WorldWideScience

Sample records for chronic care model

  1. Adapting chronic care models for diabetes care delivery inlow-and-middle-income countries: A review

    Institute of Scientific and Technical Information of China (English)

    2015-01-01

    A contextual review of models for chronic care was doneto develop a context-adapted chronic care model-basedservice delivery model for chronic conditions includingdiabetes. The Philippines was used as the setting ofa low-to-middle-income country. A context-basednarrative review of existing models for chronic carewas conducted. A situational analysis was done at thegrassroots level, involving the leaders and members ofthe community, the patients, the local health system andthe healthcare providers. A second analysis making useof certain organizational theories was done to explore onimproving feasibility and acceptability of organizing carefor chronic conditions. The analyses indicated that carefor chronic conditions may be introduced, consideringthe needs of people with diabetes in particular andthe community in general as recipients of care, andthe issues and factors that may affect the healthcareworkers and the health system as providers of thiscare. The context-adapted chronic care model-basedservice delivery model was constructed accordingly.Key features are incorporation of chronic care in thehealth system's services; assimilation of chronic caredelivery with the other responsibilities of the healthcareworkers but with redistribution of certain tasks; andensuring that the recipients of care experience thewhole spectrum of basic chronic care that includes educationand promotion in the general population, riskidentification, screening, counseling including self-caredevelopment, and clinical management of the chroniccondition and any co-morbidities, regardless of level ofcontrol of the condition. This way, low-to-middle incomecountries can introduce and improve care for chronicconditions without entailing much additional demand ontheir limited resources.

  2. Facilitators and barriers of implementing the chronic care model in primary care: a systematic review

    OpenAIRE

    Kadu, Mudathira K; Stolee, Paul

    2015-01-01

    Background The Chronic Care Model (CCM) is a framework developed to redesign care delivery for individuals living with chronic diseases in primary care. The CCM and its various components have been widely adopted and evaluated, however, little is known about different primary care experiences with its implementation, and the factors that influence its successful uptake. The purpose of this review is to synthesize findings of studies that implemented the CCM in primary care, in order to identi...

  3. Care production for tuberculosis cases:analysis according to the elements of the Chronic Care Model

    OpenAIRE

    Daiane Medeiros da Silva; Hérika Brito Gomes de Farias; Tereza Cristina Scatena Villa; Lenilde Duarte de Sá; Maria Eugênia Firmino Brunello; Jordana Almeida Nogueira

    2016-01-01

    Abstract OBJECTIVE: To analyze the care provided to tuberculosis cases in primary health care services according to the elements of the Chronic Care Model. METHOD: Cross-sectional study conducted in a capital city of the northeastern region of Brazil involving 83 Family Health Strategy professionals.A structured tool adapted to tuberculosis-related care in Brazil was applied.Analysis was based on the development of indicators with capacity to produce care varying between limited and optimum...

  4. Do telemonitoring projects of heart failure fit the Chronic Care Model?

    OpenAIRE

    Willemse, Evi; Adriaenssens, Jef; Dilles, Tinne; Remmen, Roy

    2014-01-01

    This study describes the characteristics of extramural and transmural telemonitoring projects on chronic heart failure in Belgium. It describes to what extent these telemonitoring projects coincide with the Chronic Care Model of Wagner.Background: The Chronic Care Model describes essential components for high-quality health care. Telemonitoring can be used to optimise home care for chronic heart failure. It provides a potential prospective to change the current care organisation.Methods: This...

  5. The Chronic Care Model and Diabetes Management in US Primary Care Settings: A Systematic Review

    OpenAIRE

    Stellefson, Michael; Dipnarine, Krishna; Stopka, Christine

    2013-01-01

    Introduction The Chronic Care Model (CCM) uses a systematic approach to restructuring medical care to create partnerships between health systems and communities. The objective of this study was to describe how researchers have applied CCM in US primary care settings to provide care for people who have diabetes and to describe outcomes of CCM implementation. Methods We conducted a literature review by using the Cochrane database of systematic reviews, CINAHL, and Health Source: Nursing/Academi...

  6. Attitudes of Doctors and Nurses toward the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Rolando Bonal Ruiz

    2015-06-01

    Full Text Available Background: the fact that chronic diseases replace traditional causes of morbidity and mortality in a country, or are on a par with major common health problems, demands the development of new strategies to address them. Objective: to explore attitudes of doctors and nurses from the Rolando López Peña Polyclinic toward the Chronic Care Model. Methods: a quantitative and qualitative cross-sectional study was conducted including the 22 family physicians and 26 nurses who provide care to patients with chronic diseases and were at the polyclinic at the time of the study. All were administered a 5 point Likert scale and a focus group interview, which was taped, transcribed and analyzed. Results: the attitudinal results correspond with the actions assessed in each component of the model, being the most common barriers: the lack of awareness and training on the new approaches to care of these patients, work overload created by other programs such as the maternal-child and vector control programs, uncertainties on the effectiveness of patient education and ignorance of the practice guidelines. Conclusions: favorable attitudes toward the introduction of the model to the practice of the family physician and nurse predominated as long as organizational changes are made and the suggestions of these service providers are put into practice with the support of the decision makers of the health sector.

  7. Challenges of Change: A Qualitative Study of Chronic Care Model Implementation

    OpenAIRE

    Hroscikoski, Mary C.; Solberg, Leif I.; Sperl-Hillen, JoAnn M.; Harper, Peter G.; McGrail, Michael P.; Crabtree, Benjamin F.

    2006-01-01

    PURPOSE The Chronic Care Model (CCM) provides a conceptual framework for transforming health care for patients with chronic conditions; however, little is known about how to best design and implement its specifics. One large health care organization that tried to implement the CCM in primary care provided an opportunity to study these issues.

  8. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Stewart Allison

    2008-05-01

    Full Text Available Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territory. Using the Chronic Care Model as a framework, we carried out a mail-out survey to collect information on material, financial and human resources relating to chronic illness care in participating health centres. Follow up face-to-face interviews with health centre staff were conducted to identify successes and difficulties in the systems in relation to providing chronic illness care to community members. Results Participating health centres had distinct areas of strength and weakness in each component of systems: 1 organisational influence – strengthened by inclusion of chronic illness goals in business plans, appointment of designated chronic disease coordinators and introduction of external clinical audits, but weakened by lack of training in disease prevention and health promotion and limited access to Medicare funding; 2 community linkages – facilitated by working together with community organisations (e.g. local stores and running community-based programs (e.g. "health week", but detracted by a shortage of staff especially of Aboriginal health workers working in the community; 3 self management – promoted through patient education and goal setting with clients, but impeded by limited focus on family and community-based activities due to understaffing; 4 decision support – facilitated by distribution of clinical guidelines and their integration with daily care, but limited by inadequate access to and support from specialists; 5 delivery system

  9. Le «Chronic care model» en médecine de famille en Suisse

    OpenAIRE

    Steurer-Stey, C.; Frei, A; Rosemann, T

    2010-01-01

    The Chronic care model in Swiss primary care The care of patients with chronic disease is one of the most urgent medical challenges of actual society. The chronic care model (CCM) is an organizational, proactive approach for chronic disease in primary care. The system creates practical, supportive, evidence-based interactions between an informed, activated patient and a proactive practice team. CCM identifies six essential elements of high-quality health care : community ; heal...

  10. Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative

    OpenAIRE

    Shantanu Nundy; Jonathan J. Dick; Goddu, Anna P.; Patrick Hogan; Lu, Chen-Yuan E.; Solomon, Marla C; Arnell Bussie; Chin, Marshall H; Peek, Monica E.

    2012-01-01

    Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot...

  11. Program Implementation in the Prison System: An Organizational Study of the Chronic Care Model Program

    OpenAIRE

    Robinson, Greg

    2013-01-01

    This study provides evidence of a successful implementation of a not-for-profit operational model within a public setting. The federal government placed a receiver in charge of improving health care within the California Department of Corrections and Rehabilitation. To achieve the receivership's goals, a chronic care model from the not-for-profit sector was selected and implemented to improve the delivery of health care to inmates. The data suggest that operational programs developed outsi...

  12. Describing and analysing primary health care system support for chronic illness care in Indigenous communities in Australia's Northern Territory – use of the Chronic Care Model

    OpenAIRE

    Stewart Allison; Dowden Michelle; Robinson Gary; Cunningham Joan; Bailie Ross; Si Damin; Connors Christine; Weeramanthri Tarun

    2008-01-01

    Abstract Background Indigenous Australians experience disproportionately high prevalence of, and morbidity and mortality from chronic illness such as diabetes, renal disease and cardiovascular disease. Improving the understanding of how Indigenous primary care systems are organised to deliver chronic illness care will inform efforts to improve the quality of care for Indigenous people. Methods This cross-sectional study was conducted in 12 Indigenous communities in Australia's Northern Territ...

  13. Reciprocal learning and chronic care model implementation in primary care: results from a new scale of learning in primary care

    OpenAIRE

    Noël Polly H; Jordan Michelle; McDaniel Reuben R; Lanham Holly; Palmer Ray; Leykum Luci K; Parchman Michael

    2011-01-01

    Abstract Background Efforts to improve the care of patients with chronic disease in primary care settings have been mixed. Application of a complex adaptive systems framework suggests that this may be because implementation efforts often focus on education or decision support of individual providers, and not on the dynamic system as a whole. We believe that learning among clinic group members is a particularly important attribute of a primary care clinic that has not yet been well-studied in ...

  14. Complementary therapy in chronic wound management: a holistic caring case study and praxis model.

    Science.gov (United States)

    Popoola, Mercy Mammah

    2003-01-01

    Holistic caring consists of providing care to each aspect of a patient's life through the use of therapeutic caring and complementary or alternative healing modalities. Since nursing consists of caring for the whole person and not just the disease process, consideration of a patient's physical, emotional, social, economic, spiritual, and cultural needs is necessary in dealing with any chronic health problem such as chronic wounds. In this model case studies presentation, the purpose of this article is to discuss the importance of the holistic caring approach and the use of complementary and alternative medicine or therapeutic modalities in chronic wound management. The use or role of theory in practice will also be discussed to emphasize the holistic caring praxis model used in the holistic assessment and holistic plan of care for the cases presented. This article also presents a framework that will help wound care and holistic nurses move from simply the positivist-modernist philosophy to begin to embrace the postmodernist philosophy. PMID:12784899

  15. Disease management projects and the Chronic CareModel in action: Baseline qualitative research

    OpenAIRE

    Hipple-Walters, Bethany; Adams, Samantha; Nieboer, Anna; Bal, Roland

    2012-01-01

    textabstractBackground: Disease management programs, especially those based on the Chronic Care Model (CCM),are increasingly common in the Netherlands. While disease management programs have beenwell-researched quantitatively and economically, less qualitative research has been done. Theoverall aim of the study is to explore how disease management programs are implementedwithin primary care settings in the Netherlands; this paper focuses on the early developmentand implementation stages of fi...

  16. Disease management projects and the Chronic Care Model in action: baseline qualitative research

    OpenAIRE

    Walters Bethany; Adams Samantha A; Nieboer Anna P; Bal Roland

    2012-01-01

    Abstract Background Disease management programs, especially those based on the Chronic Care Model (CCM), are increasingly common in the Netherlands. While disease management programs have been well-researched quantitatively and economically, less qualitative research has been done. The overall aim of the study is to explore how disease management programs are implemented within primary care settings in the Netherlands; this paper focuses on the early development and implementation stages of f...

  17. Disease management projects and the Chronic CareModel in action: Baseline qualitative research

    NARCIS (Netherlands)

    B. Hipple-Walters (Bethany); S.A. Adams (Samantha); A.P. Nieboer (Anna); R.A. Bal (Roland)

    2012-01-01

    textabstractBackground: Disease management programs, especially those based on the Chronic Care Model (CCM),are increasingly common in the Netherlands. While disease management programs have beenwell-researched quantitatively and economically, less qualitative research has been done. Theoverall aim

  18. Effect of Primary Health Care Orientation on Chronic Care Management

    OpenAIRE

    Schmittdiel, Julie A.; Shortell, Stephen M.; Rundall, Thomas G; Bodenheimer, Thomas; SELBY, Joe V.

    2006-01-01

    PURPOSE It has been suggested that the best way to improve chronic illness care is through a redesign of primary care emphasizing comprehensive, coordinated care as espoused by the Chronic Care Model (CCM). This study examined the relationship between primary care orientation and the implementation of the CCM in physician organizations.

  19. Using Mobile Health to Support the Chronic Care Model: Developing an Institutional Initiative

    Directory of Open Access Journals (Sweden)

    Shantanu Nundy

    2012-01-01

    Full Text Available Background. Self-management support and team-based care are essential elements of the Chronic Care Model but are often limited by staff availability and reimbursement. Mobile phones are a promising platform for improving chronic care but there are few examples of successful health system implementation. Program Development. An iterative process of program design was built upon a pilot study and engaged multiple institutional stakeholders. Patients identified having a “human face” to the pilot program as essential. Stakeholders recognized the need to integrate the program with primary and specialty care but voiced concerns about competing demands on clinician time. Program Description. Nurse administrators at a university-affiliated health plan use automated text messaging to provide personalized self-management support for member patients with diabetes and facilitate care coordination with the primary care team. For example, when a patient texts a request to meet with a dietitian, a nurse-administrator coordinates with the primary care team to provide a referral. Conclusion. Our innovative program enables the existing health system to support a de novo care management program by leveraging mobile technology. The program supports self-management and team-based care in a way that we believe engages patients yet meets the limited availability of providers and needs of health plan administrators.

  20. Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition)

    OpenAIRE

    Muntinga Maaike E; Hoogendijk Emiel O; van Leeuwen Karen M; van Hout Hein PJ; Twisk Jos WR; van der Horst Henriette E; Nijpels Giel; Jansen Aaltje PD

    2012-01-01

    Abstract Background Care for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care professionals. We aim to address these challenges by introducing the geriatric care model, based on the chronic care model, and to evaluate its effects on the quality of life of community-dwelling...

  1. Disease management projects and the Chronic Care Model in action: baseline qualitative research

    Directory of Open Access Journals (Sweden)

    Walters Bethany

    2012-05-01

    Full Text Available Abstract Background Disease management programs, especially those based on the Chronic Care Model (CCM, are increasingly common in the Netherlands. While disease management programs have been well-researched quantitatively and economically, less qualitative research has been done. The overall aim of the study is to explore how disease management programs are implemented within primary care settings in the Netherlands; this paper focuses on the early development and implementation stages of five disease management programs in the primary care setting, based on interviews with project leadership teams. Methods Eleven semi-structured interviews were conducted at the five selected sites with sixteen professionals interviewed; all project directors and managers were interviewed. The interviews focused on each project’s chosen chronic illness (diabetes, eating disorders, COPD, multi-morbidity, CVRM and project plan, barriers to development and implementation, the project leaders’ action and reactions, as well as their roles and responsibilities, and disease management strategies. Analysis was inductive and interpretive, based on the content of the interviews. After analysis, the results of this research on disease management programs and the Chronic Care Model are viewed from a traveling technology framework. Results This analysis uncovered four themes that can be mapped to disease management and the Chronic Care Model: (1 changing the health care system, (2 patient-centered care, (3 technological systems and barriers, and (4 integrating projects into the larger system. Project leaders discussed the paths, both direct and indirect, for transforming the health care system to one that addresses chronic illness. Patient-centered care was highlighted as needed and a paradigm shift for many. Challenges with technological systems were pervasive. Project leaders managed the expenses of a traveling technology, including the social, financial, and

  2. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study

    Science.gov (United States)

    Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.

    2015-01-01

    Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs. Methods Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through “Embrace,” an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach. Results Responses of participants concerned two focus areas: 1) Experiences with aging, with the themes “Struggling with health,” “Increasing dependency,” “Decreasing social interaction,” “Loss of control,” and “Fears;” and 2) Experiences with Embrace, with the themes “Relationship with the case manager,” “Interactions,” and “Feeling in control, safe, and secure”. The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants’ ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system. Conclusion The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging. PMID:26489096

  3. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model: A Qualitative Study.

    Directory of Open Access Journals (Sweden)

    Sophie L W Spoorenberg

    Full Text Available Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this study was to evaluate the opinions and experiences of community-living older adults with regard to integrated care and support, along with the extent to which it meets their health and social needs.Semi-structured interviews were conducted with 23 older adults receiving integrated care and support through "Embrace," an integrated care model for community-living older adults that is based on the Chronic Care Model and a population health management model. Embrace is currently fully operational in the northern region of the Netherlands. Data analysis was based on the grounded theory approach.Responses of participants concerned two focus areas: 1 Experiences with aging, with the themes "Struggling with health," "Increasing dependency," "Decreasing social interaction," "Loss of control," and "Fears;" and 2 Experiences with Embrace, with the themes "Relationship with the case manager," "Interactions," and "Feeling in control, safe, and secure". The prospect of becoming dependent and losing control was a key concept in the lives of the older adults interviewed. Embrace reinforced the participants' ability to stay in control, even if they were dependent on others. Furthermore, participants felt safe and secure, in contrast to the fears of increasing dependency within the standard care system.The results indicate that integrated care and support provided through Embrace met the health and social needs of older adults, who were coping with the consequences of aging.

  4. Analysing the Costs of Integrated Care: A Case on Model Selection for Chronic Care Purposes

    OpenAIRE

    Carreras, Marc; Sánchez-Pérez, Inma; Ibern, Pere; Coderch, Jordi; Inoriza, José María

    2016-01-01

    Background: The objective of this study is to investigate whether the algorithm proposed by Manning and Mullahy, a consolidated health economics procedure, can also be used to estimate individual costs for different groups of healthcare services in the context of integrated care.Methods: A cross-sectional study focused on the population of the Baix Empordà (Catalonia-Spain) for the year 2012 (N = 92,498 individuals). A set of individual cost models as a function of sex, age and morbidity burd...

  5. Assessment of a primary and tertiary care integrated management model for chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Peiro Meritxell

    2009-02-01

    Full Text Available Abstract Background The diagnosis and treatment of patients with chronic obstructive pulmonary disease (COPD in Spain continues to present challenges, and problems are exacerbated when there is a lack of coordinated follow-up between levels of care. This paper sets out the protocol for assessing the impact of an integrated management model for the care of patients with COPD. The new model will be evaluated in terms of 1 improvement in the rational utilization of health-care services and 2 benefits reflected in improved health status and quality of life for patients. Methods/Design A quasi-experimental study of the effectiveness of a COPD management model called COPD PROCESS. The patients in the study cohorts will be residents of neighborhoods served by two referral hospitals in Barcelona, Spain. One area comprises the intervention group (n = 32,248 patients and the other the control group (n = 32,114 patients. The study will include pre- and post-intervention assessment 18 months after the program goes into effect. Analyses will be on two datasets: clinical and administrative data available for all patients, and clinical assessment information for a cohort of 440 patients sampled randomly from the intervention and control areas. The main endpoints will be the hospitalization rates in the two health-care areas and quality-of-life measures in the two cohorts. Discussion The COPD PROCESS model foresees the integrated multidisciplinary management of interventions at different levels of the health-care system through coordinated routine clinical practice. It will put into practice diagnostic and treatment procedures that are based on current evidence, multidisciplinary consensus, and efficient use of available resources. Care pathways in this model are defined in terms of patient characteristics, level of disease severity and the presence or absence of exacerbation. The protocol covers the full range of care from primary prevention to treatment of

  6. Implementation of a program for type 2 diabetes based on the Chronic Care Model in a hospital-centered health care system: 'the Belgian experience'

    OpenAIRE

    Van Royen Paul; Vermeire Etienne; Wens Johan; Nobels Frank; Snauwaert Boris; Feyen Luc; Bastiaens Hilde; Sunaert Patricia; De Maeseneer Jan; De Sutter An; Willems Sara

    2009-01-01

    Abstract Background Most research publications on Chronic Care Model (CCM) implementation originate from organizations or countries with a well-structured primary health care system. Information about efforts made in countries with a less well-organized primary health care system is scarce. In 2003, the Belgian National Institute for Health and Disability Insurance commissioned a pilot study to explore how care for type 2 diabetes patients could be organized in a more efficient way in the Bel...

  7. Improving Population Health by Incorporating Chronic Disease and Injury Prevention Into Value-Based Care Models.

    Science.gov (United States)

    Petersen, Ruth; Rushing, Jill; Nelson, Sharon; Rhyne, Sharon

    2016-01-01

    Today's health system transformation provides a prime opportunity to leverage the capacity of public health to reduce the burden of chronic disease and injury, improve population health, and contain health care costs. Health care settings and organizations should support public health capacity as a key investment in population health. PMID:27422946

  8. Low maternal care exacerbates adult stress susceptibility in the chronic mild stress rat model of depression

    DEFF Research Database (Denmark)

    Henningsen, Kim; Dyrvig, Mads; Bouzinova, Elena V;

    2012-01-01

    In the present study we report the finding that the quality of maternal care, in early life, increased the susceptibility to stress exposure in adulthood, when rats were exposed to the chronic mild stress paradigm. Our results indicate that high, as opposed to low maternal care, predisposed rats ...

  9. Integrated palliative care in Europe: a qualitative systematic literature review of empirically-tested models in cancer and chronic disease

    OpenAIRE

    Siouta, Naouma; Beek, K.; van der Eerden, M. E.; Preston, N.; Hasselaar, J.G.; Hughes, S; GARRALDA, E.; Centeno, C. (Carlos); Csikos, A.; Groot, M. de; Radbruch, L.; Payne, S; Menten, J.

