed by higher scores in all subscales. Those 70 years or older had lower mean total and subscale scores compared to younger patient groups. A higher number of diabetes visits were associated with higher total scores; a higher number of emergency department visits were associated with lower total scores. The effects of healthcare utilisation on subscale scores varied. Conclusions These results provide insight into variations in the quality of provided care and can be used for targeting initiatives towards improving diabetes care. Factors important to the quality of perceived care are having a GP or hospital outpatient clinic as the primary organization. Also having a higher number of visits to the two organizations are perceived as higher quality of care as well as participating in a rehabilitation program. Floor and ceiling effects were comparable to an evaluation of the PACIC questionnaire in a Danish population. Yet, floor effects suggest a need for further evaluation and possible improvement of the PACIC questionnaire in a Danish setting. Total PACIC scores were lower than in other healthcare systems, possible being a result of different contexts and cultures, and of a need for improving diabetes care in Denmark. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07051-6.
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Affiliation(s)
- Anne Frølich
- Section of General Practice, Department of Public Health, University of Copenhagen, 1356 K, Copenhagen, Denmark. .,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, 4200, Slagelse, Denmark.
| | - Ann Nielsen
- Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, 2100, Copenhagen, Denmark
| | | | | | | | | | - Hanne Birke
- Center for clinical Research and Prevention, Frederiksberg Hospital, Frederiksberg, Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, 2800, Kgs. Lyngby, Denmark
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25
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Hansen H, Beyer N, Frølich A, Godtfredsen N, Bieler T. Inter-Day Test-Retest Reproducibility of the CAT, CCQ, HADS and EQ-5D-3L in Patients with Severe and Very Severe COPD. Patient Relat Outcome Meas 2021; 12:117-128. [PMID: 34104024 PMCID: PMC8179805 DOI: 10.2147/prom.s306352] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/30/2021] [Indexed: 11/23/2022]
Abstract
Introduction In patients with COPD, the COPD Assessment Test (CAT), Clinical COPD Questionnaire (CCQ), Hospital Anxiety and Depression Scale (HADS) and EuroQol 5D (EQ-5D-3L) are widely used patient reported outcome measures (PROMs) of respiratory symptoms, anxiety, depression and quality of life. Despite established validity, responsiveness and minimal important change (MIC), the reproducibility and especially important agreement parameters remain unreported in these frequently used PROMs. The aim of this study was to investigate the inter-day test–retest reliability and agreement of the CAT, CCQ, HADS and EQ-5D-3L in patients with severe and very severe COPD (FEV1 <50%) eligible for hospital-based pulmonary rehabilitation. Patients and Methods Fifty patients (22 females, mean [SD] age 67 [9] yrs.; FEV1 32[9] %; 6-minute walk distance 347 [102] meters; CAT 21 [6] points; BMI: 26 [6] kg/m2) completed the questionnaires (CAT, CCQ, HADS, EQ-5D-3L) in combination with functional performance test instructed by one assessor on test-day one (T1) and by another assessor 7–10 days later on test-day two (T2). Results The inter-day test–retest reliability ICC was 0.88 (LL95CI: 0.80) for CAT; 0.69 (LL95CI: 0.46) for CCQ; 0.86 (LL95CI: 0.75) and 0.90 (LL95CI: 0.82) for HADS-anxiety (A) and depression (D) and 0.87 (LL95CI: 0.76) for EQ-5D-VAS. The corresponding agreements within a single measurement (standard error of measurement, SEM) and for repeated measurement errors (smallest real difference, SRD) were respectively 2.1 and 2.9 points for CAT; 0.5 and 0.7 points for CCQ total; 1.3 and 1.9 points for HADS-A; 0.9 and 1.3 points for HADS-D and 6.8 and 9.7 VAS-score for EQ-5D-3L, respectively. Ceiling/flooring effect was present in <5% for all questionnaires. Conclusion In patients with severe and very severe COPD, the CAT, CCQ, HADS and EQ-5D-3L questionnaires presented moderate to excellent inter-day test–retest reliability, and no floor or ceiling effect was documented for any of the questionnaires. Only CAT and HADS had an acceptable SRD below the established MIC for assessing change over time on group level, and none of the PROMS were fit to assess individual changes over time.
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Affiliation(s)
- Henrik Hansen
- Department of Respiratory Medicine, Respiratory Research Unit, Hvidovre University Hospital, Hvidovre, Denmark
| | - Nina Beyer
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark.,Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Respiratory Research Unit, Hvidovre University Hospital, Hvidovre, Denmark.,Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Theresa Bieler
- Department of Physical & Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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26
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Lobo EH, Frølich A, Rasmussen LJ, Livingston PM, Grundy J, Abdelrazek M, Kensing F. Understanding the Methodological Issues and Solutions in the Research Design of Stroke Caregiving Technology. Front Public Health 2021; 9:647249. [PMID: 33937175 PMCID: PMC8085388 DOI: 10.3389/fpubh.2021.647249] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 03/15/2021] [Indexed: 11/25/2022] Open
Abstract
The rise in the number of cases of stroke has resulted in a significant burden on the healthcare system. As a result, the majority of care for the person living with stroke occurs within the community, resulting in caregivers being a central and challenged agent in care. To better support caregivers during the recovery trajectory poststroke, we investigated the role of health technologies to promote education and offer various kinds of support. However, the introduction of any new technology comes with challenges due to the growing need for more user-centric systems. The integration of user-centric systems in stroke caregiving has the potential to ensure long-term acceptance, success, and engagement with the technology, thereby ensuring better care for the person living with stroke. We first briefly characterize the affordances of available technologies for stroke caregiving. We then discuss key methodological issues related to the acceptance to such technologies. Finally, we suggest user-centered design strategies for mitigating such challenges.
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Affiliation(s)
- Elton H Lobo
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, VIC, Australia.,Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Lene J Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - John Grundy
- Faculty of Information Technology, Monash University, Clayton, VIC, Australia
| | - Mohamed Abdelrazek
- School of Information Technology, Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, VIC, Australia
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
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27
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Tang LH, Thygesen LC, Willadsen TG, Jepsen R, la Cour K, Frølich A, Møller A, Jørgensen LB, Skou ST. The association between clusters of chronic conditions and psychological well-being in younger and older people-A cross-sectional, population-based study from the Lolland-Falster Health Study, Denmark. J Comorb 2021; 10:2235042X20981185. [PMID: 33415082 PMCID: PMC7750742 DOI: 10.1177/2235042x20981185] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/22/2022]
Abstract
Aim: To investigate the association between clusters of conditions and
psychological well-being across age groups. Method: This cross-sectional study used data collected in the Danish population-based
Lolland-Falster Health Study. We included adults over the age of 18 years.
Self-reported chronic conditions were divided into 10 groups of conditions.