    2016-01-01

    Background Integrated Palliative Care (PC) strategies are often implemented following models, namely standardized designs that provide frameworks for the organization of care for people with a progressive life-threatening illness and/or for their (in)formal caregivers. The aim of this qualitative systematic review is to identify empirically-evaluated models of PC in cancer and chronic disease in Europe. Further, develop a generic framework that will consist of the basis for the design of futu...

  10. Experiences of Community-Living Older Adults Receiving Integrated Care Based on the Chronic Care Model : A Qualitative Study

    NARCIS (Netherlands)

    Spoorenberg, Sophie L. W.; Wynia, Klaske; Fokkens, Andrea S.; Slotman, Karin; Kremer, Hubertus P. H.; Reijneveld, Sijmen A.

    2015-01-01

    Background Integrated care models aim to solve the problem of fragmented and poorly coordinated care in current healthcare systems. These models aim to be patient-centered by providing continuous and coordinated care and by considering the needs and preferences of patients. The objective of this stu

  11. A personalized care plan in chronic care: implementation and evaluation

    OpenAIRE

    Jeanny Engels; Marjolein Rebel; Doortje Boshuizen

    2012-01-01

    Purpose Implementation and evaluation of a personalized care plan for approximately 350 people with (an increased risk of) cardiovascular disease in ten general practices in the Netherlands. Context The ‘Healthy Vessels’ (‘Vitale Vaten’) care standard of 2009 describes the optimum care for people with (an increased risk of) cardiovascular disease and is based on the Chronic Care Model. New: working with a personalized care plan, with detailed attention for the promotion of self-management and...

  12. Caring, chronicity and community: an emergent model of community health services provision for people living with chronic illness

    OpenAIRE

    Ryan, Denis

    2008-01-01

    Purpose An evaluation of an Integrated Care approach with the aim of exploring the components of the service which contributed to its functioning. Theory There is growing recognition internationally that conventional approaches to the management of chronic illness are not adequately meeting the needs of people with such conditions. This concern is also shared in Ireland and a pilot programme to provide an alternative community based approach was established in Callan, Co. Kilkennny, Ireland f...

  13. Effectiveness of the introduction of a Chronic Care Model-based program for type 2 diabetes in Belgium

    OpenAIRE

    De Maeseneer Jan; Vermeire Etienne; Verbeke Geert; Feyen Luc; Nobels Frank; Bastiaens Hilde; Sunaert Patricia; Willems Sara; De Sutter An

    2010-01-01

    Abstract Background During a four-year action research project (2003-2007), a program targeting all type 2 diabetes patients was implemented in a well-defined geographical region in Belgium. The implementation of the program resulted in an increase of the overall Assessment of Chronic Illness Care (ACIC) score from 1.45 in 2003 to 5.5 in 2007. The aim of the follow-up study in 2008 was to assess the effect of the implementation of Chronic Care Model (CCM) elements on the quality of diabetes c...

  14. Implementing the chronic care model for frail older adults in the Netherlands: study protocol of ACT (frail older adults: care in transition

    Directory of Open Access Journals (Sweden)

    Muntinga Maaike E

    2012-04-01

    Full Text Available Abstract Background Care for older adults is facing a number of challenges: health problems are not consistently identified at a timely stage, older adults report a lack of autonomy in their care process, and care systems are often confronted with the need for better coordination between health care professionals. We aim to address these challenges by introducing the geriatric care model, based on the chronic care model, and to evaluate its effects on the quality of life of community-dwelling frail older adults. Methods/design In a 2-year stepped-wedge cluster randomised clinical trial with 6-monthly measurements, the chronic care model will be compared with usual care. The trial will be carried out among 35 primary care practices in two regions in the Netherlands. Per region, practices will be randomly allocated to four allocation arms designating the starting point of the intervention. Participants: 1200 community-dwelling older adults aged 65 or over and their primary informal caregivers. Primary care physicians will identify frail individuals based on a composite definition of frailty and a polypharmacy criterion. Final inclusion criterion: scoring 3 or more on a disability case-finding tool. Intervention: Every 6 months patients will receive a geriatric in-home assessment by a practice nurse, followed by a tailored care plan. Expert teams will manage and train practice nurses. Patients with complex care needs will be reviewed in interdisciplinary consultations. Evaluation: We will perform an effect evaluation, an economic evaluation, and a process evaluation. Primary outcome is quality of life as measured with the Short Form-12 questionnaire. Effect analyses will be based on the “intention-to-treat” principle, using multilevel regression analysis. Cost measurements will be administered continually during the study period. A cost-effectiveness analysis and cost-utility analysis will be conducted comparing mean total costs to functional

  15. Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions

    OpenAIRE

    Leppin, Aaron L; Victor M Montori; Gionfriddo, Michael R

    2015-01-01

    An increasing proportion of healthcare resources in the United States are directed toward an expanding group of complex and multimorbid patients. Federal stakeholders have called for new models of care to meet the needs of these patients. Minimally Disruptive Medicine (MDM) is a theory-based, patient-centered, and context-sensitive approach to care that focuses on achieving patient goals for life and health while imposing the smallest possible treatment burden on patients’ lives. The MDM Care...

  16. Care of Adult Refugees with Chronic Conditions.

    Science.gov (United States)

    Terasaki, Genji; Ahrenholz, Nicole Chow; Haider, Mahri Z

    2015-09-01

    Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees. PMID:26320045

  17. Effectiveness of the introduction of a Chronic Care Model-based program for type 2 diabetes in Belgium

    Directory of Open Access Journals (Sweden)

    De Maeseneer Jan

    2010-07-01

    Full Text Available Abstract Background During a four-year action research project (2003-2007, a program targeting all type 2 diabetes patients was implemented in a well-defined geographical region in Belgium. The implementation of the program resulted in an increase of the overall Assessment of Chronic Illness Care (ACIC score from 1.45 in 2003 to 5.5 in 2007. The aim of the follow-up study in 2008 was to assess the effect of the implementation of Chronic Care Model (CCM elements on the quality of diabetes care in a country where the efforts to adapt primary care to a more chronic care oriented system are still at a starting point. Methods A quasi-experimental study design involving a control region with comparable geographical and socio-economic characteristics and health care facilities was used to evaluate the effect of the intervention in the region. In collaboration with the InterMutualistic Agency (IMA and the laboratories from both regions a research database was set up. Study cohorts in both regions were defined by using administrative data from the Sickness Funds and selected from the research database. A set of nine quality indicators was defined based on current scientific evidence. Data were analysed by an institution experienced in longitudinal data analysis. Results In total 4,174 type 2 diabetes patients were selected from the research database; 2,425 patients (52.9% women with a mean age of 67.5 from the intervention region and 1,749 patients (55.7% women with a mean age of 67.4 from the control region. At the end of the intervention period, improvements were observed in five of the nine defined quality indicators in the intervention region, three of which (HbA1c assessment, statin therapy, cholesterol target improved significantly more than in the control region. Mean HbA1c improved significantly in the intervention region (7.55 to 7.06%, but this evolution did not differ significantly (p = 0.4207 from the one in the control region (7.44 to 6

  18. An economic analysis of usual care and acupuncture collaborative treatment on chronic low back pain: A Markov model decision analysis

    Directory of Open Access Journals (Sweden)

    Lee Taejin

    2010-11-01

    Full Text Available Abstract Background The collaborative treatment of acupuncture in addition to routine care as an approach for the management of low back pain (LBP is receiving increasing recognition from both public and professional arenas. In 2010, the Ministry of Health, Welfare and Family Affairs (MOHW of South Korea approved the practice of doctors and Oriental medical doctors (acupuncture qualified working together in the same facility and offering collaborative treatment at the same time for the same disease. However, there is little more than anecdotal evidence on the health and economic implications of this current practice. Therefore, the objective of this study is to examine the effectiveness and costs of acupuncture in addition to routine care in the treatment of chronic LBP patients in South Korea. Methods The Markov model was developed to synthesise evidence on both costs and outcomes for patients with chronic LBP. We conducted the base case analysis, univariate and probabilistic sensitivity analyses, and also performed the value of information analysis for future researches. Model parameters were sourced from systematic review of both alternatives, simple bibliographic reviews of relevant articles published in English or Korean, and statistical analyses of the 2005 and 2007 Korean National Health and Nutrition Survey (KNHNS data. The analyses were based on the societal perspective over a five year time horizon using a 5% discount rate. Results In the base case, collaborative treatment resulted in better outcomes, but at a relatively high cost. Overall, the incremental cost-effectiveness ratio of a collaborative practice was 3,421,394 KRW (Korean rate Won per QALY (Quality adjusted life year (2,895.80 USD per QALY. Univariate sensitivity analysis of indirect non-medical costs did not affect the preference order of the strategies. Probabilistic sensitivity analysis revealed that if the threshold was over 3,260,000 KRW per QALY (2,759.20 USD per QALY

  19. Confronting the barriers to chronic care management in Medicare.

    Science.gov (United States)

    Berenson, Robert A; Horvath, Jane

    2003-01-01

    This paper examines the ability of the current Medicare program--both traditional fee-for-service and risk-based contracting--to address the needs of beneficiaries with chronic conditions, who represent almost 80 percent of program enrollment. Grounded in indemnity insurance principles, including concerns about "moral hazard," the traditional Medicare program faces difficulty evolving to support of a chronic care model of health care practice. Although capitation may be the most desirable platform to support provision of care to beneficiaries with chronic conditions, the current structural limitations and problems faced in the Medicare+Choice program limit capitation's use at this time. PMID:14527234

  20. Chronic Obstructive Pulmonary Disease Patients' Experiences of an Enhanced Self-Management Model of Care.

    Science.gov (United States)

    Patel, Neil; Jones, Pauline; Adamson, Vikki; Spiteri, Monica; Kinmond, Kathryn

    2016-03-01

    Chronic obstructive pulmonary disease (COPD) is debilitating and costly. Self-management is championed to empower individuals to better manage their condition and also to efficiently utilize health resources. As a multi-disciplinary team, we conducted focus group research with individuals living with COPD who were participating in a longitudinal study to use an electronic "diary" to monitor, record, and transmit their own health status, plus receiving regular nurse visits. The main aims of the focus groups were to investigate how far individuals embraced the electronic diary and experienced it as an aid to the self-management of their condition. We also looked at the importance of the nurse visits to the process. Thematic analysis revealed that patients responded positively to the use of technology (the electronic diary), including psychological benefits of perceived support offered by the remote symptom surveillance. Findings also showed patients' increased awareness and monitoring of personal symptoms together with an improved understanding of disease self-management. Nurse support emerged as an important "human" factor in the process. In addition, a reduction in hospital admission was observed, thus reducing costs to the health service. PMID:25711841

  1. Shared decision-making after implementation of the Chronic Care Modell (CCM)- an evaluative approach

    OpenAIRE

    Holm, Anne Lise; Lyberg, Anne Marit; Berggren, Ingela; Severinsson, Ingeborg Elisabeth

    2014-01-01

    Background: In paternalistic models, healthcare providers’ responsibility is to decide what is best for patients. The main concern is that such models fail to respect patient autonomy and do not promote patient responsibility. Aim: To evaluate mental healthcare team members’ perceptions of their own role in encouraging elderly persons to participate in shared decision-making after implementation of the CCM. The CCM is not an explanatory theory, but an evidence-based guideline and synthesis...

  2. Health care 2020: reengineering health care delivery to combat chronic disease.

    Science.gov (United States)

    Milani, Richard V; Lavie, Carl J

    2015-04-01

    Chronic disease has become the great epidemic of our times, responsible for 75% of total health care costs and the majority of deaths in the US. Our current delivery model is poorly constructed to manage chronic disease, as evidenced by low adherence to quality indicators and poor control of treatable conditions. New technologies have emerged that can engage patients and offer additional modalities in the treatment of chronic disease. Modifying our delivery model to include team-based care in concert with patient-centered technologies offers great promise in managing the chronic disease epidemic. PMID:25460529

  3. The Role of Acting Participants, Definitions, and the Determining Factors of Adherence to Treatment from Two Perspectives: The Biomedical Model and the Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Adrian LUPU

    2014-11-01

    Full Text Available Management of chronic illness implies significant changing the lifestyle, taking medication, watching the diet, introducing and maintaining exercise in daily life, etc. These actions represent elements of adherence to treatment and they reflect the responsibility of patient’s participation to healthcare. The increase in adherence to treatment and in the quality of care, implicitly, may depend on allotting the resources necessary within therapeutic effort and on the effectiveness of the partnership between patient and doctor. Assuming the medical decision as a team may lead to solving the issue of non-adherence (Armstrong, 2014. Whereas the values of the functional parameters of the body represent an objective measurement of treatment efficiency and to some extent of adherence to it, implicitly, assessing the patient’s lifestyle involves understanding his experience, which is governed by subjectivity. This article has the following objectives: (1 to analyze the definitions of adherence to treatment from a biomedical perspective and from the perspective of Chronic Care Model (CCM; (2 to identify the characteristics specific to the roles of acting participants to healthcare and to analyze the modifications of roles by the choice of theoretical model and (3 to identify the determining factors of adherence to treatment.

  4. Qualitative Evaluation of the Implementation of an Integrated Care Delivery Model for Chronic Patients with Multi-Morbidity in the Basque Country

    OpenAIRE

    Jauregui, María Luz; Silvestre, Carmen; Valdes, Pedro; de Gaminde, Idoia

    2016-01-01

    Introduction: The objective of this study was to assess a model for improving healthcare integration for patients with multiple chronic diseases in an integrated healthcare organisation in the Basque Country and to propose areas for improvement.Methods: We organised four nominal groups composed of representatives from different categories of clinicians involved in the development of an integrated healthcare organisation and in the integrated care of patients with multiple diseases, namely, in...

  5. A predictive model of Health Related Quality of life of parents of chronically ill children: the importance of care-dependency of their child and their support system

    Directory of Open Access Journals (Sweden)

    Heymans Hugo SA

    2009-07-01

    Full Text Available Abstract Background Parents of chronically ill children are at risk for a lower Health Related Quality of Life (HRQoL. Insight in the dynamics of factors influencing parental HRQoL is necessary for development of interventions. Aim of the present study was to explore the influence of demographic and disease related factors on parental HRQoL, mediated by employment, income, leisure time, holiday and emotional support in a comprehensive model. Methods In a cross-sectional design, 543 parents of chronically ill children completed questionnaires. A conceptual model of parental HRQoL was developed. Structural equation modeling was performed to explore the relations in the conceptual model, and to test if the model fitted the data. Results The model fitted the data closely (CHISQ(14 = 11.37, p = 0.66; RMSEA = 0.0, 90%CI [0.00;0.034]. The effect of socio-demographic and medical data on HRQoL was mediated by days on holiday (MCS: β = .21 and emotional support (PCS: β = .14; MCS: β = .28. Also, female gender (β = -.10, age (β = .10, being chronically ill as a parent (β = -.34, and care dependency of the child (β = -.14; β = -.15 were directly related to parental HRQoL. Conclusion The final model was slightly different from the conceptual model. Main factors explaining parental HRQoL seemed to be emotional support, care dependency, days on holiday and being chronically ill as a parent. Holiday and emotional support mediated the effect of demographic and disease-related factors on HRQoL. Hours of employment, leisure time and household income did not mediate between background characteristics and HRQoL, contrasting the hypotheses.

  6. A rehabilitation model as key to comprehensive care in the era of HIV as a chronic disease in South Africa.

    Science.gov (United States)

    Chetty, Verusia; Hanass-Hancock, Jill

    2016-01-01

    In the era of widespread access to antiretroviral therapy, people living with HIV survive; however, this comes with new experiences of comorbidities and HIV-related disability posing new challenges to rehabilitation professionals and an already fragile health system in Southern Africa. Public health approaches to HIV need to include not only prevention, treatment and support but also rehabilitation. While some well-resourced countries have developed rehabilitation approaches for HIV, resource-poor settings of Southern Africa lack a model of care that includes rehabilitation approaches providing accessible and comprehensive care for people living with HIV. In this study, a learning in action approach was used to conceptualize a comprehensive model of care that addresses HIV-related disability and a feasible rehabilitation framework for resource-poor settings. The study used qualitative methods in the form of a focus group discussion with thirty participants including people living with HIV, the multidisciplinary healthcare team and community outreach partners at a semi-rural health facility in South Africa. The discussion focused on barriers and enablers of access to rehabilitation. Participants identified barriers at various levels, including transport, physical access, financial constraints and poor multi-stakeholder team interaction. The results of the group discussions informed the design of an inclusive model of HIV care. This model was further informed by established integrated rehabilitation models. Participants emphasized that objectives need to respond to policy, improve access to patient-centered care and maintain a multidisciplinary team approach. They proposed that guiding principles should include efficient communication, collaboration of all stakeholders and leadership in teams to enable staff to implement the model. Training of professional staff and lay personnel within task-shifting approaches was seen as an essential enabler to implementation. The

  7. [Chronic pruritus : Care in daily practice].

    Science.gov (United States)

    Ständer, S; Ständer, H F; Steinke, S; Bruland, P; Dugas, M; Augustin, M

    2016-08-01

    Chronic pruritus is a highly prevalent, multifactorial symptom requiring extensive diagnostics, treatment and consideration of accompanying symptoms (reduced quality of life, sleep disorders, psychic factors). Patient care is thus complex and requires consideration of individual treatment goals. Patients indicate their wish for a symptom-free life an explanation of the causes and a trustful physician-patient relationship. The targeted use of questionnaires is thus advisable in order to structurally survey the history, pruritus intensity, quality of life and treatment progression. Nevertheless, there are many administrative and economical hurdles in the health care system to overcome in order to provide patients with chronic pruritus the best possible care, also per the recommended guidelines. The development of specialized centers and training courses for medical practitioners is thus urgently needed. PMID:27316924

  8. Measuring organizational readiness for knowledge translation in chronic care

    Directory of Open Access Journals (Sweden)

    Ouimet Mathieu

    2011-07-01

    Full Text Available Abstract Background Knowledge translation (KT is an imperative in order to implement research-based and contextualized practices that can answer the numerous challenges of complex health problems. The Chronic Care Model (CCM provides a conceptual framework to guide the implementation process in chronic care. Yet, organizations aiming to improve chronic care require an adequate level of organizational readiness (OR for KT. Available instruments on organizational readiness for change (ORC have shown limited validity, and are not tailored or adapted to specific phases of the knowledge-to-action (KTA process. We aim to develop an evidence-based, comprehensive, and valid instrument to measure OR for KT in healthcare. The OR for KT instrument will be based on core concepts retrieved from existing literature and validated by a Delphi study. We will specifically test the instrument in chronic care that is of an increasing importance for the health system. Methods Phase one: We will conduct a systematic review of the theories and instruments assessing ORC in healthcare. The retained theoretical information will be synthesized in a conceptual map. A bibliography and database of ORC instruments will be prepared after appraisal of their psychometric properties according to the standards for educational and psychological testing. An online Delphi study will be carried out among decision makers and knowledge users across Canada to assess the importance of these concepts and measures at different steps in the KTA process in chronic care. Phase two: A final OR for KT instrument will be developed and validated both in French and in English and tested in chronic disease management to measure OR for KT regarding the adoption of comprehensive, patient-centered, and system-based CCMs. Discussion This study provides a comprehensive synthesis of current knowledge on explanatory models and instruments assessing OR for KT. Moreover, this project aims to create more

  9. Collaborative Chronic Care Networks (C3Ns) to Transform Chronic Illness Care

    OpenAIRE

    Margolis, Peter A; Peterson, Laura E.; Seid, Michael

    2013-01-01

    Despite significant gains by pediatric collaborative improvement networks, the overall US system of chronic illness care does not work well. A new paradigm is needed: a Collaborative Chronic Care Network (C3N). A C3N is a network-based production system that harnesses the collective intelligence of patients, clinicians, and researchers and distributes the production of knowledge, information, and know-how over large groups of people, dramatically accelerating the discovery process. A C3N is a...

  10. [Palliative care needs in advanced chronic illness].

    Science.gov (United States)

    Tripodoro, Vilma A; Rynkiewicz, María C; Llanos, Victoria; Padova, Susana; De Lellis, Silvina; De Simone, Gustavo

    2016-01-01

    About 75% of population will die from one or more chronic progressive diseases. From this projection WHO urged countries to devise strategies for strengthening palliative treatment as part of comprehensive care. In Catalonia, Spain, direct measurement of the prevalence of these patients with NECPAL CCOMS-ICO© tool was 1.5% of the population. This tool is an indicative, not dichotomous, quali-quantitative multifactorial evaluation to be completed by the treating physician. In Argentina there is no information on these patients. Our goal was to explore and characterize the proportion of chronically ill patients in palliative care needs, by NECPAL CCOMS-ICO© tool, in an accessible population of the City of Buenos Aires. General hospitals of the Health Region 2 (Piñero, álvarez and Santojanni) and its program areas were surveyed. In Health Region 1, we surveyed the Udaondo gastroenterology hospital. A total of 53 physicians (704 patients) were interviewed. It was identified that 29.5% of these patients were affected by advanced chronic diseases; 72.1% of them were NECPAL positive, younger (median 64) than in others studies, and more than 98% presented high levels of comorbidity. Palliative care demand (31.4%) and needs (52.7%) were recorded. Specific indicators of fragility, progression, severity and kind of chronic disease were described. The main finding was to identify, with an instrument not based on mortality that, in Buenos Aires City, 1 in 3 patients with chronic diseases could die in the next year and had palliative care needs. PMID:27295702

  11. The Role of Technology in Chronic Disease Care.

    Science.gov (United States)

    Milani, Richard V; Bober, Robert M; Lavie, Carl J

    2016-01-01

    Chronic disease represents the epidemic of our time, present in half the adult population and responsible for 86% of United States (US) healthcare costs and 70% of deaths. The major chronic diseases are primarily due to health risk behaviors that are widely communicable across populations. As a nation, the US has performed poorly in managing chronic disease, in large part because of a failed delivery model of care. New opportunities exist as a result of recent advances in home-based wireless devices, apps and wearables, enabling health delivery systems to monitor disease metrics in near real time. These technologies provide a framework for patient engagement and a new model of care delivery utilizing integrated practice units, both of which are needed to navigate the healthcare needs of the 21st century. PMID:26772623

  12. Using group-based latent class transition models to analyze chronic disability data from the National Long-Term Care Survey 1984-2004.