The primary outcome was psychological well-being (the WHO-5 Well-Being
Index). Factor analysis constructed the clusters of conditions, and
regression analysis investigated the association between clusters and
psychological well-being. Results: Of 10,781 participants, 31.4% were between 18 and 49 years, 35.7% were
between 50 and 64 years and 32.9% were above ≥65 years. 35.2% had conditions
represented in 1 and 32.9% in at least 2 of 10 condition groups. Across age
groups, living with one or more chronic conditions was associated with
poorer psychological well-being. Two chronic condition patterns were
identified; one comprised cardiovascular, endocrine, kidney, musculoskeletal
and cancer conditions, the second mental, lung, neurological,
gastrointestinal and sensory conditions. Both patterns were associated with
poorer psychological well-being (Pattern 1: −4.5 (95% CI: −5.3 to −3.7),
Pattern 2: −9.1 (95% CI −13.8 to −8.2). For pattern 2, participants ≥65
years had poorer psychological well-being compared to younger (−12.6 (95% CI
−14.2 to −11.0) vs −6.6 (95% CI: −7.8 to −5.4) for 18–49 years and −8.7 (95%
CI: −10.1 to −7.3) for 50–64 years, interaction: p ≤ 0.001) Conclusion: Living with one or more chronic conditions is associated with poorer
psychological well-being. Findings point toward a greater focus on
supporting psychological well-being in older adults with both mental and
somatic conditions.
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Affiliation(s)
- Lars Hermann Tang
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.,Department of Regional Health Research, University of Southern Denmark, Denmark.,National Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Denmark
| | - Tora Grauers Willadsen
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Randi Jepsen
- Lolland-Falster Health Study, Centre for Epidemiological Research, Nykøbing Falster Hospital, Nykøbing F., Denmark
| | - Karen la Cour
- National Centre for Rehabilitation and Palliative Care, University of Southern Denmark and Odense University Hospital, Nyborg, Denmark
| | - Anne Frølich
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse hospital (NSR), Region Zealand, Denmark
| | - Anne Møller
- The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Lars Bo Jørgensen
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.,Department of Rheumatology, Zealand University Hospital, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark.,Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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28
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Lobo EH, Frølich A, Kensing F, Rasmussen LJ, Livingston PM, Grundy J, Abdelrazek M. mHealth applications to support caregiver needs and engagement during stroke recovery: A content review. Res Nurs Health 2020; 44:213-225. [PMID: 33341958 DOI: 10.1002/nur.22096] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 12/15/2022]
Abstract
Caregiving in stroke results in severe physical, psychological, and social impacts on the caregiver. Over the past few years, researchers have explored the use of mHealth technologies to support healthcare-related activities due to their ability to provide real-time care at any given place or time. The purpose of this content review is to investigate mHealth apps in supporting stroke caregiving engagement based on three aspects: motivation, value, and satisfaction. We searched app stores and repositories for apps related to stroke caregiving published up to September 2020. Extracted apps were reviewed and filtered using inclusion criteria, and then downloaded onto compatible devices to determine eligibility. Results were compared with evidence-based frameworks to identify the ability of these apps in engaging and supporting the caregiver. Forty-seven apps were included in this review that enabled caregivers to support their needs, such as adjustment to new roles and relationships, involvement in care and caring for oneself using several different functionalities. These functionalities include information resources, risk assessment, remote monitoring, data sharing, reminders and so on. However, no single app was identified that focuses on all aspects of stroke caregiving. We also identified several challenges faced by users through their reviews and the factors associated with value and satisfaction. Our findings can add to the knowledge of existing mHealth technologies and their functionalities to support stroke caregiving needs, and the importance of considering user engagement in the design. They can be used by developers and researchers looking to design better mHealth apps for stroke caregiving.
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Affiliation(s)
- Elton H Lobo
- Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark.,Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Region Zealand, Denmark
| | - Finn Kensing
- Department of Computer Science, University of Copenhagen, Copenhagen, Denmark
| | - Lene J Rasmussen
- Department of Cellular and Molecular Medicine, University of Copenhagen, Copenhagen, Denmark.,Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| | | | - John Grundy
- Faculty of Information Technology, Monash University, Melbourne, Victoria, Australia
| | - Mohamed Abdelrazek
- Faculty of Science, Engineering and Built Environment, Deakin University, Geelong, Victoria, Australia
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29
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Eriksen CU, Kyriakidis S, Christensen LD, Jacobsen R, Laursen J, Christensen MB, Frølich A. Medication-related experiences of patients with polypharmacy: a systematic review of qualitative studies. BMJ Open 2020; 10:e036158. [PMID: 32895268 PMCID: PMC7477975 DOI: 10.1136/bmjopen-2019-036158] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [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: 12/15/2022] Open
Abstract
BACKGROUND We aimed to synthesise qualitative studies exploring medication-related experiences of polypharmacy among patients with multimorbidity. METHODS We systematically searched PubMed, Embase and Cumulative Index to Nursing and Allied Health Literature in February 2020 for primary, peer-reviewed qualitative studies about multimorbid patients' medication-related experiences with polypharmacy, defined as the use of four or more medications. Identified studies were appraised for methodological quality by applying the Critical Appraisal Skills Programme checklist for qualitative research, and data were extracted and synthesised by the meta-aggregation approach. RESULTS We included 13 qualitative studies, representing 499 patients with polypharmacy and a wide range of chronic conditions. Overall, most Critical Appraisal Skills Programme items were reported in the studies. We extracted 140 findings, synthesised these into 17 categories, and developed five interrelated syntheses: (1) patients with polypharmacy are a heterogeneous group in terms of needing and appraising medication information; (2) patients are aware of the importance of medication adherence, but it is difficult to achieve; (3) decision-making about medications is complex; (4) multiple relational factors affect communication between patients and physicians, and these factors can prevent patients from disclosing important information; and (5) polypharmacy affects patients' lives and self-perception, and challenges with polypharmacy are not limited to practical issues of medication-taking. DISCUSSION Polypharmacy poses many challenges to patients, which have a negative impact on quality of life and adherence. Thus, when dealing with polypharmacy patients, it is crucial that healthcare professionals actively solicit individual patients' perspectives on challenges related to polypharmacy. Based on the reported experiences, we recommend that healthcare professionals upscale communicative efforts and involve patients' social network on an individualised basis to facilitate shared decision-making and treatment adherence in multimorbidpatients with polypharmacy.
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Affiliation(s)
- Christian Ulrich Eriksen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Frederiksberg, Denmark
| | - Stavros Kyriakidis
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Capital Region of Denmark, Frederiksberg, Denmark
| | | | - Ramune Jacobsen
- Research Group for Social and Clinical Pharmacy, Department of Pharmacy, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Jannie Laursen
- Global Business Quality Management, Falck, Copenhagen, Denmark
| | - Mikkel Bring Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Anne Frølich
- The Research Unit for General Practice, Department of Public Health, University of Copenhagen, Faculty of Health and Medical Sciences, Copenhagen, Denmark
- Innovation and Research Center for Multimorbidity and Chronic Conditions, Region Zealand, Slagelse, Denmark
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Birke H, Jacobsen R, Jønsson AB, Guassora ADK, Walther M, Saxild T, Laursen JT, Vall-Lamora MHD, Frølich A. A complex intervention for multimorbidity in primary care: A feasibility study. J Comorb 2020; 10:2235042X20935312. [PMID: 32844099 PMCID: PMC7418232 DOI: 10.1177/2235042x20935312] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/28/2020] [Indexed: 11/15/2022]
Abstract
Aim To assess the feasibility of a patient-centered complex intervention for multimorbidity (CIM) based on general practice in collaboration with community health-care centers and outpatient clinics. Methods Inclusion criteria were age ≥18 years, diagnoses of two or more of three chronic conditions (diabetes, chronic obstructive pulmonary disease (COPD), and chronic heart conditions), and a hospital contact during the previous year. The CIM included extended consultations and nurse care manager support in general practice and intensified cross-sectorial collaboration. Elements included a structured care plan based on patients' care goals, coordination of services, and, if appropriate, shifting outpatient clinic visits to general practice, medication review, referral to rehabilitation, and home care. The acceptability dimension of feasibility was assessed with validated questionnaires, observations, and focus groups. Results Forty-eight patients were included (mean age 72.2 (standard deviation (SD) 9.5, range 52-89); 23 (48%) were men. Thirty-seven patients had two diseases; most commonly COPD and cardiovascular disease (46%), followed by diabetes and cardiovascular disease (23%), and COPD and diabetes (15%). Eleven (23%) patients had all three conditions. Focus group interviews with patients with multimorbidity identified three main themes: (1) lack of care coordination existed across health-care sectors before the CIM, (2) extended consultations provided better care coordination, and (3) patients want to be involved in planning their treatment and care. In focus groups, health-care professionals discussed two main themes: (1) patient-centered care and (2) culture and organizational change. Completion rates for questionnaires were 98% (47/48). Conclusions Patients and health-care professionals found the CIM acceptable.