    Science.gov (United States)

    White, Toby A; Erosheva, Elena A

    2013-09-10

    Latent class transition models track how individuals move among latent classes through time, traditionally assuming a complete set of observations for each individual. In this paper, we develop group-based latent class transition models that allow for staggered entry and exit, common in surveys with rolling enrollment designs. Such models are conceptually similar to, but structurally distinct from, pattern mixture models of the missing data literature. We employ group-based latent class transition modeling to conduct an in-depth data analysis of recent trends in chronic disability among the U.S. elderly population. Using activities of daily living data from the National Long-Term Care Survey (NLTCS), 1982-2004, we estimate model parameters using the expectation-maximization algorithm, implemented in SAS PROC IML. Our findings indicate that declines in chronic disability prevalence, observed in the 1980s and 1990s, did not continue in the early 2000s as previous NLTCS cross-sectional analyses have indicated. PMID:23553714

  13. Guideline compliance in chronic heart failure patients with multiple comorbid diseases: evaluation of an individualised multidisciplinary model of care.

    Directory of Open Access Journals (Sweden)

    Tam H Ho

    Full Text Available OBJECTIVE: To assess the impact of individualised, reconciled evidence-based recommendations (IRERs and multidisciplinary care in patients with chronic heart failure (CHF on clinical guideline compliance for CHF and common comorbid conditions. DESIGN AND SETTING: A retrospective hospital clinical audit conducted between 1st July 2006 and February 2011. PARTICIPANTS: A total of 255 patients with a diagnosis of CHF who attended the Multidisciplinary Ambulatory Consulting Services (MACS clinics, at the Royal Adelaide Hospital, were included. MAIN OUTCOME MEASURES: Compliance with Australian clinical guideline recommendations for CHF, atrial fibrillation, diabetes mellitus and ischaemic heart disease. RESULTS: Study participants had a median of eight medical conditions (IQR 6-10 and were on an average of 10 (±4 unique medications. Compliance with clinical guideline recommendations for pharmacological therapy for CHF, comorbid atrial fibrillation, diabetes or ischaemic heart disease was high, ranging from 86% for lipid lowering therapy to 98% anti-platelet agents. For all conditions, compliance with lifestyle recommendations was lower than pharmacological therapy, ranging from no podiatry reviews for CHF patients with comorbid diabetes to 75% for heart failure education. Concordance with many guideline recommendations was significantly associated if the patient had IRERs determined, a greater number of recommendations, more clinic visits or if patients participated in a heart failure program. CONCLUSIONS: Despite the high number of comorbid conditions and resulting complexity of the management, high compliance to clinical guideline recommendations was associated with IRER determination in older patients with CHF. Importantly these recommendations need to be communicated to the patient's general practitioner, regularly monitored and adjusted at clinic visits.

  14. Program evaluation of Sea Mar’s Chronic Care Program for Latino and Caucasian patients with type 2 diabetes: providers and staff perspectives

    OpenAIRE

    Bond, Gail E; Rechholtz, Laurie; Bosa, Christina; Impert, Celine; Barker, Sara

    2012-01-01

    Problem statement Unprecedented consumption of health care resources in the USA coupled with increasing rates of chronic disease has fueled pursuit of improved models of health care delivery. The Chronic Care Model provides an organizational framework for chronic care management and practice improvement. Sea Mar, a community health care organization in Washington state, implemented the Chronic Care Model, but has not evaluated the outcomes related to provider and staff satisfaction. The speci...

  15. Designing Shared Electronic Records for Chronic Care

    DEFF Research Database (Denmark)

    Bansler, Jørgen Peter; Havn, Erling C.; Mønsted, Troels

    This paper reports preliminary findings from an ongoing research project on the development of IT support for communication and information sharing across institutional and professional boundaries within the Danish healthcare system. The project focuses on the treatment of patients with implanted...... ICDs (implantable cardioverter-defibrillator). These are chronic patients who usually see several different healthcare providers on a regular basis. The main findings so far are: (1) Most of the data produced and recorded as part of the care process are context-specific and often difficult to interpret...

  16. Estimating the Clinical Outcomes and Cost Differences Between Standard Care With and Without Cadexomer Iodine in the Management of Chronic Venous Leg Ulcers Using a Markov Model.

    Science.gov (United States)

    Nherera, Leo M; Woodmansey, Emma; Trueman, Paul; Gibbons, Garry W

    2016-06-01

    Chronic venous leg ulcers (VLUs) affect up to 1% of the adult population in the developed world and present a significant financial and resource burden to health care systems. Cadexomer iodine (CI) is an antimicrobial dressing indicated for use in chronic exuding wounds. The aim of this study was to estimate the cost utility of using CI + standard care (SC) - ie, high compression multicomponent bandaging including debridement - compared with SC alone in the management of chronic (>6 months' duration) VLUs from a payer's perspective. A Markov model was constructed to evaluate the cost and clinical benefits (healing and decreased infection rates) of the 2 treatment modalities over a 1-year period using data from 4 randomized, controlled clinical studies (RCTs) included in a recent Cochrane review and cost data from a recently published economic evaluation of VLUs. Costs were calculated using 2014 United States dollars; wound outcomes in- cluded complete healing in 212 patients reported in the Cochrane meta-analysis and quality-adjusted life years (QALYs), with utility values obtained from 200 patients with VLUs calculated using standard gamble. Treatment with CI over 1 year was $7,259 compared to $7,901 for SC. This resulted in a cost savings of $643/patient in favor of CI compared with SC. More patients treated with CI (61%) had their wounds healed compared to 54% treated with SC. Furthermore, patients treated with CI+SC experienced 6 additional ulcer-free weeks compared to persons treated with SC alone (ie, 25 ulcer- free weeks compared to 19 ulcer-free weeks, respectively). Overall, CI resulted in 0.03 more QALYs (ie, 0.86 QALYs compared to 0.83 for SC). The use of CI in addition to SC compared to SC alone over 52 weeks resulted in more wounds healed and more QALYs along with a decrease of overall costs The results of this study suggest CI is cost effective com- pared to SC alone in the management of patients with chronic VLUs. Prospective, controlled clinical

  17. [Palliative care in non-cancer, chronic, progressive diseases].

    Science.gov (United States)

    Radványi, Ildikó; Nagy, Lajos; Balogh, Sándor; Csikós, Ágnes

    2015-10-18

    Malignant and other chronic diseases cause the death of 2.5 million people in Europe annually. It is anticipated that this number will grow due to the aging of the European population. The death of a significant proportion of patients having progressive chronic disease is preceded by an extended end of life stadium. In this stage the patients have severe symptoms and pain that necessitate their symptomatic treatment and palliative care. The assessment of the life expectancy of patients, estimation of the prognosis of their illness and, therefore, selection of patients with a need of intensified palliative care often pose difficulties. This paper provides a summary on the basic elements of "good palliative care". It introduces the most frequent models for the procession of chronic diseases and those indicators that help practicing doctors to recognise easier patients with a need of intensified palliative care, and as a result provides more adequate medical attendance that is better suited to the specific needs of the patients. PMID:26551310

  18. Assessing patient-centered care in patients with chronic health conditions attending chiropractic practice: protocol for a mixed-methods study

    OpenAIRE

    Stuber, Kent Jason; Langweiler, Mark; Mior, Silvano; McCarthy, Peter William

    2016-01-01

    Background The management of chronic health conditions increasingly requires an organized, coordinated, and patient-centered approach to care. The Chronic Care Model (CCM) has been adopted in primary care to improve care delivery for those with chronic health conditions. Chiropractors manage chronic health conditions; however, little is known if such care is patient-centered. The primary aim of this study is to determine to what extent chiropractic patients with chronic health conditions perc...

  19. Condition based payment: improving care of chronic illness

    OpenAIRE

    DiPiero, Albert; Sanders, David G

    2005-01-01

    Fee-for-service is more than a payment method; it defines the method of care. Fee-for-condition—a payment method that rewards superior results and encourages innovation—could greatly improve care for chronic conditions

  20. The Chronic CARe for diAbeTes study (CARAT: a cluster randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Birnbaum Beatrice

    2010-06-01

    Full Text Available Abstract Background Diabetes is a major challenge for the health care system and especially for the primary care provider. The Chronic Care Model represents an evidence-based framework for the care for chronically ill. An increasing number of studies showed that implementing elements of the Chronic Care Model improves patient relevant outcomes and process parameters. However, most of these findings have been performed in settings different from the Swiss health care system which is dominated by single handed practices. Methods/Design CARAT is a cluster randomized controlled trial with general practitioners as the unit of randomization (trial registration: ISRCTN05947538. The study challenges the hypothesis that implementing several elements of the Chronic Care Model via a specially trained practice nurse improves the HbA1c level of diabetes type II patients significantly after one year (primary outcome. Furthermore, we assume that the intervention increases the proportion of patients who achieve the recommended targets regarding blood pressure ( Discussion This study challenges the hypothesis that the Chronic Care Model can be easily implemented by a practice nurse focused approach. If our results will confirm this hypothesis the suggestion arises whether this approach should be implemented in other chronic diseases and multimorbid patients and how to redesign care in Switzerland.

  1. Stakeholders’ perception on the organization of chronic care: a SWOT analysis to draft avenues for health care reforms

    Science.gov (United States)

    2014-01-01

    Background Adequate care for individuals living with chronic illnesses calls for a healthcare system redesign, moving from acute, disease-centered to patient-centered models. The aim of this study was to identify Belgian stakeholders’ perceptions on the strengths, weaknesses, opportunities and threats of the healthcare system for people with chronic diseases in Belgium. Methods Four focus groups were held with stakeholders from the micro and meso level, in addition to two interviews with stakeholders who could not attend the focus group sessions. Data collection and the discussion were based on the Chronic Care model. Thematic analysis of the transcripts allowed for the identification of the strengths, weaknesses, opportunities and threats of the current health care system with focus on chronic care. Results Informants stressed the overall good quality of the acute health care system and the level of reimbursement of care as an important strength of the current system. In contrast, the lack of integration of care was identified as one of the biggest weaknesses of today’s health care system, along with the unclear definitions of the roles and functions of health professionals involved in care processes. Patient education to support self-management exists for patients with diabetes and/or terminal kidney failure but not for those living with other or multiple chronic conditions. The current overall fee-for-service system is a barrier to integrated care, as are the lack of incentives for integrated care. Attending multidisciplinary meetings, for example, is underfinanced to date. Finally, clinical information systems lack interoperability, which further impedes the information flow across settings and disciplines. Conclusion Our study’s methods allowed for the identification of problematic domains in the health system for people living with chronic conditions. These findings provided useful insights surrounding perceived priorities. This methodology may inspire

  2. Revisiting the concept of ‘chronic disease’ from the perspective of the episode of care model. Does the ratio of incidence to prevalence rate help us to define a problem as chronic?

    OpenAIRE

    Soler, Jean K; Inge Okkes; Sibo Oskam; Kes van Boven; Predag Zivotic; Milan Jevtic; Frank Dobbs; Henk Lamberts

    2013-01-01

    Background This is a study of the epidemiology of acute and chronic episodes of care (EoCs) in the Transition Project in three countries. We studied the duration of EoCs for acute and chronic health problems and the relationship of incidence to prevalence rates for these EoCs.Method The Transition Project databases collect data on all elements of the doctor–patient encounter in family medicine. Family doctors code these elements using the International Classification of Primary Care.We used t...

  3. The Gold Coast Integrated Care Model

    OpenAIRE

    Connor, Martin; Cooper, Helen; McMurray, Anne

    2016-01-01

    This article outlines the development of the Australian Gold Coast Integrated Care Model based on the elements identified in contemporary research literature as essential for successful integration of care between primary care, and acute hospital services. The objectives of the model are to proactively manage high risk patients with complex and chronic conditions in collaboration with General Practitioners to ultimately reduce presentations to the health service emergency department, improve ...

  4. Spanning boundaries and creating strong patient relationships to coordinate care are strategies used by experienced chronic condition care coordinators.

    Science.gov (United States)

    Ehrlich, Carolyn; Kendall, Elizabeth; Muenchberger, Heidi

    2012-08-01

    People with complex chronic conditions frequently need to navigate their own way through and around a fragmented and siloed health care system. Care coordination is a defining principle of primary care and is frequently proposed as a solution to this problem. However, care coordination requires more time and effort than primary care physicians alone have the capacity to deliver. Although registered nurses (RNs) are skilled team members who can be included in the delivery of coordinated patient care, any model of care coordination that involves RNs needs to fit within the existing health care delivery system. In this study, which used qualitative techniques based on grounded theory and included face-to-face interviews and open coding and theoretical sampling until data saturation was achieved, and which was one component of a larger action research study, we aimed to gain an understanding of the difference between usual chronic condition care and the work of chronic condition care coordination. The researchers interviewed general practitioners and RNs from various general practice sites who were actively coordinating care. Four unique processes were found to define care coordination implementation, namely: (1) moving beyond usual practice by spanning boundaries; (2) relationship-based care; (3) agreed roles and routines among relevant parties; and (4) committing to chronic condition care coordination. The findings suggested that existing professional and organisational cultures required negotiation before care coordination could be integrated into existing contexts. The challenge, however, seems to be in acknowledging and overcoming professional practice boundaries that define existing care through reflective practice and shared resourcing. PMID:23050573

  5. Application of chronic disease health management model in community home-based care services%慢性病健康管理模式在社区居家养老服务中的应用

    Institute of Scientific and Technical Information of China (English)

    孙海燕; 汤晓峰; 周丽华; 乔学斌; 刘洋; 俞黎黎

    2016-01-01

    Objective To provide reference for exploring the senile chronic disease health management new model by apply‐ing the chronic disease health management model into the practice of home‐based care service center in community .Methods The chronic disease health management team was established and the management platform of home‐based care service centers in com‐munity was applied to implement the chronic disease health management service .The senile chronic disease management and service situation were compared between before and after implementing chronic disease health management ,and the difference of service be‐tween the home‐based care service center and community health service center after implementing the chronic disease health man‐agement was compared as well .Results The service content implementation in the home‐based care service center was significantly improved after senile chronic disease health management (P<0 .01) ,and the chronic disease management satisfaction was increased by 39 .66% .Meanwhile ,the management rate and control rate of chronic diseases in the community home‐based care service center were superior to those in the community health service center (P<0 .01) .Conclusion Applying the chronic disease health manage‐ment model into the platform of the home‐based care service center can provide more comprehensive ,specific and efficient chronic disease health management service ,w hich provides a new model of senile chronic disease management application .%目的:通过把慢性病健康管理模式应用于社区居家养老服务中心的养老服务实践中,为探索一条老年慢性病健康管理的新模式提供参考。方法建立慢性病健康管理小组,利用社区居家养老服务中心的管理平台实施慢性病健康管理服务。对比慢性病健康管理实施前、后社区老年人慢性病管理和服务情况,以及慢性病健康管理实施后与社区卫生服务中心在服务

  6. Revisiting the concept of ‘chronic disease’ from the perspective of the episode of care model. Does the ratio of incidence to prevalence rate help us to define a problem as chronic?

    Directory of Open Access Journals (Sweden)

    Jean K Soler

    2013-12-01

    Full Text Available Background This is a study of the epidemiology of acute and chronic episodes of care (EoCs in the Transition Project in three countries. We studied the duration of EoCs for acute and chronic health problems and the relationship of incidence to prevalence rates for these EoCs.Method The Transition Project databases collect data on all elements of the doctor–patient encounter in family medicine. Family doctors code these elements using the International Classification of Primary Care.We used the data from three practice populations to study the duration of EoCs and the ratio of incidence to prevalence for common health problems.Results We found that chronic health problems tended to have proportionately longer duration EoCs, as expected, but also a lower incidence to prevalence rate ratio than acute health problems. Thus, the incidence to prevalence index could be used to define a chronic condition as one with a low ratio, below a defined threshold.Conclusions Chronic health problems tend to have longer duration EoCs, proportionately, across populations. This result is expected, but we found important similarities and differences which make defining a problem as chronic on the basis of time rather difficult. The ratio of incidence to prevalence rates has potential to categorise health problems into acute or chronic categories, at different ratio thresholds (such as 20, 30 or 50%. It seems to perform well in this study of three family practice populations, and is proposed to the scientific community for further evaluation.

  7. Applicability of the assessment of chronic illness care (ACIC instrument in Germany resulting in a new questionnaire: questionnaire of chronic illness care in primary care

    Directory of Open Access Journals (Sweden)

    Campbell Stephen

    2011-07-01

    Full Text Available Abstract Background The Chronic Care Model (CCM is an evidence based, population based approach to improve care for people with chronic conditions. The Assessment of Chronic Illness Care (ACIC instrument is widely used to measure to what extent within a healthcare system the CCM is implemented. The aim of this study was to translate and culturally adapt the ACIC Instrument for the German healthcare system. Methods For translating the ACIC instrument, principles of Good Practice for the Translation and Cultural Adaptation Process by the ISPOR Task Force were followed. Focus groups were additionally conducted with general practitioners to adapt the items culturally. Results The ACIC instrument can not be used in the German healthcare system easily due to a multifaceted understanding of words, different levels of knowledge of the CCM and fundamental differences between health systems. Conclusions As following the CCM leads to benefits for patients with chronic illnesses, measuring to which extent it is implemented is of major interest. A new questionnaire using the CCM as its theoretical basis, sensitive to the healthcare systems of the host country has to be created. Knowledge transfer between countries by using an instrument from a different healthcare system can lead to a completely new questionnaire.

  8. The changing nature of chronic care and coproduction of care between primary care professionals and patients with COPD and their informal caregivers.

    Science.gov (United States)

    Cramm, Jane Murray; Nieboer, Anna Petra

    2016-01-01

    The aim of this study was to investigate whether care delivery in accordance with a care model is associated with co-productive relationships between professionals and COPD patients and their informal caregivers. A co-productive relationship refers to productive patient-professional interaction or shared decision making. This cross-sectional study was conducted in 2014 among 411 patients (out of 981) enrolled in the Dutch COPD care program Kennemer Lucht and 62 professionals treating them (out of 97). Kennemer Lucht COPD involved multicomponent interventions within all six dimensions of the chronic care model (organizational support, community, self-management, decision support, delivery system design, and information and communications technology) to improve the quality of care for patients with COPD. This approach was expected to improve relational coproduction of care between professionals and patients with COPD and their informal caregivers. Results show clearly that the perceived quality of chronic care delivery is related significantly to productive interaction/relational coproduction of care. The strength of the relationship between perceptions of quality of chronic care and relational coproduction among patients is strong (r=0.5; P≤0.001) and among professionals moderate (r=0.4; P≤0.001 relational coproduction with patients and informal caregivers). Furthermore, patients' perceptions of the quality of chronic care were associated with the existence of productive interaction with health care professionals (β=0.7; P≤0.001). The changing nature of chronic care is associated with coproduction of care, leading to the development of more productive relationships between primary care professionals and COPD patients and their informal caregivers. Further research is necessary to determine how best to sustain these developments. PMID:26869783

  9. Specialty Care Use in US Patients with Chronic Diseases

    Directory of Open Access Journals (Sweden)

    Saundra H. Glover

    2010-03-01

    Full Text Available Despite efforts to eliminate health disparities, racial, ethnic, and geographic groups continue lag behind their counterparts in health outcomes in the United States. The purpose of this study is to determine variation in specialty care utilization by chronic disease status. Data were extracted from the Commonwealth Fund 2006 Health Care Quality Survey (n = 2475. A stratified minority sample design was employed to ensure a representative sample. Logistic regression was used in analyses to predict specialty care utilization in the sample. Poor perceived health, minority status, and lack of insurance was associated with reduced specialty care use and chronic disease diagnosis.

  10. Impact of Chronic Conditions on the Cost of Cancer Care...

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in Impact of Chronic Conditions on the Cost of Cancer Care for Medicaid Beneficiaries, published in Volume 2, Issue 4 of the Medicare...