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Affiliation(s)
- Hanne Birke
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Ramune Jacobsen
- Department of Pharmacy, Section of Social and Clinical Pharmacy, Copenhagen Ø, Denmark
| | - Alexandra Br Jønsson
- Section of General Practice in Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | - Ann Dorrit Kristiane Guassora
- Section of General Practice in Copenhagen, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen K, Denmark
| | | | - Thomas Saxild
- General Practice, Groendalslaegerne, Vanloese, Denmark
| | | | - Maria Helena Dominquez Vall-Lamora
- Department of Cardiology Y, Bispebjerg-Frederiksberg University Hospital, Copenhagen, Denmark; Department of Biomedicine, University of Copenhagen, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark; Innovation and Research Centre for Multimorbidity, Slagelse Hospital, Slagelse, Denmark
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Loeppenthin K, Dalton SO, Johansen C, Andersen E, Christensen MB, Pappot H, Petersen LN, Thisted LB, Frølich A, Mortensen CE, Lassen U, Ørsted J, Bidstrup PE. Total burden of disease in cancer patients at diagnosis-a Danish nationwide study of multimorbidity and redeemed medication. Br J Cancer 2020; 123:1033-1040. [PMID: 32632149 PMCID: PMC7493878 DOI: 10.1038/s41416-020-0950-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2019] [Revised: 05/19/2020] [Accepted: 06/04/2020] [Indexed: 01/09/2023] Open
Abstract
Background Multimorbidity is a growing challenge worldwide. In this nationwide study, we investigated the prevalence of multimorbidity and polypharmacy at the time of diagnosis across 20 cancers. Methods We conducted a nationwide register-based cohort study of all Danish residents with a first primary cancer diagnosed between 1 January 2005 and 31 December 2015. Multimorbidity was defined as one or more of 20 conditions (131 specific diagnoses) registered in the Danish National Patient Registry < 5 years before the cancer diagnosis. Polypharmacy was defined as five or more medications registered in the Danish National Prescription Registry and redeemed twice 2–12 months before the cancer diagnosis. Results We included 261,745 patients with a first primary cancer, of whom 55% had at least one comorbid condition at diagnosis and 27% had two or more. The most prevalent conditions at the time of cancer diagnosis were cardiovascular disease, chronic obstructive pulmonary disease, diabetes, stroke and depression/anxiety disorder. Polypharmacy was present in one-third of the cancer patients with antihypertensives, anti-thrombotic agents, anti-hyperlipidaemic agents, analgesics and diuretics as the most prevalent redeemed medications. Conclusion Among patients with a newly established cancer diagnosis, 55% had at least one comorbid condition and 32% were exposed to polypharmacy.
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Affiliation(s)
- Katrine Loeppenthin
- Late Effect Research Unit CASTLE, Department of Oncology, Rigshospitalet, Blegdamsvej 58, 9601, 2100, Copenhagen, Denmark. .,Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.
| | - Susanne Oksbjerg Dalton
- Survivorship and Inequality in Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Naestved, Denmark
| | - Christoffer Johansen
- Late Effect Research Unit CASTLE, Department of Oncology, Rigshospitalet, Blegdamsvej 58, 9601, 2100, Copenhagen, Denmark.,Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Elisabeth Andersen
- Statistics and Data Analysis, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
| | - Mikkel Bring Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 24, 2400, Copenhagen, Denmark
| | - Helle Pappot
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark.,Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | | | - Lise Bjerrum Thisted
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Anne Frølich
- Research Center for Multimorbidity and Chronic Conditions, Region Zealand, University of Copenhagen, Copenhagen, Denmark
| | | | - Ulrik Lassen
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Jytte Ørsted
- Department of Oncology, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Pernille Envold Bidstrup
- Psychological Aspects of Cancer, Danish Cancer Society Research Center, Strandboulevarden 49, 2100, Copenhagen, Denmark
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Hansen H, Bieler T, Beyer N, Kallemose T, Wilcke JT, Østergaard LM, Frost Andeassen H, Martinez G, Lavesen M, Frølich A, Godtfredsen NS. Supervised pulmonary tele-rehabilitation versus pulmonary rehabilitation in severe COPD: a randomised multicentre trial. Thorax 2020; 75:413-421. [PMID: 32229541 PMCID: PMC7231436 DOI: 10.1136/thoraxjnl-2019-214246] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 01/24/2023]
Abstract
RATIONALE Pulmonary rehabilitation (PR) is an effective, key standard treatment for people with COPD. Nevertheless, low participant uptake, insufficient attendance and high drop-out rates are reported. Investigation is warranted of the benefits achieved through alternative approaches, such as pulmonary tele-rehabilitation (PTR). OBJECTIVE To investigate whether PTR is superior to conventional PR on 6 min walk distance (6MWD) and secondarily on respiratory symptoms, quality of life, physical activity and lower limb muscle function in patients with COPD and FEV1 <50% eligible for routine hospital-based, outpatient PR. METHODS In this single-blinded, multicentre, superiority randomised controlled trial, patients were assigned 1:1 to 10 weeks of groups-based PTR (60 min, three times weekly) or conventional PR (90 min, two times weekly). Assessments were performed by blinded assessors at baseline, end of intervention and at 22 weeks' follow-up from baseline. The primary analysis was based on the intention-to-treat principle. MEASUREMENTS AND MAIN RESULTS The primary outcome was change in 6MWD from baseline to 10 weeks; 134 participants (74 females, mean±SD age 68±9 years, FEV1 33%±9% predicted, 6MWD 327±103 metres) were included and randomised. The analysis showed no between-group differences for changes in 6MWD after intervention (9.2 metres (95% CI: -6.6 to 24.9)) or at 22 weeks' follow-up (-5.3 metres (95% CI: -28.9 to 18.3)). More participants completed the PTR intervention (n=57) than conventional PR (n=43) (χ2 test p<0.01). CONCLUSION PTR was not superior to conventional PR on the 6MWD and we found no differences between groups. As more participants completed PTR, supervised PTR would be relevant to compare with conventional PR in a non-inferiority design. Trial registration number ClinicalTrials.gov (NCT02667171), 28 January 2016.
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Affiliation(s)
- Henrik Hansen
- Respiratory Research Unit, Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Theresa Bieler
- Department of Physical and Occupational Therapy, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nina Beyer
- Institute for Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark
| | - Thomas Kallemose
- Clinical Research Center, Copenhagen University Hospital Amager and Hvidovre, Hvidovre, Denmark
| | - Jon Torgny Wilcke
- Department of Pulmonary Medicine, Gentofte Hospital, Hellerup, Denmark
| | | | | | - Gerd Martinez
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Marie Lavesen
- Department of Respiratory Medicine and Infectious Diseases, Hillerød Hospital, Hillerød, Denmark
| | - Anne Frølich
- Department of Public Health, University of Copenhagen Faculty of Health Sciences, Copenhagen, Denmark
| | - Nina Skavlan Godtfredsen
- Institute for Clinical Medicine, University of Copenhagen Faculty of Health and Medical Sciences, Copenhagen, Denmark.,Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
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Ghith N, Merlo J, Frølich A. Albuminuria measurement in diabetic care: a multilevel analysis measuring the influence of accreditation on institutional performance. BMJ Open Qual 2019; 8:e000449. [PMID: 30729192 PMCID: PMC6340563 DOI: 10.1136/bmjoq-2018-000449] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2018] [Revised: 11/27/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
Background Studies assessing institutional performance regarding quality of care are frequently performed using single-level statistical analyses investigating differences between provider averages of various quality indicators. However, such analyses are insufficient as they do not consider patients’ heterogeneity around those averages. Hence, we apply a multilevel analysis of individual-patient heterogeneity that distinguishes between ‘general’ (‘latent quality’ or measures of variance) and ‘specific’ (measures of association) contextual effects. We assess general contextual effects of the hospital departments and the specific contextual effect of a national accreditation programme on adherence to the standard benchmark for albuminuria measurement in Danish patients with diabetes. Methods From the Danish Adult Diabetes Database, we extracted data on 137 893 patient cases admitted to hospitals between 2010 and 2013. Applying multilevel logistic and probit regression models for every year, we quantified general contextual effects of hospital department by the intraclass correlation coefficient (ICC) and the area under the receiver operating characteristic curve (AUC) values. We evaluated the specific effect of hospital accreditation using the ORs and the change in the department variance. Results In 2010, the department context had considerable influence on adherence with albuminuria measurement (ICC=21.8%, AUC=0.770), but the general effect attenuated along with the implementation of the national accreditation programme. The ICC value was 16.5% in 2013 and the rate of compliance with albuminuria measurement increased from 91.6% in 2010 to 96% in 2013. Conclusions Parallel to implementation of the national accreditation programme, departments’ compliance with the standard benchmark for albuminuria measurement increased and the ICC values decreased, but remained high. While those results indicate an overall quality improvement, further intervention focusing on departments with the lowest compliance could be considered.
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Affiliation(s)
- Nermin Ghith
- Research Unit of Chronic Conditions, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark.,Unit for Social Epidemiology, Lunds Universitet, Lund, Sweden
| | - Juan Merlo
- Unit for Social Epidemiology, Lunds Universitet, Lund, Sweden
| | - Anne Frølich
- Research Unit of Chronic Conditions, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Frederiksberg, Denmark
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Schiøtz ML, Frølich A, Jensen AK, Reuther L, Perrild H, Petersen TS, Kornholt J, Christensen MB. Polypharmacy and medication deprescribing: A survey among multimorbid older adults in Denmark. Pharmacol Res Perspect 2018; 6:e00431. [PMID: 30386624 PMCID: PMC6198567 DOI: 10.1002/prp2.431] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/15/2018] [Indexed: 12/02/2022] Open
Abstract
Polypharmacy is common among multimorbid adults and associated with increased morbidity and mortality. Excessive polypharmacy (ie, ≥10 medicine) is strongly associated with inappropriate medication use, but little is known about attitudes toward deprescribing in patients with excessive polypharmacy. We surveyed 100 Danish individuals aged 65 years and above with ≥10 prescribed medications, using the validated Patients' Attitudes Towards Deprescribing (PATD) instrument. Most participants (81, 81%) thought they took a large number of medications, and 79 (79%) believed that their medications were necessary. Even so, 85 (85%) reported that they would be willing to stop taking one or more of their regular medications if their doctor told them they could, and 11 (11%) felt that they took at least one regular medication that they no longer needed. When presented with visual presentation of various amounts of tablets and capsules, 62 (62%) of participants reported that they would be comfortable taking fewer medications than they did. Forty-two (42%) participants had experience with stopping a regular medication. Almost all participants (92%) wanted to receive follow-up by various means if a medication was discontinued. Forty-one (41%) participants were interested in a consultation at an outpatient clinic specializing in polypharmacy. Overall, the answers to the PATD questionnaire suggest that our cohort of Danish, multimorbid outpatients with extensive polypharmacy have a high confidence in their healthcare providers for medication-related decisions, even though some feel that they are taking more medications than they would like to and feel that some medications may be unnecessary. Our results underline the need for healthcare providers to offer medication reviews in patients with multimorbidity.
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Affiliation(s)
- Michaela L. Schiøtz
- Cross‐sectoral Research UnitCenter for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalsUniversity of CopnhagenDenmark
| | - Anne Frølich
- Research Unit for Chronic ConditionsCenter for Clinical Research and PreventionBispebjerg and Frederiksberg HospitalsUniversity of CopenhagenCopenhagenDenmark
| | - Anette K. Jensen
- Department of Clinical PharmacologyBispebjerg and Frederiksberg HospitalsUniversity of CopenhagenCopenhagenDenmark
| | - Lene Reuther
- Department of Clinical PharmacologyBispebjerg and Frederiksberg HospitalsUniversity of CopenhagenCopenhagenDenmark
| | - Hans Perrild
- Department of EndocrinologyBispebjerg and Frederiksberg HospitalsUniversity of CopenhagenCopenhagenDenmark
| | - Tonny S. Petersen
- Department of Clinical PharmacologyBispebjerg and Frederiksberg HospitalsUniversity of CopenhagenCopenhagenDenmark
| | - Jonatan Kornholt
- Department of Clinical PharmacologyBispebjerg and Frederiksberg HospitalsUniversity of CopenhagenCopenhagenDenmark
| | - Mikkel B. Christensen
- Department of Clinical PharmacologyBispebjerg and Frederiksberg HospitalsUniversity of CopenhagenCopenhagenDenmark
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Hansen N, Jacobsen R, Frølich A. Heart and cardiovascular comorbidities considerably increase health care use in Danish COPD patients. Eur J Public Health 2018. [DOI: 10.1093/eurpub/cky214.256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- N Hansen
- University of Copenhagen, Copenhagen, Denmark
| | - R Jacobsen
- Research Unit for Chronic Conditions, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg hospital, Frederiksberg, Denmark
| | - A Frølich
- Research Unit for Chronic Conditions, Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg hospital, Frederiksberg, Denmark
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Hansen H, Beyer N, Frølich A, Godtfredsen N, Bieler T. Intra- and inter-rater reproducibility of the 6-minute walk test and the 30-second sit-to-stand test in patients with severe and very severe COPD. Int J Chron Obstruct Pulmon Dis 2018; 13:3447-3457. [PMID: 30425474 PMCID: PMC6203115 DOI: 10.2147/copd.s174248] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Background In patients with COPD, the 6-minute walk test (6MWT) and the 30-second sit-to-stand test (30sec-STS) are widely used as clinical outcome measures of walking capacity, lower limb muscle strength, and functional ability. Due to a documented learning effect, at least two trials are recommended for assessment. The aim of our study was to investigate the intra- and inter-rater reliability and agreement of the two tests in patients with severe and very severe COPD (FEV1 <50%). Patients and methods Fifty patients (22 females; mean [SD]: age 67 [9] years, FEV1 predicted 32 [9]%) were assessed with the 6MWT and the 30sec-STS twice by the same assessor on test-day 1 (T1) and by another assessor 7–10 days later on test-day 2 (T2). Results The 6MWT intra- and inter-rater reliability (intraclass correlation coefficient, ICC1.1) was 0.98 (lower limit 95% CI: 0.94) and 0.96 (lower limit 95% CI: 0.94), respectively, and agreement (standard error of the measurement, SEM) was 14.8 and 20.5 m, respectively. The 30sec-STS intra- and inter-rater reliability and agreement results were, respectively, ICC1.1 0.94 (lower limit 95% CI: 0.90) and 0.92 (lower limit 95% CI: 0.86), with SEM of 0.97 and 1.14 repetitions. There was no difference (95% CI: −5.3; 8.1) between the 6MWT distances on T1, while the mean walking distance improved 7.9 m (0.0 m; 15.8 m) from T1 to T2. Improvement on the same test date was less likely (OR: 3.6 [95% CI: 1.1; 11.8], Fisher’s exact test, P=0.047) in patients who walked less than 350 m in the 6MWT. We found no clinically relevant learning effect in the 30sec-STS. Conclusion In patients with severe and very severe COPD the 6MWT and the 30sec-STS showed excellent intra- and inter-rater reliability and acceptable agreement. No learning effect was documented for the tests when performed on the same day. Our data suggest that in clinical practice using different assessors is acceptable, and that a single test trial may be sufficient to assess patients with severe and very severe COPD.