  11. Inadequate Palliative Care in Chronic Lung Disease. An Issue of Health Care Inequality.

    Science.gov (United States)

    Brown, Crystal E; Jecker, Nancy S; Curtis, J Randall

    2016-03-01

    Patients with chronic lung diseases suffer higher symptom burden, lower quality of life, and greater social isolation compared with patients with other diagnoses, such as cancer. These conditions may be alleviated by palliative care, yet palliative care is used less by patients with chronic lung disease compared with patients with cancer. Underuse is due, in part, to poor implementation of primary palliative care and inadequate referral to specialty palliative care. Lack of primary and specialty palliative care in patients with chronic lung disease falls short of the minimum standard of competent health care, and represents a disparity in health care and a social injustice. We invoke the ethical principles of justice and sufficiency to highlight the importance of this issue. We identify five barriers to implementing palliative care in patients with chronic lung disease: uncertainty in prognosis; lack of provider skill to engage in discussions about palliative care; fear of using opioids among patients with chronic lung disease; fear of diminishing hope; and perceived and implicit bias against patients with smoking-related lung diseases. We propose mechanisms for improving implementation of palliative care for patients with chronic lung disease with the goal of enhancing justice in health care. PMID:26730490

  12. Reported barriers to evaluation in chronic care

    DEFF Research Database (Denmark)

    Knai, Cécile; Nolte, Ellen; Brunn, Matthias; Elissen, Arianne; Conklin, Annalijn; Pedersen, Janice Pedersen; Brereton, Laura; Erler, Antje; Frølich, Anne; Flamm, Maria; Fullerton, Birgitte; Jacobsen, Ramune; Krohn, Robert; Saz-Parkinson, Zuleika; Vrijhoef, Bert; Chevreul, Karine; Durand-Zaleski, Isabelle; Farsi, Fadila; Sarría-Santamera, Antonio; Soennichsen, Andreas

    The growing movement of innovative approaches to chronic disease management in Europe has not been matched by a corresponding effort to evaluate them. This paper discusses challenges to evaluation of chronic disease management as reported by experts in six European countries....

  13. Evidence-based models of care for people with epilepsy.

    LENUS (Irish Health Repository)

    Fitzsimons, Mary

    2012-02-01

    Advances in medical science and technology, together with improved medical and nursing care, are continuously improving health outcomes in chronic illness, including epilepsy. The consequent increasing diagnostic and therapeutic complexity is placing a burgeoning strain on health care systems. In response, an international move to transform chronic disease management (CDM) aims to optimize the quality and safety of care while containing health care costs. CDM models recommend: integration of care across organizational boundaries that is supported with information and communication technology; patient self-management; and guideline implementation to promote standardized care. Evidence of the effectiveness of CDM models in epilepsy care is presented in this review article.

  14. An intelligent partner system for improving chronic illness care

    Directory of Open Access Journals (Sweden)

    Tibor Deutsch

    2003-02-01

    Full Text Available Chronic care consists of a sequence of actions to treat a specific clinical disorder over time as a function of the ways in which illness progresses and patients respond to management actions. Outcomes depend on physicians' skills to select the actions best suited for their patients and competent self-management. This paper presents the architecture of an intelligent partner system (IPS, which helps to provide doctors with relevant data and skills and empowers chronically ill patients with the information and confidence to manage their health wisely. The services of this intelligent system are presented as 'therapies' for the information-processing 'pathologies' associated with traditional chronic illness care.

  15. Predictive Medicine for Chronic Patients in an Integrated Care Scenario. Chronic Obstructive Pulmonary Disease as Use Case

    OpenAIRE

    Cano Franco, Isaac

    2014-01-01

    Tesi realitzada a l'Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS) BACKGROUND The epidemics of non-communicable diseases and the need for cost-containment are triggering a profound reshaping of healthcare delivery toward adoption of the Chronic Care model, involving deployment of integrated care services (ICS) with the support of information and communication technologies (ICS-ICT). In this scenario, emerging systems medicine, with a holistic mechanism-based approa...

  16. The family experience of care in chronic situation.

    Science.gov (United States)

    Bellato, Roseney; Araújo, Laura Filomena Santos de; Dolina, Janderléia Valéria; Musquim, Cleciene Dos Anjos; Corrêa, Geovana Hagata de Lima Souza Thaines

    2016-06-01

    An essay that aims to reflect on the family experience of care in chronic situation, increasing the understanding of the family as the primary caregiver. It is based on comprehensive approach in studies conducted in three matrix searches from family care experiences. We have taken three axes to organize our reflections: a) conformation of family care in chronic situation, highlighting the multiple costs incurred to the family, which can exhaust the potential of care and establish or increase its vulnerability if it is not backed by networks support and sustenance; b) family rearrangements for the care, giving visibility to care cores in which many loved family members share the care, dynamic, plural and changeable way; c) self care modeling family care, pointing to the range of possibilities of the person taking care of diseased conditions supported by people close to them. We learn that the family takes care of itself in everyday life and in the illness experience, creating networks that can provide you support and sustenance. Thus, professionals in health practices should shape up in a longitudinal and very personal way, by reference to the family care, supporting him in what is his own. Ensaio que tem por objetivo refletir sobre a experiência familiar de cuidado na situação crônica, ampliando a compreensão da família como cuidadora primária. Embasa-se em estudos de abordagem compreensiva realizados em três pesquisas matriciais que abordaram experiências familiares de cuidado. Tomamos três eixos para organizar nossas reflexões: a) conformação do cuidado familiar na situação crônica, destacando os múltiplos custos gerados à família, que podem exaurir seus potenciais de cuidado, instaurando ou ampliando sua vulnerabilidade se não for amparada por redes de apoio e sustentação; b) rearranjos familiares para o cuidado, dando visibilidade aos núcleos de cuidado compartilhados pelos diversos entes familiares, de modo dinâmico, plural e mut

  17. The Chronic Responsibility: A Critical Discourse Analysis of Danish Chronic Care Policies.

    Science.gov (United States)

    Ravn, Iben M; Frederiksen, Kirsten; Beedholm, Kirsten

    2016-03-01

    This article reports on the results of a Fairclough-inspired critical discourse analysis aiming to clarify how chronically ill patients are presented in contemporary Danish chronic care policies. Drawing on Fairclough's three-dimensional framework for analyzing discourse, and using Dean's concepts of governmentality as an interpretative lens, we analyzed and explained six policies published by the Danish Health and Medicines Authority between 2005 and 2013. The analysis revealed that discourses within the policy vision of chronic care consider chronically ill patients' active role, lifestyle, and health behavior to be the main factors influencing susceptibility to chronic diseases. We argue that this discursive construction naturalizes a division between people who can actively manage responsible self-care and those who cannot. Such discourses may serve the interests of those patients who are already activated, while others remain subjugated to certain roles. For example, they may be labeled as "vulnerable." PMID:25662943

  18. Care for chronic illness in Australian general practice – focus groups of chronic disease self-help groups over 10 years: implications for chronic care systems reforms

    OpenAIRE

    Martin Carmel M; Peterson Chris; Robinson Rowena; Sturmberg Joachim P

    2009-01-01

    Abstract Background Chronic disease is a major global challenge. However, chronic illness and its care, when intruding into everyday life, has received less attention in Asia Pacific countries, including Australia, who are in the process of transitioning to chronic disease orientated health systems. Aim The study aims to examine experiences of chronic illness before and after the introduction of Australian Medicare incentives for longer consultations and structured health assessments in gener...

  19. Patient-Assessed Chronic Illness Care (PACIC) scenario in an Indian homeopathic hospital.

    Science.gov (United States)

    Koley, Munmun; Saha, Subhranil; Ghosh, Shubhamoy; Nag, Goutam; Kundu, Monojit; Mondal, Ramkumar; Purkait, Rajib; Patra, Supratim; Ali, Seikh Swaif

    2016-01-01

    Homeopathy research has focused on chronic conditions; however, the extent to which current homeopathic care is compliant with the Chronic Care Model (CCM) has been sparsely shown. As the Bengali Patient-Assessed Chronic Illness Care (PACIC)-20 was not available, the English questionnaire was translated and evaluated in a government homeopathic hospital in West Bengal, India. The translation was done in six steps, and approved by an expert committee. Face validity was tested by 15 people for comprehension. Test/retest reliability (reproducibility) was tested on 30 patients with chronic conditions. Internal consistency was tested in 377 patients suffering from various chronic conditions. The questionnaire showed acceptable test/retest reliability [intraclass correlation coefficient (ICC) 0.57-0.75; positive to strong positive correlations; p  0.05); however, monthly household income had a significant influence (p < 0.05) on the subscales except for "delivery system or practice design." Overall, chronic illness care appeared to be quite promising and CCM-compliant. The psychometric properties of the Bengali PACIC-20 were satisfactory, rendering it a valid and reliable instrument for assessing chronic illness care among the patients attending a homeopathic hospital. PMID:26933640

  20. Healthcare professional acceptance of telemonitoring for chronic care patients in primary care

    Directory of Open Access Journals (Sweden)

    Asua José

    2012-11-01

    Full Text Available Abstract Background A pilot experimentation of a telemonitoring system for chronic care patients is conducted in the Bilbao Primary Care Health Region (Basque Country, Spain. It seems important to understand the factors related to healthcare professionals’ acceptance of this new technology in order to inform its extension to the whole healthcare system. This study aims to examine the psychosocial factors related to telemonitoring acceptance among healthcare professionals and to apply a theory-based instrument. Methods A validated questionnaire, based on an extension of the Technology Acceptance Model (TAM, was distributed to a total of 605 nurses, general practitioners and paediatricians. Logistic regression analysis was performed to test the theoretical model. Adjusted odds ratios (OR and their 95% confidence intervals (CI were computed. Results A response rate of 44.3% was achieved. The original TAM model was good at predicting intention to use the telemonitoring system. However, the extended model, that included other theoretical variables, was more powerful. Perceived Usefulness, Compatibility, and Facilitators were the significant predictors of intention. A detailed analysis showed that intention to use telemonitoring was best predicted by healthcare professionals’ beliefs that they would obtain adequate training and technical support and that telemonitoring would require important changes in their practice. Conclusion The extended TAM explained a significant portion of the variance in healthcare professionals' intention to use a telemonitoring system for chronic care patients in primary care. The perception of facilitators in the organisational context is the most important variable to consider for increasing healthcare professionals’ intention to use the new technology.

  1. Program evaluation of Sea Mar’s Chronic Care Program for Latino and Caucasian patients with type 2 diabetes: providers and staff perspectives

    OpenAIRE

    Bond GE; Rechholtz L; Bosa C; Impert C; Barker S

    2012-01-01

    Gail E Bond,1 Laurie Rechholtz,1 Christina Bosa,1 Celine Impert,1,2 Sara Barker21College of Nursing, Seattle University, Seattle WA, USA; 2Sea Mar Community Health Center, Seattle, WA, USAProblem statement: Unprecedented consumption of health care resources in the USA coupled with increasing rates of chronic disease has fueled pursuit of improved models of health care delivery. The Chronic Care Model provides an organizational framework for chronic care management and practice improvement. Se...

  2. A predictive model of Health Related Quality of life of parents of chronically ill children: the importance of care-dependency of their child and their support system

    OpenAIRE

    Hatzmann, J.; Maurice-Stam, H.; Heymans, H. S.; Grootenhuis, M.A.

    2009-01-01

    BACKGROUND: Parents of chronically ill children are at risk for a lower Health Related Quality of Life (HRQoL). Insight in the dynamics of factors influencing parental HRQoL is necessary for development of interventions. Aim of the present study was to explore the influence of demographic and disease related factors on parental HRQoL, mediated by employment, income, leisure time, holiday and emotional support in a comprehensive model. METHODS: In a cross-sectional design, 543 parents of chron...

  3. A predictive model of Health Related Quality of life of parents of chronically ill children: the importance of care-dependency of their child and their support system

    OpenAIRE

    Heymans Hugo SA; Maurice-Stam Heleen; Hatzmann Janneke; Grootenhuis Martha A

    2009-01-01

    Abstract Background Parents of chronically ill children are at risk for a lower Health Related Quality of Life (HRQoL). Insight in the dynamics of factors influencing parental HRQoL is necessary for development of interventions. Aim of the present study was to explore the influence of demographic and disease related factors on parental HRQoL, mediated by employment, income, leisure time, holiday and emotional support in a comprehensive model. Methods In a cross-sectional design, 543 parents o...

  4. The chronic care for age-related macular degeneration study (CHARMED): Study protocol for a randomized controlled trial

    OpenAIRE

    Held Ulrike; Wang Mathyas; Woitzek Katja; Frei Anja; Rosemann Thomas

    2011-01-01

    Abstract Background Neovascular age-related macular degeneration is the leading cause of irreversible blindness in people 50 years of age or older in the developed world. As in other chronic diseases, several effective treatments are available, but in clinical daily practice there is an evidence performance gap. The Chronic Care Model represents an evidence-based framework for the care of chronically ill patients and aims at closing that gap. However, no data are available regarding patients ...

  5. Maggot debridement therapy in chronic wound care

    OpenAIRE

    Patil, NG; Leung, GKK; Chan, DCW; Fong, DHF; Leung, JYY

    2007-01-01

    Objective: To review the current evidence on the mechanism of actions and clinical applications of maggot debridement therapy. Data sources: Literature search of PubMed and Medline was performed up to January 2007. Study selection: Original and major review articles related to maggot debridement therapy were reviewed. Key words used in the literature search were 'maggot debridement therapy', 'wound healing', and 'chronic wound management'. Data extraction: All relevant English and Chinese art...

  6. Improving Chronic Care: Developing and testing disease-management interventions applied in COPD care

    OpenAIRE

    Lemmens, Karin

    2009-01-01

    textabstractDisease management has emerged as a new strategy to enhance quality of care for patients suffering from chronic conditions, and to control health care costs. So far, however, the effects of this strategy remain unclear. The purpose of this thesis was to determine the core elements of disease management and to understand how they operate and interact in order to effectively evaluate disease-management programmes, particularly for patients with chronic obstructive pulmonary disease....

  7. Wound care matrices for chronic leg ulcers: role in therapy

    OpenAIRE

    Sano H; Kouraba S; Ogawa R

    2015-01-01

    Hitomi Sano,1 Sachio Kouraba,2 Rei Ogawa11Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; 2Sapporo Wound Care and Anti-Aging Laboratory, Sapporo, JapanAbstract: Chronic leg ulcers are a significant health care concern. Although deep wounds are usually treated by flap transfers, the operation is invasive and associates with serious complications. Skin grafts may be a less invasive means of covering wounds. However, skin grafts cannot survive o...

  8. Specialty Care Use in US Patients with Chronic Diseases

    OpenAIRE

    Glover, Saundra H.; Edith Williams; Qiang Cheng,; Rivers, Patrick A; Hassan, Rahnuma M.; Bellinger, Jessica D.

    2010-01-01

    Despite efforts to eliminate health disparities, racial, ethnic, and geographic groups continue lag behind their counterparts in health outcomes in the United States. The purpose of this study is to determine variation in specialty care utilization by chronic disease status. Data were extracted from the Commonwealth Fund 2006 Health Care Quality Survey (n = 2475). A stratified minority sample design was employed to ensure a representative sample. Logistic regression was used in analyses to pr...

  9. Chronic kidney disease: identification and management in primary care

    OpenAIRE

    Fraser, Simon; Blakeman, Thomas

    2016-01-01

    Simon DS Fraser,1 Tom Blakeman2 1Academic Unit of Primary Care and Population Sciences, Faculty of Medicine, Southampton General Hospital, University of Southampton, Southampton, 2National Institute for Health Research Collaboration for Leadership in Applied Health Research Greater Manchester, Centre for Primary Care, Institute of Population Health, The University of Manchester, Manchester, UK Abstract: Chronic kidney disease (CKD) is an important and common noncommunicable condition globally...

  10. Chronic patient care at North West Province clinics

    Directory of Open Access Journals (Sweden)

    Claire van Deventer

    2009-04-01

    Full Text Available Background: Chronic illnesses are a significant burden to the health services in South Africa. There is a specific national health plan whereby chronically ill patients who are acceptably controlled should be managed at clinic level. The perception has emerged that the management of primary care has not been optimal in the Southern District of the North West Province. This provided the motivation to initiate this research, namely consideration of chronic patient care at clinics in the North West Province of South Africa.Method: A cross-sectional descriptive study was carried out at four randomly selected clinics covering four sub-districts in the Southern District (North West Province. This was done using charts and registers at the clinics. Inclusion criteria were patients older than 18, and presenting with the following chronic illnesses: asthma/chronic obstructive airways disease (COAD, hypertension, diabetes and epilepsy. The major focus areas were the regular assessment of the patients, the level of control of the illness and the use of the Essential Drugs List and Standard Treatment Guidelines (EDL/STG.Results: In the cases of all the chronic illnesses it was found that regular assessments were poorly done, with asthma (peak flow measurements being the most poorly done. Control was generally less than 50% for all the illnesses, although the EDL was followed fairly well by the personnel at the clinics.Conclusion: In the light of the burden of chronic illness the results give cause for great concern about the quality of care for chronically ill patients, and reasons were sought for some of the poor results. A subsequent decision was taken to carry out comprehensive quality improvement projects on each of the illnesses over the following five years.

  11. Rethinking chronic pain in a primary care setting.

    Science.gov (United States)

    Stanos, Steven; Brodsky, Marina; Argoff, Charles; Clauw, Daniel J; D'Arcy, Yvonne; Donevan, Sean; Gebke, Kevin B; Jensen, Mark P; Lewis Clark, Evelyn; McCarberg, Bill; Park, Peter W; Turk, Dennis C; Watt, Stephen

    2016-06-01

    Chronic pain substantially impacts patient function and quality of life and is a burden to society at large in terms of increased health care utilization and loss of productivity. As a result, there is an increasing recognition of chronic pain as a public health crisis. However, there remains wide variability in clinical practices related to the prevention, assessment, and treatment of chronic pain. Certain fundamental aspects of chronic pain are often neglected including the contribution of the psychological, social, and contextual factors associated with chronic pain. Also commonly overlooked is the importance of understanding the likely neurobiological mechanism(s) of the presenting pain and how they can guide treatment selection. Finally, physicians may not recognize the value of using electronic medical records to systematically capture data on pain and its impact on mood, function, and sleep. Such data can be used to monitor onset and maintenance of treatments effects at the patient level and evaluate costs at the systems level. In this review we explain how these factors play a critical role in the development of a coordinated, evidence-based treatment approach tailored to meet specific needs of the patient. We also discuss some practical approaches and techniques that can be implemented by clinicians in order to enhance the assessment and management of individuals with chronic pain in primary care settings. PMID:27166559

  12. PRIMARY CARE PROBLEMS IN PATIENTS WITH CHRONIC HEART FAILURE

    Directory of Open Access Journals (Sweden)

    O. A. Shtegman

    2015-09-01

    Full Text Available Aim. To evaluate primary care efficacy in patients with chronic heart failure (CHF.Material and methods. Outpatients (n=139 with CHF and 35 primary care physicians were included into the study. The evaluation of drug therapy and patient awareness of the principles of non-drug CHF treatment were performed. An anonymous survey among doctors in terms of current CHF guidelines knowledge, patient information provided by physicians, and doctors’ burnout status was also carried out.Results. Only 39% and 10% of CHF outpatients received target doses of ACE inhibitors/sartans and beta-blockers, respectively. Majority of CHF outpatients and their doctors need in additional education/training. 56% of primary care physicians demonstrated an emotional burnout.Conclusion. Author considers it essential to distribute short pocket-guidelines on CHF management among primary care physicians, and to reduce the load on primary care physicians with simultaneous strengthening of their performance control.

  13. Orem自护模式对慢性精神分裂症患者的影响%Effect of Orem self-care model on patients with chronic schiZophrenia

    Institute of Scientific and Technical Information of China (English)

    李晶晶

    2014-01-01

    Objective:To eXplore the effect of Orem self-care model on patients with chronic schizophrenia. Methods:108 patients with chronic schizophrenia were randomly divided into the observation group and the control group(54 cases in each group). The patients in the control group received the routine nursing care and the Orem self-care model was adopted in the observation group. The rehabilitation effect,self-esteem,general well-being and the scores of life quality of the patients were compared between the two groups. Results:The rehabilitation effect and the scores of life quality of the patients were better and higher in the observation group than the control group( P<0. 05);the scores of self-esteem and general well-being were higher in the observation group than the control group after nursing care (P<0. 05). Conclusion:The Orem self -care model for patients with chronic schizophrenia can effectively improve the rehabilitation effect,self-esteem,general well-being and quality of life of the patients.%目的:探讨Orem自护模式对慢性精神分裂症患者的影响。方法:将108例慢性精神分裂症患者随机分为观察组和对照组各54例,对照组接受常规护理模式,观察组接受Orem自护模式;比较两组康复效果、自尊、总体幸福感及各项生活质量评分情况。结果:观察组康复效果及各项生活质量评分均高于对照组( P<0.05);经护理后观察组自尊及总体幸福感评分高于对照组(P<0.05)。结论:对慢性精神分裂症患者实施Orem自护模式,可有效提高患者的康复效果,提升自尊感、幸福感及生活质量。

  14. "What we want": Chronically ill adolescents' preferences and priorities for improving health care

    NARCIS (Netherlands)

    A.L. van Staa (AnneLoes); S. Jedeloo (Susan); H.A. van der Stege (Heleen)

    2011-01-01

    textabstractBackground: As important users of health care, adolescents with chronic conditions deserve to be consulted about their experiences and expectations. This study aimed to explore chronically ill adolescents' preferences regarding providers' qualities, and outpatient and inpatient care. Fur

  15. Validation of the Spanish Translation of the Patient Assessment of Chronic Illness Care (PACIC Survey

    Directory of Open Access Journals (Sweden)

    Abraham Aragones, MD, MSCI

    2008-10-01

    Full Text Available IntroductionThe Patient Assessment of Chronic Illness Care (PACIC survey is a patient-centered instrument for evaluating the quality and patient-centeredness of chronic illness care received according to the Chronic Care Model paradigm. This study validates the Spanish translation of the PACIC in an urban, Spanish-speaking population.MethodsOne hundred Spanish-speaking patients with diabetes completed the translated PACIC and sociodemographic and cultural questionnaires. Test-retest reliability was assessed in a subset of 20 patients who completed the questionnaire 2 to 4 months later. Internal consistency was evaluated with Cronbach α. PACIC score and subscale associations with sociodemographic characteristics were examined.ResultsTest-retest reliability for the overall translated PACIC scale was 0.77. Scores were not associated with patient sociodemographic characteristics, including age, country of birth, years living in the United States, or education level (P >.05.ConclusionThe Spanish translation of the PACIC survey demonstrated high reliability, internal consistency, and test-retest reliability. Scores showed no association with sociodemographic or cultural characteristics. The Spanish version can reliably be used to assess care delivered according to the Chronic Care Model in a heterogeneous Spanish-speaking population.