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Affiliation(s)
- Henrik Hansen
- Research Unit of Chronic Diseases and Telemedicine - Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark,
| | - Nina Beyer
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Research Unit of Chronic Diseases and Telemedicine - Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark,
| | - Nina Godtfredsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.,Department of Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - Theresa Bieler
- Department of Physical and Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
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Frølich A, McNair P, Transbøl I. Awareness of hypercalcaemia in a hospital population? Scandinavian Journal of Clinical and Laboratory Investigation 2018. [DOI: 10.1080/00365513.1991.11978687] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A. Frølich
- Mineral Metabolic Research Group and Department of Clinical Chemistry, Herlev County Hospital, Herlev and Department of Clinical Chemistry, Division of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - P. McNair
- Mineral Metabolic Research Group and Department of Clinical Chemistry, Herlev County Hospital, Herlev and Department of Clinical Chemistry, Division of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
| | - I. Transbøl
- Mineral Metabolic Research Group and Department of Clinical Chemistry, Herlev County Hospital, Herlev and Department of Clinical Chemistry, Division of Endocrinology, Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark
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Schiøtz ML, Høst D, Christensen MB, Domínguez H, Hamid Y, Almind M, Sørensen KL, Saxild T, Holm RH, Frølich A. Quality of care for people with multimorbidity - a case series. BMC Health Serv Res 2017; 17:745. [PMID: 29151022 PMCID: PMC5694163 DOI: 10.1186/s12913-017-2724-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2016] [Accepted: 11/13/2017] [Indexed: 12/16/2022] Open
Abstract
Background Multimorbidity is becoming increasingly prevalent and presents challenges for healthcare providers and systems. Studies examining the relationship between multimorbidity and quality of care report mixed findings. The purpose of this study was to investigate quality of care for people with multimorbidity in the publicly funded healthcare system in Denmark. Methods To investigate the quality of care for people with multimorbidity different groups of clinicians from the hospital, general practice and the municipality reviewed records from 23 persons with multimorbidity and discussed them in three focus groups. Before each focus group, clinicians were asked to review patients’ medical records and assess their care by responding to a questionnaire. Medical records from 2013 from hospitals, general practice, and health centers in the local municipality were collected and linked for the 23 patients. Further, two clinical pharmacologists reviewed the appropriateness of medications listed in patient records. Results The review of the patients’ records conducted by three groups of clinicians revealed that around half of the patients received adequate care for the single condition which prompted the episode of care such as a hospitalization, a visit to an outpatient clinic or the general practitioner. Further, the care provided to approximately two-thirds of the patients did not take comorbidities into account and insufficiently addressed more diffuse symptoms or problems. The review of the medication lists revealed that the majority of the medication lists contained inappropriate medications and that there were incongruity in medication listed in the primary and secondary care sector. Several barriers for providing high quality care were identified. These included relative short consultation times in general practice and outpatient clinics, lack of care coordinators, and lack of shared IT-system proving an overview of the treatment. Conclusions Our findings reveal quality of care deficiencies for people with multimorbidity. Suggestions for care improvement for people with multimorbidity includes formally assigned responsibility for care coordination, a change in the financial incentive structure towards a system rewarding high quality care and care focusing on prevention of disease exacerbation, as well as implementing shared medical record systems.
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Affiliation(s)
- Michaela L Schiøtz
- Cross-sectoral Research Unit, The Danish Capital Region, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark. .,Research Unit for Chronic Conditions, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark.
| | - Dorte Høst
- Cross-sectoral Research Unit, The Danish Capital Region, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark.,Research Unit for Chronic Conditions, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel B Christensen
- Department of Clinical Pharmacology, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Helena Domínguez
- Department of Cardiology, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Yasmin Hamid
- Department of Endocrinology, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | - Merete Almind
- Department of Respiratory Medicine, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Rikke Høgsbro Holm
- Health Prevention Center, Municipality of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Research Unit for Chronic Conditions, Department of Clinical Epidemiology, Bispebjerg and Frederiksberg Hospitals, University of Copenhagen, Copenhagen, Denmark
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Hansen H, Bieler T, Beyer N, Godtfredsen N, Kallemose T, Frølich A. COPD online-rehabilitation versus conventional COPD rehabilitation - rationale and design for a multicenter randomized controlled trial study protocol (CORe trial). BMC Pulm Med 2017; 17:140. [PMID: 29145831 PMCID: PMC5689178 DOI: 10.1186/s12890-017-0488-1] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 11/10/2017] [Indexed: 01/18/2023] Open
Abstract
Background Rehabilitation of patients with chronic obstructive pulmonary disease (COPD) is a key treatment in COPD. However, despite the existing evidence and a strong recommendation from lung associations worldwide, 50% of patients with COPD decline to participate in COPD rehabilitation program and 30–50% drop-out before completion. The main reasons are severe symptoms, inflexible accessibility and necessity for transportation. Currently there are no well-established and evident rehabilitation alternatives. Supervised online screen rehabilitation could be a useful approach to increase accessibility and compliance. The aim of this multicenter RCT study is to compare the potential benefits of a 10-week online COPD rehabilitation program (CORe) with conventional outpatient COPD rehabilitation (CCRe). Methods This study is a randomized assessor- and statistician blinded superiority multicenter trial with two parallel groups, employing 1:1 allocation to the intervention and the comparison group.On the basis of a sample size calculation, 134 patients with severe or very severe COPD and eligible to conventional hospital based outpatient COPD rehabilitation will be included and randomized from eight different hospitals. The CORe intervention group receives group supervised resistance- and endurance training and patient education, 60 min, three times/week for 10 weeks at home via online-screen. The CCRe comparison group receives group based supervised resistance- and endurance training and patient education, 90 min, two times/week for 10 weeks (two hospitals) or 12 weeks (six hospitals) in groups at the local hospital. The primary outcome is change in the 6-min walking distance after 10/12 weeks; the secondary outcomes are changes in 30 s sit-to-stand chair test, physical activity level, symptoms, anxiety and depression symptoms, disease specific and generic quality of life. Primary endpoint is 10/12 weeks from baseline, while secondary endpoints are 22, 36, 62 weeks from baseline assessments. Discussion The study will likely contribute to knowledge regarding COPD tele-rehabilitation and to which extent it is more feasible and thereby more efficient than conventional COPD rehabilitation in patients with severe and very severe COPD. Trial registration Clinicaltrials.gov Identifier: NCT02667171. Registration data: January 28th 2016.
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Affiliation(s)
- Henrik Hansen
- Research Unit for Chronic Diseases and Telemedicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2450, Copenhagen, NV, Denmark. .,Research Unit for Chronic Diseases and Telemedicine, University Hospital Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2450, Copenhagen, NV, Denmark.
| | - Theresa Bieler
- Department of Physical & Occupational Therapy, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Nina Beyer
- Institute for Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Nina Godtfredsen
- Department of Respiratory Medicine, Hvidovre University Hospital, Hvidovre, Denmark
| | - Thomas Kallemose
- Clinical Research Center, Hvidovre University Hospital, Hvidovre, Denmark
| | - Anne Frølich
- Research Unit for Chronic Diseases and Telemedicine, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Bispebjerg Bakke 23, 2450, Copenhagen, NV, Denmark
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Laursen DH, Christensen KB, Christensen U, Frølich A. Assessment of short and long-term outcomes of diabetes patient education using the health education impact questionnaire (HeiQ). BMC Res Notes 2017; 10:213. [PMID: 28619041 PMCID: PMC5471707 DOI: 10.1186/s13104-017-2536-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2016] [Accepted: 06/05/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Type 2 diabetes is a progressive chronic illness that will affect more than 500 million people worldwide by 2030. It is a significant cause of morbidity and mortality. Finding the right care management for diabetes patients is necessary to effectively address the growing population of affected individuals and escalating costs. Patient education is one option for improving patient self-management. However, there are large discrepancies in the outcomes of such programs and long-term data are lacking. We assessed the short and long-term outcomes of diabetes patient education using the health education impact questionnaire (HeiQ). METHODS We conducted a observational cohort study of 83 type 2 diabetes patients participating in patient education programs in Denmark. The seven-scale HeiQ was completed by telephone interview at baseline and 2 weeks (76 participants, 93%) and 12 months (66, 80%) after the patient education ended. Changes over time were assessed using mean values and standard deviation at each time point and Cohen effect sizes. RESULTS Patients reported improvements 2 weeks after the program ended in 4 of 7 constructs: skills and technique acquisition (ES = 0.59), self-monitoring and insight (ES = 0.52), constructive attitudes and approaches (ES = 0.43) and social integration and support (ES = 0.27). After 12 months, patients reported improvements in 3 of 7 constructs: skills and technique acquisition (ES = 0.66), constructive attitudes and approaches (ES = 0.43), and emotional wellbeing (ES = 0.44). Skills and technique showed the largest short- and long-term effect size. No significant changes were found in health-related activity or positive and active engagement in life over time. CONCLUSION After 12 months, diabetes patients who participated in patient education demonstrated increased self-management skills, improved acceptance of their chronic illness and decreased negative emotional response to their disease. Applying HeiQ as an outcome measure yielded new knowledge as to what patients with diabetes can obtain by participating in a patient education.
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Affiliation(s)
- Ditte Hjorth Laursen
- Research Unit of Chronic Conditions, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 20D, 2400, Copenhagen NV, Denmark.
| | - Karl Bang Christensen
- Department of Biostatistics, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, 1014, Copenhagen K, Denmark
| | - Ulla Christensen
- Department of Social Medicine, Institute of Public Health, University of Copenhagen, Øster Farimagsgade 5, Postboks 2099, 1014, Copenhagen K, Denmark
| | - Anne Frølich
- Research Unit of Chronic Conditions, Bispebjerg and Frederiksberg Hospital, Bispebjerg Bakke 23, 20D, 2400, Copenhagen NV, Denmark
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Laursen DH, Frølich A, Christensen U. Patients’ perception of disease and experience with type 2 diabetes patient education in Denmark. Scand J Caring Sci 2017; 31:1039-1047. [DOI: 10.1111/scs.12429] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 12/15/2016] [Indexed: 11/29/2022]
Affiliation(s)
- Ditte Hjorth Laursen
- Research Unit for Chronic Conditions and Telemedicine; Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
| | - Anne Frølich
- Research Unit for Chronic Conditions and Telemedicine; Bispebjerg and Frederiksberg Hospital; Copenhagen Denmark
| | - Ulla Christensen
- Department of Public Health; Section of Social Medicine; University of Copenhagen; Copenhagen Denmark
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Hu Y, Cantarero-Arévalo L, Frølich A, Jacobsen R. Erratum to: Ethnic Differences in Persistence with COPD Medications: a Register-Based Study. J Racial Ethn Health Disparities 2017; 4:1253. [PMID: 28488250 DOI: 10.1007/s40615-017-0375-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Yusun Hu
- Faculty of Health and Medical Sciences, Department of Pharmacy, Section for Social and Clinical Pharmacy, University of Copenhagen, Universitetsparken 2, Copenhagen, Denmark
| | - Lourdes Cantarero-Arévalo
- Faculty of Health and Medical Sciences, Department of Pharmacy, Section for Social and Clinical Pharmacy, University of Copenhagen, Universitetsparken 2, Copenhagen, Denmark
| | - Anne Frølich
- Research Unit for Chronic Conditions, Department of Clinical Epidemiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark
| | - Ramune Jacobsen
- Research Unit for Chronic Conditions, Department of Clinical Epidemiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Bispebjerg Bakke 23, 2400, Copenhagen, Denmark.
- Research Unit for Dietary Studies, The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg, Nordre Fasanvej, 57, Frederiksberg, Denmark.
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Schiøtz ML, Stockmarr A, Høst D, Glümer C, Frølich A. Social disparities in the prevalence of multimorbidity - A register-based population study. BMC Public Health 2017; 17:422. [PMID: 28486983 PMCID: PMC5424300 DOI: 10.1186/s12889-017-4314-8] [Citation(s) in RCA: 105] [Impact Index Per Article: 15.0] [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] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 04/26/2017] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Prevalences of multimorbidity vary between European studies and several methods and definitions are used. In this study we examine the prevalence of multimorbidity in relation to age, gender and educational attainment and the association between physical and mental health conditions and educational attainment in a Danish population. METHODS A cross-sectional design was used to study the prevalence of multimorbidity, defined as two or more chronic conditions, and of comorbid physical and mental health conditions across age groups and educational attainment levels among 1,397,173 individuals aged 16 years and older who lived in the Capital Region of Denmark on January 1st, 2012. After calculating prevalence, odds ratios for multimorbidity and mental health conditions were derived from logistic regression on gender, age, age squared, education and number of physical conditions (only for odds ratios for mental health conditions). Odds ratios for having multimorbidity and mental health conditions for each variable were adjusted for all other variables. RESULTS Multimorbidity prevalence was 21.6%. Half of the population aged 65 and above had multimorbidity, and prevalence was inversely related to educational attainment: 26.9% (95% CI, 26.8-26.9) among those with lower secondary education versus 13.5% (95% CI, 13.5-13.6) among people with postgraduate education. Adjusted odds ratios for multimorbidity were 0.50 (95% CI, 0.49-0.51) for people with postgraduate education, compared to people with lower secondary education. Among all population members, 4.9% (95% CI, 4.9-4.9) had both a physical and a mental health condition, a proportion that increased to 22.6% of people with multimorbidity. Physical and mental health comorbidity was more prevalent in women (6.33%; 95% CI, 6.3-6.4) than men (3.34%; 95% CI, 3.3-3.4) and approximately 50 times more prevalent among older persons than younger ones. Physical and mental health comorbidity was also twice as prevalent among people with lower secondary education than among those with postgraduate education. The presence of a mental health condition was strongly associated with the number of physical conditions; those with five or more physical conditions had an adjusted odds ratio for a mental health condition of 3.93 (95% CI, 3.8-4.1), compared to those with no physical conditions. CONCLUSION Multimorbidity prevalence and patterns in the Danish population are comparable to those of other European populations. The high prevalence of mental and physical health conditions highlights the need to ensure that healthcare systems deliver care that takes physical and mental comorbidity into account. Further, the higher prevalence of multimorbidity among persons with low educational attainment emphasizes the importance of having a health care system providing care that is beneficial to all regardless of socioeconomic status.