  16. Pathways towards chronic care-focused healthcare systems: evidence from Spain.

    Science.gov (United States)

    García-Goñi, Manuel; Hernández-Quevedo, Cristina; Nuño-Solinís, Roberto; Paolucci, Francesco

    2012-12-01

    Increasing healthcare expenditure is a matter of concern in many countries, particularly in relation to the underlying drivers of such escalation that include ageing, medical innovation, and changes in the burden of disease, such as the growing prevalence of chronic diseases. Most healthcare systems in developed countries have been designed to 'cure' acute episodes, rather than to 'manage' chronic conditions, and therefore they are not suitably or efficiently organized to respond to the changing needs and preferences of users. New models of chronic care provision have been developed to respond to the changing burden of disease and there is already considerable practical experience in several different countries showing their advantages but also the difficulties associated with their implementation. In this paper, we focus on the Spanish experience in terms of policy changes and pilot studies focused on testing the feasibility of moving towards chronic care models. In particular, we discuss a framework that identifies and analyses ten key prerequisites to achieving high performing chronic care-based healthcare systems and apply it to the current Spanish National Health System (NHS). We find that the design of the Spanish NHS already meets some of these pre-requisites. However, other features are still in their early stages of development or are being applied only in limited geographical and clinical contexts. We outline the policies that are being implemented and the pathway that the Spanish NHS is taking to address the crucial challenge of the transition towards an optimal health system focused on chronic care. Given the current evidence and trends, we expect that the pathway for developing a chronicity strategy being followed by the Spanish NHS will significantly transform its current healthcare delivery model in the next few years. PMID:23116631

  17. Palliative care provision for patients with chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Yohannes Abebaw

    2007-04-01

    Full Text Available Abstract Chronic obstructive pulmonary disease (COPD is a major cause of disability, morbidity and mortality in old age. Patients with advanced stage COPD are most likely to be admitted three to four times per year with acute exacerbations of COPD (AECOPD which are costly to manage. The adverse events of AECOPD are associated with poor quality of life, severe physical disability, loneliness, and depression and anxiety symptoms. Currently there is a lack of palliative care provision for patients with advanced stage COPD compared with cancer patients despite having poor prognosis, intolerable dyspnoea, lower levels of self efficacy, greater disability, poor quality of life and higher levels of anxiety and depression. These symptoms affect patients' quality of life and can be a source of concern for family and carers as most patients are likely to be housebound and may be in need of continuous support and care. Evidence of palliative care provision for cancer patients indicate that it improves quality of life and reduces health care costs. The reasons why COPD patients do not receive palliative care are complex. This partly may relate to prognostic accuracy of patients' survival which poses a challenge for healthcare professionals, including general practitioners for patients with advanced stage COPD, as they are less likely to engage in end-of-life care planning in contrast with terminal disease like cancer. Furthermore there is a lack of resources which constraints for the wider availability of the palliative care programmes in the health care system. Potential barriers may include unwillingness of patients to discuss advance care planning and end-of-life care with their general practitioners, lack of time, increased workload, and fear of uncertainty of the information to provide about the prognosis of the disease and also lack of appropriate tools to guide general practitioners when to refer patients for palliative care. COPD is a chronic

  18. Chronic pain management as a barrier to pediatric palliative care.

    Science.gov (United States)

    Thompson, Lindsay A; Meinert, Elizabeth; Baker, Kimberly; Knapp, Caprice

    2013-12-01

    Pain is common as a presenting complaint to outpatient and emergency departments for children, yet pain management represents one of the children's largest unmet needs. A child may present with acute pain for an intermittent issue or may have acute or chronic pain in the setting of chronic illness. The mainstay of treatment for pain uses a stepwise approach for pain management, such as set up by the World Health Organization. For children with life-limiting illnesses, the Institute of Medicine guidelines recommends referral upon diagnosis for palliative care, meaning that the child receives comprehensive services that include pain control in coordination with curative therapies; yet barriers remain. From the provider perspective, pain can be better addressed through a careful assessment of one's own knowledge, skills, and attitudes. The key components of pain management in children are multimodal, regardless of the cause of the pain. PMID:23329083

  19. Intimate Partner Aggression Perpetration in Primary Care Chronic Pain Patients

    OpenAIRE

    Taft, Casey; Schwartz, Sonia; Liebschutz, Jane M.

    2010-01-01

    This study examined the prevalence and correlates of partner aggression perpetration in 597 primary care chronic pain patients. Approximately 30% of participants reported perpetrating low-level aggression, 12% reported injuring their partner, and 5% reported engaging in sexual coercion. Women reported more low-level aggression perpetration than men, and men reported more engagement in sexual coercion than women. Substance use disorders (SUD) were associated with all outcomes, and both aggress...

  20. Care for chronic illness in Australian general practice – focus groups of chronic disease self-help groups over 10 years: implications for chronic care systems reforms

    Directory of Open Access Journals (Sweden)

    Martin Carmel M

    2009-01-01

    Full Text Available Abstract Background Chronic disease is a major global challenge. However, chronic illness and its care, when intruding into everyday life, has received less attention in Asia Pacific countries, including Australia, who are in the process of transitioning to chronic disease orientated health systems. Aim The study aims to examine experiences of chronic illness before and after the introduction of Australian Medicare incentives for longer consultations and structured health assessments in general practice. Methods Self-help groups around the conditions of diabetes, epilepsy, asthma and cancer identified key informants to participate in 4 disease specific focus groups. Audio taped transcripts of the focus groups were coded using grounded theory methodology. Key themes and lesser themes identified using a process of saturation until the study questions on needs and experiences of care were addressed. Thematic comparisons were made across the 2002/3 and 1992/3 focus groups. Findings At times of chronic illness, there was need to find and then ensure access to 'the right GP'. The 'right GP or specialist' committed to an in-depth relationship of trust, personal rapport and understanding together with clinical and therapeutic competence. The 'right GP', the main specialist, the community nurse and the pharmacist were key providers, whose success depended on interprofessional communication. The need to trust and rely on care providers was balanced by the need for self-efficacy 'to be in control of disease and treatment' and 'to be your own case manager'. Changes in Medicare appeared to have little penetration into everyday perceptions of chronic illness burden or time and quality of GP care. Inequity of health system support for different disease groupings emerged. Diabetes, asthma and certain cancers, like breast cancer, had greater support, despite common experiences of disease burden, and a need for research and support programs. Conclusion Core

  1. Program evaluation of Sea Mar’s Chronic Care Program for Latino and Caucasian patients with type 2 diabetes: providers and staff perspectives

    Directory of Open Access Journals (Sweden)

    Bond GE

    2012-09-01

    Full Text Available Gail E Bond,1 Laurie Rechholtz,1 Christina Bosa,1 Celine Impert,1,2 Sara Barker21College of Nursing, Seattle University, Seattle WA, USA; 2Sea Mar Community Health Center, Seattle, WA, USAProblem statement: Unprecedented consumption of health care resources in the USA coupled with increasing rates of chronic disease has fueled pursuit of improved models of health care delivery. The Chronic Care Model provides an organizational framework for chronic care management and practice improvement. Sea Mar, a community health care organization in Washington state, implemented the Chronic Care Model, but has not evaluated the outcomes related to provider and staff satisfaction. The specific aim of this project was to evaluate the effectiveness of the Chronic Care Model with the addition of the Chronic Care Coordinator role.Approach: A descriptive method was used, which incorporated quantitative, and qualitative data from providers and clinic staff collected through a Web-based survey consisting of Likert-type questions sent via an electronic link.Results: This evaluation identified the strengths of and barriers to the chronic care model with a focus on provider and staff satisfaction regarding patient care since the addition of the Chronic Care Coordinator role. We found a high appreciation (94% and acceptance of the role; 80% agreed that the Chronic Care Coordinator was well-integrated into clinic operations. Major strengths of the program included more patient education, better follow-up, and improved team communications. Barriers to success included limited provider access, confusion regarding role expectations of the Chronic Care Coordinator, inconsistent communications, and Chronic Care Coordinator turnover.Conclusions/recommendations: Our findings help to validate the importance of community health organizations such as Sea Mar, the utility of the chronic care model, and the potential value for specific roles such as the Chronic Care Coordinator to

  2. [The impact of education on chronic wound care improvement].

    Science.gov (United States)

    Novinscak, Tomislav; Filipović, Marinko; Kristofić, Jelena; Toplek, Goran

    2014-10-01

    Although not fully understood, close relationship between health and education ensures unambiguous health and quality of life advantages to educated individuals. Education ensures different thinking and decision making processes and man is enabled to receive information from the external world. Even though the process of education and learning still relies on banking principles and coping of common knowledge, modern and technological society drives the system as well as education opportunities towards the new learning sources. In the developed world, the impact of chronic wounds on health systems is fairly perceived, as well as chronic wound treatment and education. Our health system still neglects the significant impact of chronic wounds on social and economic, individual and community well-being. Recognizing the importance of chronic wounds and implementation of a developed educational system gives us the potential for improving care for chronic wounds, and thus to substantially improve the quality of life of patients. Furthermore, consequent reduction of unnecessary health costs could reallocate substantial resources to other points of interest. PMID:25326984

  3. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    Science.gov (United States)

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population. PMID:27053406

  4. Leveraging HIV platforms to work toward comprehensive primary care in rural Malawi: the Integrated Chronic Care Clinic.

    Science.gov (United States)

    Wroe, Emily B; Kalanga, Noel; Mailosi, Bright; Mwalwanda, Stanley; Kachimanga, Chiyembekezo; Nyangulu, Kondwani; Dunbar, Elizabeth; Kerr, Lila; Nazimera, Lawrence; Dullie, Luckson

    2015-12-01

    This case study describes an integrated chronic care clinic that utilizes a robust HIV program as a platform for NCD screening and treatment. A unique model, the integrated chronic care clinic provides longitudinal care for patients with an array of chronic diseases including HIV and common NCDs, allowing for a single visit for all of a patient's conditions. Set in Malawi's remote Neno District, this clinic structure aims to (1) increase access to care for NCD patients, (2) maximize efficiency given the severe human resource shortages, and (3) replicate strong HIV outcomes for patients with other chronic conditions. The goal is to increase the number of health facilities in Neno capable of fully delivering Malawi's Essential Health Package, the set of cost-effective interventions endorsed by Malawi MOH to reduce burden of disease and leading causes of death. While implementation is ongoing and processes are evolving, this model of healthcare delivery has already improved the accessibility of NCD care by allowing patients to have all of their chronic conditions treated on the same day at their nearest health facility, notably without additional investment of human and financial resources. Currently, 6781 patients on antiretroviral therapy and 721 patients with NCDs are benefitting, including 379 with hypertension, 187 with asthma, 144 with epilepsy, and 76 with diabetes. Among the NCD patient population, 15.1% are HIV-positive. Success hinged largely on several factors, including clear leadership and staff ownership of their specific duties, and a well-defined and uniform patient flow process. Furthermore, deliberate and regular conversations about challenges allowed for constant iteration and improvement of processes. Moving forward, several tasks remain. We are refining the data management process to further consolidate medical records, along with integrating our tracking processes for clients who miss appointments. Additionally, we are exploring opportunities for

  5. Desarrollo de IEMAC, un Instrumento para la Evaluación de Modelos de Atención ante la Cronicidad Development of an instrument for the assessment of chronic care models

    Directory of Open Access Journals (Sweden)

    Roberto Nuño-Solinís

    2013-04-01

    Full Text Available Objetivos: Presentar el contexto, los objetivos y el proceso de elaboración de IEMAC, Instrumento de Evaluación de Modelos de Atención ante la Cronicidad, desarrollado para trasladar al terreno operativo los marcos conceptuales del Chronic Care Model (CCM, en el entorno del Sistema Nacional de Salud. Métodos: Mediante técnicas de investigación cualitativa y contando sucesivamente con expertos nacionales de diferentes perfiles, se desarrolló el IEMAC para operativizar el CCM a nuestro contexto sanitario. Se construyó una matriz considerando qué dimensiones básicas debían conformar el nuevo modelo. Se identificaron y categorizaron posibles acciones en cada dimensión, creando una taxonomía de componentes e intervenciones. Se evaluó la claridad, la pertinencia y el nivel de evidencia de cada intervención. El cuestionario resultante fue validado por otros expertos de diversas disciplinas y ámbitos. Finalmente, el instrumento IEMAC 1.0ha sido pilotado a niveles macro, meso y micro. Resultados: IEMAC es un instrumento para ser autoadministrado por organizaciones sanitarias a niveles macro, meso y micro. Consta de 6 dimensiones, 27 componentes y 80 intervenciones, cuya implantación se evalúa en una escala que combina despliegue, evaluación sistemática y orientación a la mejora. IEMAC tiene un enfoque sistémico y poblacional, integrando promoción, prevención y coordinación con servicios sociales. Conclusiones: IEMAC muestra un conjunto de intervenciones que pueden servir de hoja de ruta a decisores, gestores y clínicos interesados en construir un modelo de excelencia para la atención a pacientes crónicos, a la vez que permite que las organizaciones sanitarias conozcan su situación basal y el progreso alcanzado tras intervenciones de mejora.Objective: To present the context, aim and process of designing the Instrument for the Assessment of Chronic Care Models (Instrumento de Evaluación de Modelos de Atención ante la

  6. Prediction of chronic critical illness in a general intensive care unit

    Directory of Open Access Journals (Sweden)

    Sérgio H. Loss

    2013-06-01

    Full Text Available OBJECTIVE: To assess the incidence, costs, and mortality associated with chronic critical illness (CCI, and to identify clinical predictors of CCI in a general intensive care unit. METHODS: This was a prospective observational cohort study. All patients receiving supportive treatment for over 20 days were considered chronically critically ill and eligible for the study. After applying the exclusion criteria, 453 patients were analyzed. RESULTS: There was an 11% incidence of CCI. Total length of hospital stay, costs, and mortality were significantly higher among patients with CCI. Mechanical ventilation, sepsis, Glasgow score < 15, inadequate calorie intake, and higher body mass index were independent predictors for cci in the multivariate logistic regression model. CONCLUSIONS: CCI affects a distinctive population in intensive care units with higher mortality, costs, and prolonged hospitalization. Factors identifiable at the time of admission or during the first week in the intensive care unit can be used to predict CCI.

  7. Seamless health care for chronic diseases in a dual health care system: managed care and the role of family physicians.

    Science.gov (United States)

    Lee, A

    1998-01-01

    Neither private nor state run health care systems are perfect. Although there is increasing evidence that Health Maintenance Organizations (HMOs) provide comparable care at lower cost, HMOs tend to select healthy patients. The dual health care system in Hong Kong spends about 3.9 per cent of GDP, with health indices among the best in the world. Hong Kong still faces the problem of escalating health care expenditure. One should take advantage of the dual health care system to evolve a new paradigm for a primary-led seamless health care service. The Diabetes Centre of a university teaching hospital together with the University of Community and Family Medicine has started a structured shared care programme in diabetes mellitus, involving general practitioners in both the private and public sectors integrating the primary and secondary care, and the private and public sectors. This programme starts to develop an infrastructure for providing quality care at an affordable cost for a large pool of patients with chronic disease. Unlike other "managed care schemes", this one is not run by profit-oriented companies, but by health professionals with an interest in providing best possible care at an affordable cost. The "disease management" approach needs a care delivery system without traditional boundaries; and a continuous improvement process which develops and refines the knowledge base, guidelines and delivery system. PMID:10351265

  8. Wound care matrices for chronic leg ulcers: role in therapy

    Directory of Open Access Journals (Sweden)

    Sano H

    2015-07-01

    Full Text Available Hitomi Sano,1 Sachio Kouraba,2 Rei Ogawa11Department of Plastic, Reconstructive, and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan; 2Sapporo Wound Care and Anti-Aging Laboratory, Sapporo, JapanAbstract: Chronic leg ulcers are a significant health care concern. Although deep wounds are usually treated by flap transfers, the operation is invasive and associates with serious complications. Skin grafts may be a less invasive means of covering wounds. However, skin grafts cannot survive on deep defects unless high-quality granulation tissue can first be generated in the defects. Technologies that generate high-quality granulation tissue are needed. One possibility is to use wound care matrices, which are bioengineered skin and soft tissue substitutes. Because they all support the healing process by providing a premade extracellular matrix material, these matrices can be termed “extracellular matrix replacement therapies”. The matrix promotes wound healing by acting as a scaffold for regeneration, attracting host cytokines to the wound, stimulating wound epithelialization and angiogenesis, and providing the wound bed with bioactive components. This therapy has lasting benefits as it not only helps large skin defects to be closed with thin skin grafts or patch grafts but also restores cosmetic appearance and proper function. In particular, since it acts as a layer that slides over the subcutaneous fascia, it provides skin elasticity, tear resistance, and texture. Several therapies and products employing wound care matrices for wound management have been developed recently. Some of these can be applied in combination with negative pressure wound therapy or beneficial materials that promote wound healing and can be incorporated into the matrix. To date, the clinical studies on these approaches suggest that wound care matrices promote spontaneous wound healing or can be used to facilitate skin grafting, thereby avoiding the need to use

  9. Auditing chronic disease care: Does it make a difference?

    Directory of Open Access Journals (Sweden)

    Vivien Essel

    2015-02-01

    Full Text Available Background: An integrated audit tool was developed for five chronic diseases, namely diabetes, hypertension, asthma, chronic obstructive pulmonary disease and epilepsy. Annual audits have been done in the Western Cape Metro district since 2009. The year 2012 was the first year that all six districts in South Africa’s Western Cape Province participated in the audit process.Aim: To determine whether clinical audits improve chronic disease care in health districts over time.Setting: Western Cape Province, South Africa.Methods: Internal audits were conducted of primary healthcare facility processes and equipment availability as well as a folder review of 10 folders per chronic condition per facility. Random systematic sampling was used to select the 10 folders for the folder review. Combined data for all facilities gave a provincial overview and allowed for comparison between districts. Analysis was done comparing districts that have been participating in the audit process from 2009 to 2010 (‘2012 old’ to districts that started auditing recently (‘2012 new’.Results: The number of facilities audited has steadily increased from 29 in 2009 to 129 in 2012. Improvements between different years have been modest, and the overall provincial average seemed worse in 2012 compared to 2011. However, there was an improvement in the ‘2012 old’ districts compared to the ‘2012 new’ districts for both the facility audit and the folder review, including for eight clinical indicators, with ‘2012 new’ districts being less likely to record clinical processes (OR 0.25, 95% CI 0.21–0.31.Conclusion: These findings are an indication of the value of audits to improve care processes over the long term. It is hoped that this improvement will lead to improved patient outcomes.

  10. Just regionalisation: rehabilitating care for people with disabilities and chronic illnesses

    Directory of Open Access Journals (Sweden)

    Wagner Frank

    2006-08-01

    Full Text Available Abstract Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs. The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i rehabilitation and services for people with disabilities; (ii chronic illness and cancer care; (iii senior's health; (iv community support services; (v children's health; (vi health promotion; and (vii mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper

  11. A successful chronic care program in Al Ain-United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Al Husaini Alhusini I

    2010-02-01

    Full Text Available Abstract Background The cost effective provision of quality care for chronic diseases is a major challenge for health care systems. We describe a project to improve the care of patients with the highly prevalent disorders of diabetes and hypertension, conducted in one of the major cities of the United Arab Emirates. Settings and Methods The project, using the principles of quality assurance cycles, was conducted in 4 stages. The assessment stage consisted of a community survey and an audit of the health care system, with particular emphasis on chronic disease care. The information gleaned from this stage provided feedback to the staff of participating health centers. In the second stage, deficiencies in health care were identified and interventions were developed for improvements, including topics for continuing professional development. In the third stage, these strategies were piloted in a single health centre for one year and the outcomes evaluated. In the still ongoing fourth stage, the project was rolled out to all the health centers in the area, with continuing evaluation. The intervention consisted of changes to establish a structured care model based on the predicted needs of this group of patients utilizing dedicated chronic disease clinics inside the existing primary health care system. These clinics incorporated decision-making tools, including evidence-based guidelines, patient education and ongoing professional education. Results The intervention was successfully implemented in all the health centers. The health care quality indicators that showed the greatest improvement were the documentation of patient history (e.g. smoking status and physical activity; improvement in recording physical signs (e.g. body mass index (BMI; and an improvement in the requesting of appropriate investigations, such as HbA1c and microalbuminurea. There was also improvement in those parameters reflecting outcomes of care, which included HbA1c, blood

  12. From concept to content: assessing the implementation fidelity of a chronic care model for frail, older people who live at home.