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Affiliation(s)
- Michaela L. Schiøtz
- Intersectoral Research Unit for Health Services, The Danish Capital Region, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
- Research Unit for Chronic Conditions, Bispebjerg University Hospital, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
| | - Anders Stockmarr
- Department of Applied Mathematics and Computer Science, Technical University of Denmark Richard Petersens Plads, Building 324, 2800 Kongens Lyngby, Denmark
| | - Dorte Høst
- Research Unit for Chronic Conditions, Bispebjerg University Hospital, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
| | - Charlotte Glümer
- Research Centre for Prevention and Health, The Capital Region, Rigshospitalet, Copenhagen University, Nordre Ringvej 57 Building 84-85, 2600 Glostrup, DK Denmark
- Department of Health Science and Technology, Aalborg University, Frederik Bajers Vej 5, Aalborg, 9220 Denmark
| | - Anne Frølich
- Research Unit for Chronic Conditions, Bispebjerg University Hospital, Bispebjerg Bakke 23, Building 20D, 2nd Floor, DK, -2400 Copenhagen, NV Denmark
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Hu Y, Cantarero-Arévalo L, Frølich A, Jacobsen R. Erratum to: Ethnic Inequalities in COPD Outcomes: a Register-Based Study in Copenhagen, Denmark. J Racial Ethn Health Disparities 2017; 4:1165. [PMID: 28155058 DOI: 10.1007/s40615-017-0345-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Yusun Hu
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lourdes Cantarero-Arévalo
- Section for Social and Clinical Pharmacy, Department of Pharmacy, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Frølich
- Research Unit for Chronic Conditions, Hospital Bispebjerg and Frederiksberg, Copenhagen University, Copenhagen, Denmark
| | - Ramune Jacobsen
- Research Unit for Chronic Conditions, Hospital Bispebjerg and Frederiksberg, Copenhagen University, Copenhagen, Denmark. .,Research Unit for Dietary Studies, The Parker Institute, Copenhagen University Hospital Bispebjerg and Frederiksberg, Nordre Fasanvej 57, 2000, Frederiksberg, Denmark.
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Hu Y, Cantarero-Arévalo L, Frølich A, Jacobsen R. Ethnic Inequalities in COPD Outcomes: a Register-Based Study in Copenhagen, Denmark. J Racial Ethn Health Disparities 2016; 4:1159-1164. [DOI: 10.1007/s40615-016-0321-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/24/2016] [Accepted: 11/27/2016] [Indexed: 10/20/2022]
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Laursen DH, Christensen KB, Christensen U, Frølich A. Self-rated health as a predictor of outcomes of type 2 diabetes patient education programmes in Denmark. Public Health 2016; 139:170-177. [PMID: 27475450 DOI: 10.1016/j.puhe.2016.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Revised: 05/24/2016] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To explore if self-rated health (SRH) can predict differences in outcomes of patient education programmes among patients with type 2 diabetes over time. STUDY DESIGN This is an observational cohort study conducted among 83 patients with type 2 diabetes participating in patient education programmes in the Capital Region of Denmark. METHODS Questionnaire data were collected by telephone interview at baseline and 2 weeks (77 participants, 93%) and 12 months (66, 80%) after the patient education ended. The seven-scale Health Education Impact Questionnaire (HeiQ) was the primary outcome. The independent variable was SRH, which was dichotomized into optimal or poor SRH. Changes over time were assessed using mean values and standard deviation (SD) at each time point and Cohen effect sizes. Odds ratios and 95% confidence intervals were calculated for the likelihood of having poor SRH for each baseline sociodemographic and health-related variable. RESULTS Twelve months after patient education programmes, 60 (72%) patients with optimal SRH at baseline demonstrated increased self-management skills, overall acceptance of chronic illness, positive social interaction with others, and improved emotional well-being. Participants with poor SRH (23, 28%) reported no improvements over time. Not being married (odds ratio [OR] 7.79, P < 0.001), living alone (OR 4.93, P = 0.003), having hypertension (OR 8.00, P = 0.031), and being severely obese (OR 4.07, P = 0.009) were significantly associated with having poor SRH. After adjusting for sex, age and vocational training, marital status (OR 9.35, P < 0.001), cohabitation status (OR = 4.96, P = 0.005) and hypertension (OR 10.9, P = 0.03) remained associated with poor SRH. CONCLUSIONS We found a strong association between SRH and outcomes of patient education, as measured by the HeiQ, at 12 months. Only participants with optimal SRH appeared to benefit from patient education. Other patient characteristics may be responsible to explain the observed difference between patients with optimal and poor SRH.
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Affiliation(s)
- D H Laursen
- Bispebjerg Hospital, Research Unit of Chronic Conditions, Bispebjerg Bakke 23, 20D, 2400 Copenhagen NV, Denmark.
| | - K B Christensen
- University of Copenhagen, Department of Biostatistics, Institute of Public Health, Øster Farimagsgade 5, Postboks 2099, 1014 Copenhagen K, Denmark.
| | - U Christensen
- University of Copenhagen, Department of Social Medicine, Institute of Public Health, Øster Farimagsgade 5, Postboks 2099, 1014 Copenhagen K, Denmark.
| | - A Frølich
- Bispebjerg Hospital, Research Unit of Chronic Conditions, Bispebjerg Bakke 23, 20D, 2400 Copenhagen NV, Denmark.
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Nolte E, Frølich A, Hildebrandt H, Pimperl A, Schulpen GJ, Vrijhoef HJM. Implementing integrated care: A synthesis of experiences in three European countries. International Journal of Care Coordination 2016. [DOI: 10.1177/2053434516655626] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Many countries are experimenting with new models to better integrate care; yet, innovative care models are often implemented as time-limited, localised projects with limited impact on service delivery more broadly. This paper seeks to understand the processes behind successful projects that achieved some form of ‘routinisation’ and informed system-wide integrated care strategies. It draws on detailed case studies of three integrated care experiments: the ‘Integrated effort for people living with chronic diseases’ project in Denmark; the Gesundes Kinzigtal network in Germany; and Zio, a care group in the Maastricht region in the Netherlands. It explores how they were developed, implemented and sustained, and how they impacted the wider system context. All three models implicitly or explicitly adopted processes shown to be conducive to the dissemination of innovations, including dedicated time and resources, support and advocacy, leadership and management, stakeholder involvement, communication and networks, adaptation to local context and feedback. Each showed robust evidence of improvements on a number of service and patient outcomes and these findings were central to their wider impacts, shaping country-wide integrated care polices. However, the wider dissemination of projects occurred in an incremental and somewhat haphazard way. To further redesign health and social care a more formal strategy, alongside resources, may thus be needed to provide funders and providers with genuine incentives to invest in new business models of care. There remains a crucial need for better understanding of specific local conditions that influence implementation and sustainability to enable translation to other contexts and settings.