    NARCIS (Netherlands)

    Muntinga, M.E.; Leeuwen, K.M. van; Schellevis, F.G.; Nijpels, G.; Jansen, A.P.D.

    2015-01-01

    Background: Implementation fidelity, the degree to which a care program is implemented as intended, can influence program impact. Since results of trials that aim to implement comprehensive care programs for frail, older people have been conflicting, assessing implementation fidelity alongside these

  13. Wound healing and treating wounds: Chronic wound care and management.

    Science.gov (United States)

    Powers, Jennifer G; Higham, Catherine; Broussard, Karen; Phillips, Tania J

    2016-04-01

    In the United States, chronic ulcers--including decubitus, vascular, inflammatory, and rheumatologic subtypes--affect >6 million people, with increasing numbers anticipated in our growing elderly and diabetic populations. These wounds cause significant morbidity and mortality and lead to significant medical costs. Preventative and treatment measures include disease-specific approaches and the use of moisture retentive dressings and adjunctive topical therapies to promote healing. In this article, we discuss recent advances in wound care technology and current management guidelines for the treatment of wounds and ulcers. PMID:26979353

  14. Integrated, Team-Based Chronic Pain Management: Bridges from Theory and Research to High Quality Patient Care.

    Science.gov (United States)

    Driscoll, Mary A; Kerns, Robert D

    2016-01-01

    Chronic pain is a significant public health concern. For many, chronic pain is associated with declines in physical functioning and increases in emotional distress. Additionally, the socioeconomic burden associated with costs of care, lost wages and declines in productivity are significant. A large and growing body of research continues to support the biopsychosocial model as the predominant framework for conceptualizing the experience of chronic pain and its multiple negative impacts. The model also informs a widely accepted and empirically supported approach for the optimal management of chronic pain. This chapter briefly articulates the historical foundations of the biopsychosocial model of chronic pain followed by a relatively detailed discussion of an empirically informed, integrated, multimodal and interdisciplinary treatment approach. The role of mental health professionals, especially psychologists, in the management of chronic pain is particularly highlighted. PMID:26900068

  15. Co-ordination and management of chronic conditions in Europe : the role of primary care.

    NARCIS (Netherlands)

    Gress, S.; Baan, C.A.; Calnan, M.; Dedeu, T.; Groenewegen, P.P.; Howson, H.

    2009-01-01

    Healthcare systems in Europe struggle with inadequate co-ordination of care for people with chronic conditions. Moreover, there is a considerable evidence gap in the treatment of chronic conditions, lack of self-management, variation in quality of care, lack of preventive care, increasing costs for

  16. From concept to content: assessing the implementation fidelity of a chronic care model for frail, older people who live at home.

    OpenAIRE

    Muntinga, M. E.; Leeuwen, K.M. van; Schellevis, F G; Nijpels, G.; Jansen, A.P.D.

    2015-01-01

    Background Implementation fidelity, the degree to which a care program is implemented as intended, can influence program impact. Since results of trials that aim to implement comprehensive care programs for frail, older people have been conflicting, assessing implementation fidelity alongside these trials is essential to differentiate between flaws inherent to the program and implementation issues. This study demonstrates how a theory-based assessment of fidelity can increase insight in the i...

  17. The ideal of biopsychosocial chronic care: How to make it real? A qualitative study among Dutch stakeholders

    Directory of Open Access Journals (Sweden)

    van Dijk-de Vries Anneke

    2012-03-01

    Full Text Available Abstract Background Chronically ill patients often experience psychosocial problems in everyday life. A biopsychosocial approach is considered to be essential in chronic care. In Dutch primary health care the current biomedically oriented clinical practice may conflict with the biopsychosocial approach. This study is aimed to explore the views of Dutch stakeholders on achieving a biopsychosocial approach to the care of patients with chronic diseases. Methods In a qualitative explorative study design, we held semi-structured interviews with stakeholders, face-to-face or by telephone. Data were analysed using content analysis. Thirty representatives of Dutch patients with chronic illnesses, primary care professionals, policy makers, health inspectorate, health insurers, educational institutes and researchers were interviewed. Results Stakeholders were aware that a systematic biopsychosocial care approach is lacking in current practice. Opportunities for effective change are multidimensional. Achieving a biopsychosocial approach to care relates to active patient participation, the training of professionals, high-quality guidelines, protocols and tools, integrated primary care, research and financial issues. Conclusions Although the principles and importance of the biopsychosocial model have been recognized, the provision of care that starts from the medical, emotional or social needs of individual patients does not fit in easily with the current Dutch health care system. All parties involved need to make a commitment to realize the ideal of biopsychosocial chronic care. Together they need to equip health professionals with skills to understand patients' multifaceted needs and to reward integrated biopsychosocial care. Patients need to be empowered to be active partners in their own care.

  18. Models of care and delivery

    DEFF Research Database (Denmark)

    Lundgren, Jens

    2014-01-01

    Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good...... outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP), or a mixture of the two, depending on the setting. Key factors explaining...... this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach...

  19. Developing Integrated Care: Towards a development model for integrated care

    OpenAIRE

    Minkman, Mirella M.N

    2012-01-01

    textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated care. Based on a systematic approach in which a literature study, a delphi study, a concept mapping study and questionnaire research are combined, a development model for integrated care is created....

  20. Diabetic Retinopathy Screening and Monitoring of Early Stage Disease in Australian General Practice: Tackling Preventable Blindness within a Chronic Care Model

    Directory of Open Access Journals (Sweden)

    Lisa Crossland

    2016-01-01

    Full Text Available Introduction. Diabetic retinopathy (DR is the leading cause of preventable blindness in Australia. Up to 50% of people with proliferative DR who do not receive timely treatment will become legally blind within five years. Innovative and accessible screening, involving a variety of primary care providers, will become increasingly important if patients with diabetes are to receive optimal eye care. Method. An open controlled trial design was used. Five intervention practices in urban, regional, and rural Australia partnered with ophthalmologists via telehealth undertook DR screening and monitoring of type 2 diabetes patients and were compared with control practices undertaking usual care 2011–2014. Results. Recorded screening rates were 100% across intervention practices, compared with 22–53% in control practices. 31/577 (5% of patients in the control practices were diagnosed with mild-moderate DR, of whom 9 (29% had appropriate follow-up recorded. This was compared with 39/447 (9% of patients in the intervention group, of whom 37 (95% had appropriate follow-up recorded. Discussion and Conclusion. General practice-based DR screening via Annual Cycle of Care arrangements is effective across differing practice locations. It offers improved recording of screening outcomes for Australians with type 2 diabetes and better follow-up of those with screen abnormalities.

  1. A personalized framework for medication treatment management in chronic care.

    Science.gov (United States)

    Koutkias, Vassilis G; Chouvarda, Ioanna; Triantafyllidis, Andreas; Malousi, Andigoni; Giaglis, Georgios D; Maglaveras, Nicos

    2010-03-01

    The ongoing efforts toward continuity of care and the recent advances in information and communication technologies have led to a number of successful personal health systems for the management of chronic care. These systems are mostly focused on monitoring efficiently the patient's medical status at home. This paper aims at extending home care services delivery by introducing a novel framework for monitoring the patient's condition and safety with respect to the medication treatment administered. For this purpose, considering a body area network (BAN) with advanced sensors and a mobile base unit as the central communication hub from the one side, and the clinical environment from the other side, an architecture was developed, offering monitoring patterns definition for the detection of possible adverse drug events and the assessment of medication response, supported by mechanisms enabling bidirectional communication between the BAN and the clinical site. Particular emphasis was given on communication and information flow aspects that have been addressed by defining/adopting appropriate formal information structures as well as the service-oriented architecture paradigm. The proposed framework is illustrated via an application scenario concerning hypertension management. PMID:20007042

  2. Patient autonomy in chronic care: solving a paradox

    Directory of Open Access Journals (Sweden)

    Reach G

    2013-12-01

    Full Text Available Gérard Reach Department of Endocrinology, Diabetes, and Metabolic Diseases, Avicenne Hospital AP-HP, and EA 3412, CRNH-IdF, Paris 13 University, Sorbonne Paris Cité, Bobigny, France Abstract: The application of the principle of autonomy, which is considered a cornerstone of contemporary bioethics, is sometimes in obvious contradiction with the principle of beneficence. Indeed, it may happen in chronic care that the preferences of the health care provider (HCP, who is largely focused on the prevention of long term complications of diseases, differ from those, more present oriented, preferences of the patient. The aims of this narrative review are as follows: 1 to show that the exercise of autonomy by the patient is not always possible; 2 where the latter is not possible, to examine how, in the context of the autonomy principle, someone (a HCP can decide what is good (a treatment for someone else (a patient without falling into paternalism. Actually this analysis leads to a paradox: not only is the principle of beneficence sometimes conflicting with the principle of autonomy, but physician's beneficence may enter into conflict with the mere respect of the patient; and 3 to propose a solution to this paradox by revisiting the very concepts of the autonomous person, patient education, and trust in the patient–physician relationship: this article provides an ethical definition of patient education. Keywords: preference, autonomy, person, reflexivity, empathy, sympathy, patient education, trust, respect, care

  3. Getting better at chronic care in remote communities: study protocol for a pragmatic cluster randomised controlled of community based management

    Directory of Open Access Journals (Sweden)

    Schmidt Barbara

    2012-11-01

    Full Text Available Abstract Background Prevalence and incidence of diabetes and other common comorbid conditions (hypertension, coronary heart disease, renal disease and chronic lung disease are extremely high among Indigenous Australians. Recent measures to improve quality of preventive care in Indigenous community settings, while apparently successful at increasing screening and routine check-up rates, have shown only modest or little improvements in appropriate care such as the introduction of insulin and other scaled-up drug regimens in line with evidence-based guidelines, together with support for risk factor reduction. A new strategy is required to ensure high quality integrated family-centred care is available locally, with continuity and cultural safety, by community-based care coordinators with appropriate system supports. Methods/design The trial design is open parallel cluster randomised controlled trial. The objective of this pragmatic trial is to test the effectiveness of a model of health service delivery that facilitates integrated community-based, intensive chronic condition management, compared with usual care, in rural and remote Indigenous primary health care services in north Queensland. Participants are Indigenous adults (aged 18–65 years with poorly controlled diabetes (HbA1c>=8.5 and at least one other chronic condition. The intervention is to employ an Indigenous Health Worker to case manage the care of a maximum caseload of 30 participants. The Indigenous Health Workers receive intensive clinical training initially, and throughout the study, to ensure they are competent to coordinate care for people with chronic conditions. The Indigenous Health Workers, supported by the local primary health care (PHC team and an Indigenous Clinical Support Team, will manage care, including coordinating access to multidisciplinary team care based on best practice standards. Allocation by cluster to the intervention and control groups is by simple

  4. Shared Care Contributions to Self-Care and Quality of Life in Chronic Cardiac Patients.

    Science.gov (United States)

    Sebern, Margaret; Brown, Roger; Flatley-Brennan, Patricia

    2016-07-01

    Shared care is an interpersonal interaction system composed of communication, decision making, and reciprocity; it is used by patients and family caregivers (care dyads) to exchange social support. This study's purpose was to describe the contributions of shared care to outcomes for individuals with cardiac disease. A secondary data analysis was used to answer the following questions. What is the association between elements of shared care and patient outcomes? Do dyad perceptions of shared care differentially contribute to patient outcomes? Participants in this study were 93 individuals with a cardiac disease and 93 family caregivers. Composite index structured equation modeling was the analytic tool. Caregiver communication and reciprocity were related to patient mental quality of life. Patient communication and reciprocity were related to their own mental and physical quality of life and self-care confidence. Findings from this study contribute a better understanding of how care dyads are integral to patient outcomes. PMID:26864996

  5. Models of care and delivery

    Directory of Open Access Journals (Sweden)

    Jens Lundgren

    2014-11-01

    Full Text Available Marked regional differences in HIV-related clinical outcomes exist across Europe. Models of outpatient HIV care, including HIV testing, linkage and retention for positive persons, also differ across the continent, including examples of sub-optimal care. Even in settings with reasonably good outcomes, existing models are scrutinized for simplification and/or reduced cost. Outpatient HIV care models across Europe may be centralized to specialized clinics only, primarily handled by general practitioners (GP, or a mixture of the two, depending on the setting. Key factors explaining this diversity include differences in health policy, health insurance structures, case load and the prevalence of HIV-related morbidity. In clinical stable populations, the current trend is to gradually extend intervals between HIV-specific visits in a shared care model with GPs. A similar shared-model approach with community clinics for injecting drug-dependent persons is also being implemented. Shared care models require oversight to ensure that primary responsibility is defined for the persons overall health situation, for screening of co-morbidities, defining indication to treat comorbidities, prescription of non-HIV medicines, etc. Intelligent bioinformatics platforms (i.e. generation of alerts if course of care deviates from a prior defined normality are being developed to assist in providing this oversight and to provide measure of quality. Although consensus exists to assess basic quality indicators of care, a comprehensive set of harmonized indicators are urgently needed to define best practise standards via benchmarking. Such a tool will be central to guide ongoing discussions on restructuring of models, as quality of care should not be compromised in this process.

  6. The chronic care for age-related macular degeneration study (CHARMED: Study protocol for a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Held Ulrike

    2011-10-01

    Full Text Available Abstract Background Neovascular age-related macular degeneration is the leading cause of irreversible blindness in people 50 years of age or older in the developed world. As in other chronic diseases, several effective treatments are available, but in clinical daily practice there is an evidence performance gap. The Chronic Care Model represents an evidence-based framework for the care of chronically ill patients and aims at closing that gap. However, no data are available regarding patients with neovascular age-related macular degeneration. Methods/Design CHARMED is a multicenter randomized controlled trial. The study challenges the hypothesis that the implementation of core elements of the Chronic Care Model (patient empowerment, delivering evidence based information, clinical information system, reminder system with structured follow up and frequent monitoring via a specially trained Chronic Care Coach in Swiss centres for neovascular age-related macular degeneration results in better visual acuity (primary outcome and an increased disease specific quality of life (secondary outcome in patients with neovascular age-related macular degeneration. According to the power calculation, a total sample size of 352 patients is needed (drop out rate of 25%. 14 specialised medical doctors from leading ophtalmologic centres in Switzerland will include 25 patients. In each centre, a Chronic Care Coach will provide disease specific care according to the Chronic Care Model for intervention group. Patients from the control group will be treated as usual. Baseline measurements will be taken in month III - XII, starting in March 2011. Follow-up data will be collected after 6 months and 1 year. Discussion Multiple studies have shown that implementing Chronic Care Model elements improve clinical outcomes as well as process parameters in different chronic diseases as osteoarthritis, depression or e.g. the cardiovascular risk profile of diabetes patients. This

  7. The Relevance of Value Net Integrator and Shared Infrastructure Business Models in Managing Chronic Conditions

    Directory of Open Access Journals (Sweden)

    Susan Lambert

    2005-11-01

    Full Text Available There is widespread support for chronic condition management (CCM programs that require a multi-disciplinary, care-team approach. Implementation of such programs represents a paradigm shift in primary care service delivery and has significant resource implications for the general practice. Integral to the widespread uptake of care-team based CCM is information collection, storage and dissemination amongst the care-team members. This paper looks to ebusiness models for assistance in understanding the requirements of general practitioners (GPs in providing multi-disciplinary team care to patients with chronic conditions. The role required of GPs in chronic condition management is compared to that of a value net integrator. The essential characteristics of value net integrators are identified and compared to those of GPs providing multi-disciplinary team care to patients with chronic conditions. It is further suggested that a shared infrastructure is required.

  8. [Care and chronic illness: family caregiver's viewpoint in northeast Brazil].

    Science.gov (United States)

    Pinto, Juliana Maria de Sousa; Nations, Marilyn Kay

    2012-02-01

    The provision of care causes stress in everyday family dynamics leading to physical, mental and emotional complications in caregivers and spouses' loss of liberty and/or overwork. Between March and November 2006, this anthropological research examined family caregiving in the context of Chronic Obstructive Pulmonary Disease (COPD). By means of ethnographic interviews, illness narratives and participant observation, the scope was to describe family reorganization and coexistence with the disease and its evolution, caregiver perceptions about patient difficulties and limitations experienced and strategies employed to tackle their illness. Six low-income family caregivers, living in poor, urban areas in the outskirts of the capital city, Fortaleza, Ceará, Brazil, participated in the study. From the Content Analysis, two categories arose: "sharing suffering" and "attitudes and behavior perceived and experienced by caregivers." In-depth narratives revealed marked affection between patients and their family caregivers. Despite poverty, structural violence, unemployment, social prejudice and low salaries endemic in the Northeast of Brazil, the caregivers find effective ways to cope with chronic illness besides creating strategies to diminish suffering caused by the illness. PMID:22267046

  9. Effectiveness of Stepped Care for Chronic Fatigue Syndrome: A Randomized Noninferiority Trial

    Science.gov (United States)

    Tummers, Marcia; Knoop, Hans; Bleijenberg, Gijs

    2010-01-01

    Objective: In this randomized noninferiority study, the effectiveness and efficiency of stepped care for chronic fatigue syndrome (CFS) was compared to care as usual. Stepped care was formed by guided self-instruction, followed by cognitive behavior therapy (CBT) if the patient desired it. Care as usual encompassed CBT after a waiting period.…

  10. Continuity of Care Model Implementation Effect in Elderly Patients with Chronic Diseases Nursing Analysis%延续性护理服务模式在老年慢性病患者护理中的实施效果分析

    Institute of Scientific and Technical Information of China (English)

    隋颖

    2015-01-01

    Objective To analyze the continuity of care model implementation effect in elderly patients with chronic diseases nursing.Methods 260 elderly patients with chronic divided into two groups and the control group 130 cases, were taken to the continuity of care and routine care. Results The quality of life in the observation group was significantly higher activities of daily living,P < 0.05.Conclusion The continuity of care model has a higher value in elderly patients with chronic care.%目的:分析延续性护理服务模式在老年慢性病患者护理中的实施效果。方法将260例慢性病老年患者分为观察组和对照组各130例,分别采取延续性护理和常规护理。结果观察组生活质量、日常生活能力高于对照组,P <0.05。结论延续性护理服务模式在老年慢性病患者护理中具有较高应用价值。

  11. Ambivalent connections. Improving community mental health care for non-psychotic chronic patients perceived as 'difficult'

    OpenAIRE

    Koekkoek, Bauke

    2011-01-01

    Depression is a widespread psychiatric disorder, which becomes chronic in 25-30% of cases. When psychiatric and psychological treatments are ineffective, chronic depressive patients are often assigned to long-term care which is mostly provided by mental health nurses. Due to factors strongly associated with chronicity (like dependency, demoralization and hopelessness) long-term care is a difficult undertaking both for patients and mental health nurses. Areas in which major problems occur are ...