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Affiliation(s)
- Ellen Nolte
- European Observatory on Health Systems and Policies, London School of Economics and Political Science, London, UK
| | - Anne Frølich
- Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | | | | | - Guy J Schulpen
- ZIO Zorg In Ontwikkeling, Wilheminasingel 75, Maastricht, The Netherlands
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Gottlieb V, Lyngsø AM, Sæbye D, Frølich A, Backer V. The use of COPD maintenance therapy following spirometry in General Practice. Eur Clin Respir J 2016; 3:30232. [PMID: 28326172 PMCID: PMC4919365 DOI: 10.3402/ecrj.v3.30232] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 05/10/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several studies have shown that the use of pulmonary medication is widespread and often initiated without initial spirometry. Early detection of chronic obstructive pulmonary disease (COPD) by spirometry in General Practice is essential for an early and correct implementation of medical treatment. AIM The aim of the present study was to evaluate the use of regular therapy following diagnostic spirometry for COPD in General Practice from February 2008 to February 2009. METHOD Spirometry data and results were linked through Statistics Denmark with information from the Register of Medicinal Product Statistics using the unique personal identification code. Data were analysed to evaluate the impact of screening on use of regular COPD therapy. Primary outcome was initiation of regular therapy following COPD diagnosis with spirometry. RESULTS In a population of 3,376 individuals at risk, 1,458 underwent spirometric assessment with 631 being diagnosed with COPD; 110 of those received regular therapy before assessment with this figure increasing to 161 after spirometry. Of 827 participants not receiving a COPD diagnosis, 36 received regular therapy prior to assessment and 42 received regular therapy after spirometry despite no established COPD diagnosis. CONCLUSION There is a significant chance of receiving regular therapy after being diagnosed with COPD. However, a large proportion of subjects diagnosed with COPD did not receive regular therapy following diagnosis. Efforts should be made to ensure correct diagnosis and correct medical treatment according to guidelines in individuals with COPD.
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Affiliation(s)
- Vibeke Gottlieb
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Anne Marie Lyngsø
- Research Unit for Chronic Conditions, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Ditte Sæbye
- Institute of Preventive Medicine, Frederiksberg University Hospital, Frederiksberg, Denmark
| | - Anne Frølich
- Research Unit for Chronic Conditions, Bispebjerg and Frederiksberg University Hospital, Copenhagen, Denmark
| | - Vibeke Backer
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark
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Ghith N, Wagner P, Frølich A, Merlo J. Short Term Survival after Admission for Heart Failure in Sweden: Applying Multilevel Analyses of Discriminatory Accuracy to Evaluate Institutional Performance. PLoS One 2016; 11:e0148187. [PMID: 26840122 PMCID: PMC4739586 DOI: 10.1371/journal.pone.0148187] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 01/14/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Hospital performance is frequently evaluated by analyzing differences between hospital averages in some quality indicators. The results are often expressed as quality charts of hospital variance (e.g., league tables, funnel plots). However, those analyses seldom consider patients heterogeneity around averages, which is of fundamental relevance for a correct evaluation. Therefore, we apply an innovative methodology based on measures of components of variance and discriminatory accuracy to analyze 30-day mortality after hospital discharge with a diagnosis of Heart Failure (HF) in Sweden. METHODS We analyzed 36,943 patients aged 45-80 treated in 565 wards at 71 hospitals during 2007-2009. We applied single and multilevel logistic regression analyses to calculate the odds ratios and the area under the receiver-operating characteristic (AUC). We evaluated general hospital and ward effects by quantifying the intra-class correlation coefficient (ICC) and the increment in the AUC obtained by adding random effects in a multilevel regression analysis (MLRA). Finally, the Odds Ratios (ORs) for specific ward and hospital characteristics were interpreted jointly with the proportional change in variance (PCV) and the proportion of ORs in the opposite direction (POOR). FINDINGS Overall, the average 30-day mortality was 9%. Using only patient information on age and previous hospitalizations for different diseases we obtained an AUC = 0.727. This value was almost unchanged when adding sex, country of birth as well as hospitals and wards levels. Average mortality was higher in small wards and municipal hospitals but the POOR values were 15% and 16% respectively. CONCLUSIONS Swedish wards and hospitals in general performed homogeneously well, resulting in a low 30-day mortality rate after HF. In our study, knowledge on a patient's previous hospitalizations was the best predictor of 30-day mortality, and this information did not improve by knowing the sex and country of birth of the patient or where the patient was treated.
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Affiliation(s)
- Nermin Ghith
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
- Research Unit of Chronic Conditions, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Philippe Wagner
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
- Centre for Clinical Research, Västmanland, Uppsala University, Västerås, Sweden
| | - Anne Frølich
- Research Unit of Chronic Conditions, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Juan Merlo
- Unit for Social Epidemiology, Faculty of Medicine, Lund University, Malmö, Sweden
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Wodskou PM, Høst D, Godtfredsen NS, Frølich A. A qualitative study of integrated care from the perspectives of patients with chronic obstructive pulmonary disease and their relatives. BMC Health Serv Res 2014; 14:471. [PMID: 25277208 PMCID: PMC4283082 DOI: 10.1186/1472-6963-14-471] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Accepted: 09/24/2014] [Indexed: 11/24/2022] Open
Abstract
Background Disease management programmes have been developed for chronic obstructive pulmonary disease (COPD) to facilitate the integration of care across healthcare settings. The purpose of the present study was to examine the experiences of COPD patients and their relatives of integrated care after implementation of a COPD disease management programme. Methods Seven focus groups and five individual interviews were held with 34 patients with severe or very severe COPD and two focus groups were held with eight of their relatives. Data were analysed using inductive content analysis. Results Four main categories of experiences of integrated care emerged: 1) a flexible system that provides access to appropriate healthcare and social services and furthers patient involvement; 2) the responsibility of health professionals to both take the initiative and follow up; 3) communication and providing information to patients and relatives; 4) coordination and professional cooperation. Most patients were satisfied with their care and raised few criticisms. However, patients with more unstable and severe disease tended to experience more problems. Conclusions Participant suggestions for optimizing the integration of healthcare included assigning patients a care coordinator, telehealth solutions for housebound patients and better information technology to support interprofessional cooperation. Further studies are needed to explore these and other possible solutions to problems with integrated care among COPD patients. A future effort in this field should be informed by detailed knowledge of the extent and relative importance of the identified problems. It should also be designed to address variable levels of severity of COPD and relevant comorbidities and to deliver care in ways appropriate to the respective healthcare setting. Future studies should also take health professionals’ views into account so that interventions may be planned in the light of the experiences of all those involved in the treatment of COPD patients. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-471) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pernille Maria Wodskou
- Department of Integrated Care, Bispebjerg University Hospital, Bispebjerg Bakke 23, DK-2400 Copenhagen, NV, Denmark.
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