  12. Patient Assessment of Chronic Illness Care (PACIC) in Type 2 Diabetes: A Longitudinal Study.

    Science.gov (United States)

    Aung, Eindra; Ostini, Remo; Dower, Jo; Donald, Maria; Coll, Joseph R; Williams, Gail M; Doi, Suhail A R

    2016-06-01

    The Patient Assessment of Chronic Illness Care (PACIC) was designed to measure care congruent with several elements of the chronic care model (CCM), including self-management support and delivery system design. However, support for the a priori 5-subscale structure of the PACIC in previous research has been conflicting. Thus, we aim to investigate psychometric characteristics of the PACIC including the content and stability of its construct over time. A population-based prospective cohort study of patients with type 2 diabetes was conducted in Queensland, Australia, from 2008 (N = 3,761) to 2010 (N = 3,040). Participants completed annually the 20-item PACIC as well as measures of providers' adherence to guideline-recommended self-management support activities. We used exploratory factor analysis to determine its factor structure and examined internal consistency as well as agreement between the PACIC at baseline with repeated measurements at follow-up after 1 and 2 years. We also determined a criterion-related validity using multinomial logistic regression to explore PACIC's association with providers' self-management support. A one-factor structure was deemed optimal according to our findings. High internal consistency and moderate agreement within the scales over time were observed. Higher PACIC scores predicted better providers' self-management support. In conclusion, the PACIC is a reliable, valid, and reproducible instrument for assessment of diabetes care, and we recommend its promotion and use as a single scale rather than subscales as originally proposed. PMID:25380699

  13. Developing Integrated Care: Towards a development model for integrated care

    NARCIS (Netherlands)

    M.M.N. Minkman (Mirella)

    2012-01-01

    textabstractThe thesis adresses the phenomenon of integrated care. The implementation of integrated care for patients with a stroke or dementia is studied. Because a generic quality management model for integrated care is lacking, the study works towards building a development model for integrated c

  14. Intercultural caring-an abductive model.

    Science.gov (United States)

    Wikberg, Anita; Eriksson, Katie

    2008-09-01

    The aim of this study was to increase the understanding of caring from a transcultural perspective and to develop the first outline of a theory. The theoretical perspective includes Eriksson's theory of caritative caring. Texts on caring by the transcultural theorists, including Campinha-Bacote, Kim-Godwin, Leininger and Ray, are analysed using content analysis. The overall theme that resulted from this analysis was that caring is a complex whole. Three main categories of caring emerged: inner caring, outer caring and the goal of caring. Inner caring consists of caring is a relationship, and caring and culture are seen in different dimensions. Outer caring refers to caring affected by educational, administrative and social and other structures. The goal of caring consists of caring leading to change towards health and well-being. The main categories include categories and subcategories that are compared with Eriksson's theory of caritative caring. A model for intercultural caring is generated abductively. Caring and culture appear in three dimensions: caring as ontology independent of context; caring as a phenomenon emphasised differently in different cultures; caring as nursing care activities is unique. Caring alleviates suffering and leads to health and well-being. This model describes caring from an intercultural perspective as a mutual but asymmetric relationship between the nurse and the patient, including the patient's family and community. The patient's cultural background and acculturation influence caring. The cultural background, cultural competence and organisation of the nurse also influence caring. Caring is seen as a complex whole. This study integrates Campinha-Bacote's, Kim-Godwin's, Leininger's and Ray's views of caring with Eriksson's caritative caring and presents caring from a transcultural perspective in a new way as a model for intercultural caring, which can benefit nursing care, education, research and administration. PMID:18840233

  15. Development of a primary care-based complex care management intervention for chronically ill patients at high risk for hospitalization: a study protocol

    Directory of Open Access Journals (Sweden)

    Beyer Martin

    2010-09-01

    Full Text Available Abstract Background Complex care management is seen as an approach to face the challenges of an ageing society with increasing numbers of patients with complex care needs. The Medical Research Council in the United Kingdom has proposed a framework for the development and evaluation of complex interventions that will be used to develop and evaluate a primary care-based complex care management program for chronically ill patients at high risk for future hospitalization in Germany. Methods and design We present a multi-method procedure to develop a complex care management program to implement interventions aimed at reducing potentially avoidable hospitalizations for primary care patients with type 2 diabetes mellitus, chronic obstructive pulmonary disease, or chronic heart failure and a high likelihood of hospitalization. The procedure will start with reflection about underlying precipitating factors of hospitalizations and how they may be targeted by the planned intervention (pre-clinical phase. An intervention model will then be developed (phase I based on theory, literature, and exploratory studies (phase II. Exploratory studies are planned that entail the recruitment of 200 patients from 10 general practices. Eligible patients will be identified using two ways of 'case finding': software based predictive modelling and physicians' proposal of patients based on clinical experience. The resulting subpopulations will be compared regarding healthcare utilization, care needs and resources using insurance claims data, a patient survey, and chart review. Qualitative studies with healthcare professionals and patients will be undertaken to identify potential barriers and enablers for optimal performance of the complex care management program. Discussion This multi-method procedure will support the development of a primary care-based care management program enabling the implementation of interventions that will potentially reduce avoidable

  16. Primary care physicians' attitudes and beliefs towards chronic low back pain: an Asian study.

    Directory of Open Access Journals (Sweden)

    Regina W S Sit

    Full Text Available Chronic low back pain is a serious global health problem. There is substantial evidence that physicians' attitudes towards and beliefs about chronic low back pain can influence their subsequent management of the condition.(1 to evaluate the attitudes and beliefs towards chronic low back pain among primary care physicians in Asia; (2 to study the cultural differences and other factors that are associated with these attitudes and beliefs.A cross sectional online survey was sent to primary care physicians who are members of the Hong Kong College of Family Physician (HKCFP. The Pain Attitudes and Beliefs Scale for Physiotherapist (PABS-PT was used as the questionnaire to determine the biomedical and biopsychosocial orientation of the participants.The mean Biomedical (BM score was 34.8+/-6.1; the mean biopsychosocial (BPS score was 35.6 (+/- 4.8. Both scores were higher than those of European doctors. Family medicine specialists had a lower biomedical score than General practitioners. Physicians working in the public sector tended to have low BM and low BPS scores; whereas physicians working in private practice tended to have high BM and high BPS scores.The lack of concordance in the pain explanatory models used by private and public sector may have a detrimental effect on patients who are under the care of both parties. The uncertain treatment orientation may have a negative influence on patients' attitudes and beliefs, thus contributing to the tension and, perhaps, even ailing mental state of a person with chronic LBP.

  17. Patient identified needs for chronic obstructive pulmonary disease versus billed services for care received

    Directory of Open Access Journals (Sweden)

    Jill Heins-Nesvold

    2008-09-01

    Full Text Available Jill Heins-Nesvold1, Angeline Carlson2, Leslie King-Schultz3, Kenneth E Joslyn41American Lung Association of Minnesota, St. Paul, MN, USA; 2Data Intelligence Consultants, LLC, Eden Prairie, MN, USA; 3Mayo Medical School, Rochester, MN, USA; 4Medica Health Plan, Minnetonka, MN, USAAbstract: The American Lung Association of Minnesota (ALAMN was granted access to a 2004 administrative claims data from an upper mid-Western, independent practice association model health plan. Claims information, including demographics, prevalence, medication and oxygen therapy, and health care utilization, was extracted for 7,782 patients with COPD who were 40 years of age and older. In addition, ALAMN conducted a survey of 1,911 patients from Minnesota diagnosed with COPD. The survey queried the patients about demographics, treatment, medications, limitations, wants, and needs. This article compares and contrasts the information gained through the health plan administrative claims database with the findings from the COPD patient survey in areas of age, gender, types of provider primarily responsible for COPD care, spirometry use, medication therapy, pulmonary rehabilitation, oxygen therapy, and health care utilization. Primary care practitioners provided a majority of the COPD-related care. The claims evidence of spirometry use was 16%–62% of COPD patients had claims evidence of COPD-related medications. 25% of patients reported, and 23% of patients had claims evidence of, a hospitalization during the observation year. 16% of patients reported using pulmonary rehabilitation programs. The results indicate there is an opportunity to improve COPD diagnosis and management.Keywords: chronic obstructive pulmonary disease, oxygen therapy, medication therapy, spirometry, chronic care, assessment

  18. Validation of the Danish version of the Patient Assessment of Care for Chronic Conditions questionnaire (PACIC)

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Maindal, Helle Terkildsen; Vedsted, Peter

    Objective: To evaluate the level of chronic care patients must be involved. The Danish version of the 20-item Patient Assessment of Care for Chronic Conditions PACIC questionnaire consisting of 5 scales and an overall summary score measuring patient reported assessment of structured chronic care...... has not been evaluated with regard to psychometric properties. This study aims to assess data quality and internal consistency and to validate the proposed factorial structure. Materials and methods: Setting: Diabetes population receiving chronic care in Denmark. Subjects: A total of 624 patients aged...... same questionnaire is constructed and applied to different countries with diverse cultural backgrounds and health care systems. It is decisive, that translated questionnaires are validated in country they are used....

  19. Distinguishing patients with chronic fatigue from those with chronic fatigue syndrome: a diagnostic study in UK primary care.

    OpenAIRE

    Darbishire, L; Ridsdale, L.; Seed, P. T.

    2003-01-01

    BACKGROUND: Chronic fatigue syndrome (CFS) has been defined, but many more patients consult in primary care with chronic fatigue that does not meet the criteria for CFS. General practitioners (GPs) do not generally use the CFS diagnosis, and have some doubt about the validity of CFS as an illness. AIM: To describe the proportion of patients consulting their GP for fatigue that met the criteria for CFS, and to describe the social, psychological, and physical differences between patients with C...

  20. Animal models for investigating chronic pancreatitis

    Directory of Open Access Journals (Sweden)

    Aghdassi Alexander A

    2011-12-01

    Full Text Available Abstract Chronic pancreatitis is defined as a continuous or recurrent inflammatory disease of the pancreas characterized by progressive and irreversible morphological changes. It typically causes pain and permanent impairment of pancreatic function. In chronic pancreatitis areas of focal necrosis are followed by perilobular and intralobular fibrosis of the parenchyma, by stone formation in the pancreatic duct, calcifications in the parenchyma as well as the formation of pseudocysts. Late in the course of the disease a progressive loss of endocrine and exocrine function occurs. Despite advances in understanding the pathogenesis no causal treatment for chronic pancreatitis is presently available. Thus, there is a need for well characterized animal models for further investigations that allow translation to the human situation. This review summarizes existing experimental models and distinguishes them according to the type of pathological stimulus used for induction of pancreatitis. There is a special focus on pancreatic duct ligation, repetitive overstimulation with caerulein and chronic alcohol feeding. Secondly, attention is drawn to genetic models that have recently been generated and which mimic features of chronic pancreatitis in man. Each technique will be supplemented with data on the pathophysiological background of the model and their limitations will be discussed.

  1. Animal models for investigating chronic pancreatitis.

    Science.gov (United States)

    Aghdassi, Alexander A; Mayerle, Julia; Christochowitz, Sandra; Weiss, Frank U; Sendler, Matthias; Lerch, Markus M

    2011-01-01

    Chronic pancreatitis is defined as a continuous or recurrent inflammatory disease of the pancreas characterized by progressive and irreversible morphological changes. It typically causes pain and permanent impairment of pancreatic function. In chronic pancreatitis areas of focal necrosis are followed by perilobular and intralobular fibrosis of the parenchyma, by stone formation in the pancreatic duct, calcifications in the parenchyma as well as the formation of pseudocysts. Late in the course of the disease a progressive loss of endocrine and exocrine function occurs. Despite advances in understanding the pathogenesis no causal treatment for chronic pancreatitis is presently available. Thus, there is a need for well characterized animal models for further investigations that allow translation to the human situation. This review summarizes existing experimental models and distinguishes them according to the type of pathological stimulus used for induction of pancreatitis. There is a special focus on pancreatic duct ligation, repetitive overstimulation with caerulein and chronic alcohol feeding. Secondly, attention is drawn to genetic models that have recently been generated and which mimic features of chronic pancreatitis in man. Each technique will be supplemented with data on the pathophysiological background of the model and their limitations will be discussed. PMID:22133269

  2. Study protocol of EMPOWER Participatory Action Research (EMPOWER-PAR): a pragmatic cluster randomised controlled trial of multifaceted chronic disease management strategies to improve diabetes and hypertension outcomes in primary care

    OpenAIRE

    Ramli, Anis S; Lakshmanan, Sharmila; Haniff, Jamaiyah; Selvarajah, Sharmini; Tong, Seng F; Bujang, Mohamad-Adam; Abdul-Razak, Suraya; Shafie, Asrul A.; Lee, Verna KM; Abdul-Rahman, Thuhairah H; Daud, Maryam H; Ng, Kien K; Ariffin, Farnaza; Abdul-Hamid, Hasidah; Mazapuspavina, Md-Yasin

    2014-01-01

    Background Chronic disease management presents enormous challenges to the primary care workforce because of the rising epidemic of cardiovascular risk factors. The chronic care model was proven effective in improving chronic disease outcomes in developed countries, but there is little evidence of its effectiveness in developing countries. The aim of this study was to evaluate the effectiveness of the EMPOWER-PAR intervention (multifaceted chronic disease management strategies based on the chr...

  3. CHRONIC DIARRHOEA : AN ETIOLOGICAL AND EPIDEMIOLOGICAL STUDY AT A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Lokesh

    2015-10-01

    Full Text Available BACKGROUND : The etiology of malabsorption syndrome varies according to the geographical location and age of the patients. Scare data is available regarding the etiology of chronic diarrhoea in India. AIMS AND OBJECTIVES: To study etiology and epidemiological profile of chronic diarrhoea at a tert iary care center. MATERIAL AND METHODS: 100 patients of chronic diarrhoea were evaluated. RESULTS: Celiac sprue ( 54% remains the commonest cause of chronic diarrhoea followed by Tropical sprue (32%. Crohn’s disease, Intestinal tuberculosis, AIDS, Amyloid osis and Giardiasis. CONCLUSION: Celiac disease, Tropical sprue and Crohn’s disease are common causes of chronic diarrhoea

  4. Simulation model for cost estimation of integrated care concepts of heart failure patients

    OpenAIRE

    Schroettner, Joerg; Lassnig, Alexander

    2013-01-01

    Background As a direct result of the population growing older the total number of chronic illnesses increases. The future expenditure for care of chronically ill patients is an ever-present challenge for the health care system. New solutions based on integrated care or the inclusion of telemedical systems in the treatment procedure can be essential for reducing the future financial burden. Therefore a detailed economic model was developed, which enables the comparison of health and cost outco...

  5. Proactive Office Encounter: A Systematic Approach to Preventive and Chronic Care at Every Patient Encounter

    OpenAIRE

    Kanter, Michael; Martinez, Osvaldo; Lindsay, Gail; Andrews, Kristen; Denver, Cristine

    2010-01-01

    In 2007, Kaiser Permanente's (KP) Southern California Region designed and implemented a systematic in-reach program, the Proactive Office Encounter (POE), to address the growing needs of its three million patients for preventive care and management of chronic disease. The program sought staff from both primary and specialty care departments to proactively identify gaps in care and to assist physicians in closing those gaps. The POE engaged the entire health team in a proactive patient-care ex...

  6. Best practice eye care models

    Directory of Open Access Journals (Sweden)

    Babar M Qureshi

    2012-01-01

    Full Text Available Since the launching of Global Initiative, VISION 2020 "the Right to Sight" many innovative, practical and unique comprehensive eye care services provision models have evolved targeting the underserved populations in different parts of the World. At places the rapid assessment of the burden of eye diseases in confined areas or utilizing the key informants for identification of eye diseases in the communities are promoted for better planning and evidence based advocacy for getting / allocation of resources for eye care. Similarly for detection and management of diabetes related blindness, retinopathy of prematurity and avoidable blindness at primary level, the major obstacles are confronted in reaching to them in a cost effective manner and then management of the identified patients accordingly. In this regard, the concept of tele-ophthalmology model sounds to be the best solution. Whereas other models on comprehensive eye care services provision have been emphasizing on surgical output through innovative scales of economy that generate income for the program and ensure its sustainability, while guaranteeing treatment of the poorest of the poor.

  7. Adaptive leadership framework for chronic illness: framing a research agenda for transforming care delivery.

    Science.gov (United States)

    Anderson, Ruth A; Bailey, Donald E; Wu, Bei; Corazzini, Kirsten; McConnell, Eleanor S; Thygeson, N Marcus; Docherty, Sharron L

    2015-01-01

    We propose the Adaptive Leadership Framework for Chronic Illness as a novel framework for conceptualizing, studying, and providing care. This framework is an application of the Adaptive Leadership Framework developed by Heifetz and colleagues for business. Our framework views health care as a complex adaptive system and addresses the intersection at which people with chronic illness interface with the care system. We shift focus from symptoms to symptoms and the challenges they pose for patients/families. We describe how providers and patients/families might collaborate to create shared meaning of symptoms and challenges to coproduce appropriate approaches to care. PMID:25647829

  8. [Part I. End-stage chronic organ failures: a position paper on shared care planning. The Integrated Care Pathway].

    Science.gov (United States)

    Gristina, Giuseppe R; Orsi, Luciano; Carlucci, Annalisa; Causarano, Ignazio R; Formica, Marco; Romanò, Massimo

    2014-01-01

    In Italy the birth rate decrease together with the continuous improvement of living conditions on one hand, and the health care progress on the other hand, led in recent years to an increasing number of patients with chronic mono- or multi-organ failures and in an extension of their life expectancy. However, the natural history of chronic failures has not changed and the inescapable disease's worsening at the end makes more rare remissions, increasing hospital admissions rate and length of stay. Thus, when the "end-stage" get close clinicians have to engage the patient and his relatives in an advance care planning aimed to share a decision making process regarding all future treatments and related ethical choices such as patient's best interests, rights, values, and priorities. A right approach to the chronic organ failures end-stage patients consists therefore of a careful balance between the new powers of intervention provided by the biotechnology and pharmacology (intensive care), both with the quality of remaining life supplied by physicians to these patients (proportionality and beneficence) and the effective resources rationing and allocation (distributive justice). However, uncertainty still marks the criteria used by doctors to assess prognosis of these patients in order to make decisions concerning intensive or palliative care. The integrated care pathway suggested in this position paper shared by nine Italian medical societies, has to be intended as a guide focused to identify end-stage patients and choosing for them the best care option between intensive treatments and palliative care. PMID:24553592

  9. Patient-Centered Medical Home Features and Health Care Expenditures of Medicare Beneficiaries with Chronic Disease Dyads.

    Science.gov (United States)

    Philpot, Lindsey M; Stockbridge, Erica L; Padrón, Norma A; Pagán, José A

    2016-06-01

    Three out of 4 Medicare beneficiaries have multiple chronic conditions, and managing the care of this growing population can be complex and costly because of care coordination challenges. This study assesses how different elements of the patient-centered medical home (PCMH) model may impact the health care expenditures of Medicare beneficiaries with the most prevalent chronic disease dyads (ie, co-occurring high cholesterol and high blood pressure, high cholesterol and heart disease, high cholesterol and diabetes, high cholesterol and arthritis, heart disease and high blood pressure). Data from the 2007-2011 Medical Expenditure Panel Survey suggest that increased access to PCMH features may differentially impact the distribution of health care expenditures across health care service categories depending on the combination of chronic conditions experienced by each beneficiary. For example, having no difficulty contacting a provider after regular hours was associated with significantly lower outpatient expenditures for beneficiaries with high cholesterol and diabetes (n = 635; P = 0.038), but it was associated with significantly higher inpatient expenditures for beneficiaries with high blood pressure and high cholesterol (n = 1599; P = 0.015), and no significant differences in expenditures in any category for beneficiaries with high blood pressure and heart disease (n = 1018; P > 0.05 for all categories). However, average total health care expenditures are largely unaffected by implementing the PCMH features considered. Understanding how the needs of Medicare beneficiaries with multiple chronic conditions can be met through the adoption of the PCMH model is important not only to be able to provide high-quality care but also to control costs. (Population Health Management 2016;19:206-211). PMID:26440215

  10. Undiagnosed mood disorders and sleep disturbances in primary care patients with chronic musculoskeletal pain.

    OpenAIRE

    2013-01-01

    Objective. The study aims to determine the prevalence of undiagnosed comorbid mood disorders in patients suffering chronic musculoskeletal pain in a primary care setting and to identify sleep disturbances and other associated factors in these patients, and to compare the use of health services by chronic musculoskeletal pain patients with and without comorbid mood disorders. Design. Cross-sectional study. Subjects. A total of 1,006 patients with chronic musculoskele...

  11. Primary Care Management of Chronic Nonmalignant Pain in Veterans: A Qualitative Study

    Science.gov (United States)

    Ruiz, Jorge G.; Qadri, S. Sobiya; Nader, Samir; Wang, Jia; Lawler, Timothy; Hagenlocker, Brian; Roos, Bernard A.

    2010-01-01

    Clinicians managing older patients with chronic pain play an important role. This paper explores the attitudes of primary care clinicians (PCPs) toward chronic nonmalignant pain management and their experiences using a clinical decision support system. Our investigation followed a qualitative approach based on grounded theory. Twenty-one PCPs…

  12. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization.

    Science.gov (United States)

    Jiao, Jocelyn M; So, Eric; Jebakumar, Jebakaran; George, Mary Catherine; Simpson, David M; Robinson-Papp, Jessica

    2016-04-01

    Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective. PMID:26683238

  13. Complexity, comorbidity, and health care costs associated with chronic widespread pain in primary care.

    Science.gov (United States)

    Morales-Espinoza, Enma Marianela; Kostov, Belchin; Salami, Daniel Cararach; Perez, Zoe Herreras; Rosalen, Anna Pereira; Molina, Jacinto Ortiz; Paz, Luis Gonzalez-de; Momblona, Josep Miquel Sotoca; Àreu, Jaume Benavent; Brito-Zerón, Pilar; Ramos-Casals, Manuel; Sisó-Almirall, Antoni

    2016-04-01

    The objective was to estimate the prevalence of chronic widespread pain (CWP) and compare the quality-of-life (QoL), cardiovascular risk factors, comorbidity, complexity, and health costs with the reference population. A multicenter case-control study was conducted at 3 primary care centers in Barcelona between January and December 2012: 3048 randomized patients were evaluated for CWP according to the American College of Rheumatology definition. Questionnaires on pain, QoL, disability, fatigue, anxiety, depression, and sleep quality were administered. Cardiovascular risk and the Charlson index were calculated. We compared the complexity of cases and controls using Clinical Risk Groups, severity and annual direct and indirect health care costs. CWP criteria were found in 168 patients (92.3% women, prevalence 5.51% [95% confidence interval: 4.75%-6.38%]). Patients with CWP had worse QoL (34.2 vs 44.1, P Costs were &OV0556;3751 per year in patients with CWP vs &OV0556;1397 in controls (P cost associated with CWP is nearly 3 times higher than that of patients without CWP, controlling for other clinical factors. These findings have implications for disease management and budgetary considerations. PMID:26645546

  14. Chronic care treatment of obese children and adolescents

    DEFF Research Database (Denmark)

    Holm, Jens-Christian; Gamborg, Michael; Bille, Dorthe S;

    2011-01-01

    Clinically-relevant protocols for the treatment of childhood obesity are lacking. This study report results for a clinic-based structured treatment program for chronic childhood obesity.......Clinically-relevant protocols for the treatment of childhood obesity are lacking. This study report results for a clinic-based structured treatment program for chronic childhood obesity....

  15. Depression in patients with chronic pain attending a specialised pain treatment centre: prevalence and impact on health care costs.

    Science.gov (United States)

    Rayner, Lauren; Hotopf, Matthew; Petkova, Hristina; Matcham, Faith; Simpson, Anna; McCracken, Lance M

    2016-07-01

    This cross-sectional study aimed to determine the prevalence and impact of depression on health care costs in patients with complex chronic pain. The sample included 1204 patients attending a tertiary pain management service for people with chronic disabling pain, unresponsive to medical treatment. As part of routine care, patients completed a web-based questionnaire assessing mental and physical health, functioning, and service use in the preceding 3 months. Depression was assessed using the 9-item Patient Health Questionnaire. Self-report health care utilisation was measured across 4 domains: general practitioner contacts, contacts with secondary/tertiary care doctors, accident and emergency department visits, and days hospitalised. The participation rate was 89%. Seven hundred and thirty-two patients (60.8%; 95% CI 58.0-63.6) met criteria for probable depression, and 407 (33.8%) met the threshold for severe depression. Patients with depression were more likely to be unable to work because of ill health and reported greater work absence, greater pain-related interference with functioning, lower pain acceptance, and more generalised pain. Mean total health care costs per 3-month period were £731 (95% CI £646-£817) for patients with depression, compared with £448 (95% CI £366-£530) for patients without depression. A positive association between severe depression and total health care costs persisted after controlling for key demographic, functional, and clinical covariates using multiple linear regression models. These findings reveal the extent, severity, and impact of depression in patients with chronic pain and make evident a need for action. Effective treatment of depression may improve patient health and functioning and reduce the burden of chronic pain on health care services. PMID:26963849

  16. Using Cognitive Behavior Therapy and Mindfulness Techniques in the Management of Chronic Pain in Primary Care.

    Science.gov (United States)

    Baker, Norah

    2016-06-01

    Chronic pain and its associated syndrome have become increasingly prevalent in primary care. With the increase in narcotic use and subsequent adverse events, primary care physicians often seek safer alternatives to treating this condition. Prescribing narcotics necessitates using methods to screen for high abuse risk and protect against misuse. With the understanding of how chronic pain is related to mental illnesses such as depression and posttraumatic stress disorder, mindfulness techniques and behavioral therapy can be used to help decrease the dependence on dangerous opioid medications and help patients understand, accept, and cope with their chronic pain. PMID:27262002

  17. Community health centers and primary care access and quality for chronically-ill patients – a case-comparison study of urban Guangdong Province, China

    OpenAIRE

    Shi, Leiyu; Lee, De-Chih; Liang, Hailun; Zhang, Luwen; Makinen, Marty; Blanchet, Nathan; Kidane, Ruth; Lindelow, Magnus; Wang, Hong; Wu, Shaolong

    2015-01-01

    Objective Reform of the health care system in urban areas of China has prompted concerns about the utilization of Community Health Centers (CHC). This study examined which of the dominant primary care delivery models, i.e., the public CHC model, the ‘gate-keeper’ CHC model, or the hospital-owned CHC models, was most effective in enhancing access to and quality of care for patients with chronic illness. Methods The case-comparison design was used to study nine health care organizations in Guan...

  18. Caring for People with Chronic Fatigue Syndrome: Perceived Stress Versus Satisfaction.

    Science.gov (United States)

    Ferrari, Joseph R.; Jason, Leonard A.

    1997-01-01

    Examined adult caregivers (N=96) caring for persons with Chronic Fatigue Syndrome (CFS) on a long-term basis. Results indicate no significant sex difference regarding caregiver stress and satisfaction. The more life satisfaction caregivers reported, the less stress and more satisfaction they experienced in caring for a person with CFS. (RJM)

  19. The Care Needs of Community-Dwelling Seniors Suffering from Advanced Chronic Obstructive Pulmonary Disease

    Science.gov (United States)

    Wilson, Donna M.; Ross, Carolyn; Goodridge, Donna; Davis, Penny; Landreville, Alison; Roebuck, Kim

    2008-01-01

    Aim: This study was undertaken to determine the care needs of Canadian seniors living at home with advanced chronic obstructive pulmonary disease (COPD). Background: COPD is a leading cause of morbidity and mortality worldwide. Although hospitalizations for illness exacerbations and end-stage care may be common, most persons with COPD live out…

  20. Palliative Care Doula: an innovative model.

    Science.gov (United States)

    Lentz, Judy C

    2014-01-01

    Walking the journey of serious illness is very difficult and stressful for patients and families. A universal principle of palliative care is caring for the patient/ family unit. This article introduces a model for the Palliative Care Doula for experienced and advanced practice palliative care nurses to support patients and families during the traumatic and vulnerable period of end-of-life care. PMID:25296488

  1. Bridging knowledge to develop an action plan for integrated care for chronic diseases in Greece.

    Science.gov (United States)

    Tsiachristas, Apostolos; Lionis, Christos; Yfantopoulos, John

    2015-01-01

    The health, social and economic impact of chronic diseases is well documented in Europe. However, chronic diseases threaten relatively more the 'memorandum and peripheral' Eurozone countries (i.e., Greece, Spain, Portugal and Ireland), which were under heavy recession after the economic crisis in 2009. Especially in Greece, where the crisis was the most severe across Europe, the austerity measures affected mainly people with chronic diseases. As a result, the urgency to tackle the threat of chronic diseases in Greece by promoting public health and providing effective chronic care while flattening the rising health care expenditure is eminent. In many European countries, integrated care is seen as a means to achieve this. The aim of this paper was to support Greek health policy makers to develop an action plan from 2015 onwards, to integrate care by bridging local policy context and needs with knowledge and experience from other European countries. To achieve this aim, we adopted a conceptual framework developed by the World Health Organization on one hand to analyse the status of integrated care in Greece, and on the other to develop an action plan for reform. The action plan was based on an analysis of the Greek health care system regarding prerequisite conditions to integrate care, a clear understanding of its context and successful examples of integrated care from other European countries. This study showed that chronic diseases are poorly addressed in Greece and integrated care is in embryonic stage. Greek policy makers have to realise that this is the opportunity to make substantial reforms in chronic care. Failing to reform towards integrated care would lead to the significant risk of collapse of the Greek health care system with all associated negative consequences. The action plan provided in this paper could support policy makers to make the first serious step to face this challenge. The details and specifications of the action plan can only be decided by

  2. Bridging knowledge to develop an action plan for integrated care for chronic diseases in Greece

    Directory of Open Access Journals (Sweden)

    Apostolos Tsiachristas

    2015-10-01

    Full Text Available The health, social and economic impact of chronic diseases is well documented in Europe. However, chronic diseases threaten relatively more the ‘memorandum and peripheral’ Eurozone countries (i.e., Greece, Spain, Portugal and Ireland, which were under heavy recession after the economic crisis in 2009. Especially in Greece, where the crisis was the most severe across Europe, the austerity measures affected mainly people with chronic diseases. As a result, the urgency to tackle the threat of chronic diseases in Greece by promoting public health and providing effective chronic care while flattening the rising health care expenditure is eminent. In many European countries, integrated care is seen as a means to achieve this.The aim of this paper was to support Greek health policy makers to develop an action plan from 2015 onwards, to integrate care by bridging local policy context and needs with knowledge and experience from other European countries. To achieve this aim, we adopted a conceptual framework developed by the World Health Organization on one hand to analyse the status of integrated care in Greece, and on the other to develop an action plan for reform. The action plan was based on an analysis of the Greek health care system regarding prerequisite conditions to integrate care, a clear understanding of its context and successful examples of integrated care from other European countries. This study showed that chronic diseases are poorly addressed in Greece and integrated care is in embryonic stage.Greek policy makers have to realise that this is the opportunity to make substantial reforms in chronic care. Failing to reform towards integrated care would lead to the significant risk of collapse of the Greek health care system with all associated negative consequences. The action plan provided in this paper could support policy makers to make the first serious step to face this challenge. The details and specifications of the action plan

  3. Perceived Health Status and Utilization of Specialty Care: Racial and Ethnic Disparities in Patients with Chronic Diseases

    Science.gov (United States)

    Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.

    2010-01-01

    Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…

  4. Mathematical model of gas plasma applied to chronic wounds

    Energy Technology Data Exchange (ETDEWEB)

    Wang, J. G.; Liu, X. Y.; Liu, D. W.; Lu, X. P. [State Key Lab of Advanced Electromagnetic Engineering and Technology, Huazhong University of Science and Technology, WuHan, HuBei 430074 (China); Zhang, Y. T. [Shandong Provincial Key Lab of UHV Technology and Gas Discharge Physics, School of Electrical Engineering, Shandong University, Jinan, Shandong Province 250061 (China)

    2013-11-15

    Chronic wounds are a major burden for worldwide health care systems, and patients suffer pain and discomfort from this type of wound. Recently gas plasmas have been shown to safely speed chronic wounds healing. In this paper, we develop a deterministic mathematical model formulated by eight-species reaction-diffusion equations, and use it to analyze the plasma treatment process. The model follows spatial and temporal concentration within the wound of oxygen, chemoattractants, capillary sprouts, blood vessels, fibroblasts, extracellular matrix material, nitric oxide (NO), and inflammatory cell. Two effects of plasma, increasing NO concentration and reducing bacteria load, are considered in this model. The plasma treatment decreases the complete healing time from 25 days (normal wound healing) to 17 days, and the contributions of increasing NO concentration and reducing bacteria load are about 1/4 and 3/4, respectively. Increasing plasma treatment frequency from twice to three times per day accelerates healing process. Finally, the response of chronic wounds of different etiologies to treatment with gas plasmas is analyzed.

  5. Chronic bacterial infection models for BRM screening.

    Science.gov (United States)

    Dickneite, G; Schorlemmer, H U; Sedlacek, H H

    1984-05-01

    Models of chronic infections have been established to test the therapeutic and prophylactic potency of biological response modifiers (BRM). As an example for a BRM the immunostimulating drug Bestatin was tested. It is of dipeptide nature and was purified from culture supernatants of Streptomyces olivoreticuli. In two chronic bacterial infection models, induced by the inoculation of NRMI mice with Salmonella typhimurium or with a nephropathogenic strain of Escherichia coli, Bestatin acted prophylactically as well as therapeutically. This could be seen from the reduction of bacterial organ colonization and the inhibition of organ lesion formation. Bestatin could be shown to stimulate macrophage activity and to potentiate delayed type hypersensitivity, but not be effective on the humoral immune response. PMID:6383323

  6. Can Physicians Deliver Chronic Medications at the Point of Care?

    Science.gov (United States)

    Palacio, Ana; Keller, Vaughn F; Chen, Jessica; Tamariz, Leonardo; Carrasquillo, Olveen; Tanio, Craig

    2016-05-01

    Interventions aimed at improving medication adherence are challenging to integrate into clinical practice. Point-of-care medication delivery systems (POCMDSs) are an emerging approach that may be sustainable. A mixed methods approach was used to evaluate the implementation of a POCMDS in a capitated network of clinics serving vulnerable populations. The analytical approach was informed by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) and CFIR (Consolidated Framework for Implementation Research) theoretical frameworks. Data were obtained through key informant interviews, site visits, patient surveys, and claims data. POCMDS has been implemented in 23 practices in 4 states. Key facilitators were leadership and staff commitment, culture of prevention, and a feasible business model. Of the 426 diabetic patients surveyed, 92% stated that POCMDS helps them, 90% stated that refilling medications is more convenient, 90% reported better understanding of the medications, and 80% stated that POCMDS had improved communication with the physician. POCMDS is a feasible patient-centered intervention that reduces adherence barriers. PMID:25681493

  7. Effectiveness of self-instructional module on knowledge of self-care management of chronic obstructive pulmonary disease among patients with chronic obstructive pulmonary disease

    OpenAIRE

    Manoj Kumar Sharma; Atul Kumar; Mahalingam Venkateshan

    2016-01-01

    Background: Chronic obstructive pulmonary disease is a lung disease that makes it hard to breathe and patient education is integral to the care of patients with chronic obstructive pulmonary disease (COPD), also cornerstone of self-management in chronic illness. This study was aimed to improve the knowledge of COPD patients regarding self-care management of COPD. Methods: Quasi experimental (pre-test and post-test with control group) research design was used. Sixty COPD patients were sele...

  8. The Impact of a Proactive Chronic Care Management Program on Hospital Admission Rates in a German Health Insurance Society

    OpenAIRE

    Hamar, Brent; Wells, Aaron; Gandy, William; Haaf, Andreas; Coberley, Carter; Pope, James E.; Rula, Elizabeth Y.

    2010-01-01

    Hospital admissions are the source of significant health care expenses, although a large proportion of these admissions can be avoided through proper management of chronic disease. In the present study, we evaluate the impact of a proactive chronic care management program for members of a German insurance society who suffer from chronic disease. Specifically, we tested the impact of nurse-delivered care calls on hospital admission rates. Study participants were insured individuals with corona...

  9. Biopsychosocial model of chronic recurrent pain

    Directory of Open Access Journals (Sweden)

    Zlatka Rakovec-Felser

    2009-07-01

    Full Text Available Pain is not merely a symptom of disease but a complex independent phenomenon where psychological factors are always present (Sternberg, 1973. Especially by chronic, recurrent pain it's more constructive to think of chronic pain as a syndrome that evolves over time, involving a complex interaction of physiological/organic, psychological, and behavioural processes. Study of chronic recurrent functional pain covers tension form of headache. 50 suffering persons were accidentally chosen among those who had been seeking medical help over more than year ago. We tested their pain intensity and duration, extent of subjective experience of accommodation efforts, temperament characteristics, coping strategies, personal traits, the role of pain in intra- and interpersonal communication. At the end we compared this group with control group (without any manifest physical disorders and with analyse of variance (MANOVA. The typical person who suffers and expects medical help is mostly a woman, married, has elementary or secondary education, is about 40. Pain, seems to appear in the phase of stress-induced psychophysical fatigue, by persons with lower constitutional resistance to different influences, greater irritability and number of physiologic correlates of emotional tensions. Because of their ineffective style of coping, it seems they quickly exhausted their adaptation potential too. Through their higher level of social–field dependence, reactions of other persons (doctor, spouse could be important factors of reinforcement and social learning processes. In managing of chronic pain, especially such as tension headache is, it's very important to involve bio-psychosocial model of pain and integrative model of treatment. Intra- and inter-subjective psychological functions of pain must be recognised as soon as possible.

  10. Protocol and baseline data from The Inala Chronic Disease Management Service evaluation study: a health services intervention study for diabetes care

    Directory of Open Access Journals (Sweden)

    Ware Robert S

    2010-05-01

    Full Text Available Abstract Background Type 2 Diabetes Mellitus is one of the most disabling chronic conditions worldwide, resulting in significant human, social and economic costs and placing huge demands on health care systems. The Inala Chronic Disease Management Service aims to improve the efficiency and effectiveness of care for patients with type 2 diabetes who have been referred by their general practitioner to a specialist diabetes outpatient clinic. Care is provided by a multidisciplinary, integrated team consisting of an endocrinologist, diabetes nurse educators, General Practitioner Clinical Fellows (general practitioners who have undertaken focussed post-graduate training in complex diabetes care, and allied health personnel (a dietitian, podiatrist and psychologist. Methods/Design Using a geographical control, this evaluation study tests the impact of this model of diabetes care provided by the service on patient outcomes compared to usual care provided at the specialist diabetes outpatient clinic. Data collection at baseline, 6 and 12-months will compare the primary outcome (glycaemic control and secondary outcomes (serum lipid profile, blood pressure, physical activity, smoking status, quality of life, diabetes self-efficacy and cost-effectiveness. Discussion This model of diabetes care combines the patient focus and holistic care valued by the primary care sector with the specialised knowledge and skills of hospital diabetes care. Our study will provide empirical evidence about the clinical effectiveness of this model of care. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12608000010392.

  11. Telaprevir: Changing the standard of care of chronic hepatitis C

    Directory of Open Access Journals (Sweden)

    A K Rajani

    2013-01-01

    Full Text Available Chronic hepatitis C is a major public health problem and its burden is expected to increase in the near future. Out of six genotypes of hepatitis C virus (HCV identified, genotype 1 is the most prevalent genotype in America and Europe. With peg-interferon alpha and ribavirin dual therapy, sustained virological response (SVR is achieved in less than half of the patients infected with HCV genotype 1. Moreover, this dual therapy also causes many intolerable adverse effects. Telaprevir is an HCV protease inhibitor approved for chronic hepatitis C genotype 1 mono-infection. It is a type of direct acting antiviral drug acting through inhibition of viral non-structural 3/4A protease. It can be safely administered in mild hepatic dysfunction. Due to inhibition of CYP3A4 and P-glycoprotein, significant drug-drug interactions are possible with telaprevir. Trials have shown significantly higher SVR rates when telaprevir is added to peg-interferon alpha and ribavirin, particularly in patients with unfavorable prognostic factors. It is approved for use in treatment-naïve and previously treated patients. Rash and anemia are the major troublesome side-effects. Next-generation protease inhibitors may overcome the drawbacks of telaprevir and another approved HCV protease inhibitor - boceprevir. Evidence from small scale studies suggests that telaprevir may be used in conditions like HIV co-infection, post-transplantation and some HCV non-1 genotype infections also. Preliminary data show higher SVR rates with triple therapy even in patients with unfavorable interleukin-28B (IL28B genotype. With development of other direct acting antivirals, it might be possible to treat chronic hepatitis C with interferon-free regimens in future. This article briefly reviews the properties of telaprevir and its status in the context of rapidly evolving aspects of management of chronic hepatitis C.

  12. The injustice of it all: caring for the chronically ill.

    Science.gov (United States)

    Zaner, Richard M; Bliton, Mark J

    1991-01-01

    ... While Spiegelberg emphasizes these "cosmic" -- perhaps more accurately, ontological -- features of birth and undeserved inequalities, it seems to us not inappropriate to suggest that what Douard terms "outrage" and Annas "instinct" go in the same direction. When impairment occurs without desert, something should be done to help. This is all the more true when, as in cases of chronic affliction that concern Douard or the case of the Siamese twins that fascinates Annas, something helpful can be done. Then, in Spiegelberg's words, what is "undeserved" demands redress. In these terms, each of these authors points to a deeply rooted sense of our common human lot. Or, in Albert Schweitzer's apt phrase, to witness such undeserved misfortune is to awaken "a moral sense that is usually dormant but that on special occasions can be brought to the surface." Chronic illnesses, we suggest -- no less than the "accidents of birth" that concern Spiegelberg -- are just such "special occasions" for awakening that "moral sense" suggested by Douard in his appeal to the "outrage" of doing nothing for, or refusing to help, the chronically ill. PMID:11642945

  13. An eHealth Platform to Manage Chronic Disease in Primary Care: An Innovative Approach.

    Science.gov (United States)

    Talboom-Kamp, Esther Pwa; Verdijk, Noortje A; Harmans, Lara M; Numans, Mattijs E; Chavannes, Niels H

    2016-01-01

    The number of individuals with chronic illness and multimorbidity is growing due to the rapid ageing of the population and the greater longevity of individuals. This causes an increasing workload in care, which results in a growing need for structural changes of the health care system. In recent years this led to a strong focus on promoting "self-management" in chronically ill patients. Research showed that patients who understand more about their disease, health, and lifestyle have better experiences and health outcomes, and often use less health care resources; the effect is even more when these patients are empowered to and responsible for managing their health and disease. In addition to the skills of patients, health care professionals need to shift to a role of teacher, partner, and professional supervisor of their patients. One way of supervising patients is by the use of electronic health (eHealth), which helps patients manage and control their disease. The application of eHealth solutions can provide chronically ill patients high-quality care, to the satisfaction of both patients and health care professionals, alongside a reduction in health care consumption and costs. PMID:26860333

  14. Temporary services for patients in need of chronic care

    DEFF Research Database (Denmark)

    Hesse, Morten

    2008-01-01

    Background A project is a temporary endeavour undertaken to create a product or service. Projects are frequently used for the testing and development of new approaches in social work. Projects can receive grants from central, often national or international institutions, and allow for more...... experimentation than work placed within existing institutions. Discussion For socially marginalized groups who need continuing support and care, receiving help in a project means that the clients will have to be transferred to other services when the project ends. There is also a risk that clients will experience...... relating to continuity of services when serving vulnerable patients with a need for continuing care....

  15. Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments

    OpenAIRE

    Vrijhoef, Hubertus J.M.; Berbee, Rieneke; Wagner, Edward H.; Steuten, Lotte M.G.

    2009-01-01

    Objective  To identify the most appropriate generic instrument to measure experience and/or satisfaction of people receiving integrated chronic care. Background  Health care is becoming more user-centred and, as a result, the experience of users of care and evaluation of their experience and/or satisfaction is taken more seriously. It is unclear to what extent existing instruments are appropriate in measuring the experience and/or satisfaction of people using integrated chronic care. Methods ...

  16. Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes

    OpenAIRE

    DuGoff, Eva H.; Bandeen-Roche, Karen; Anderson, Gerard F.

    2016-01-01

    Background: Continuity of care is a basic tenant of primary care practice. However, the evidence on the importance of continuity of care for older adults with complex conditions is mixed. Objective: To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes. Design: We analyzed data from a cohort of 1,600 US older adults with diabetes and ≥1 other chronic condition in a private Medicare health plan from July 2010 to December 2011. M...

  17. Identification, summary and comparison of tools used to measure organizational attributes associated with chronic disease management within primary care settings

    OpenAIRE

    Lukewich, Julia; Corbin, Renée; Elizabeth G VanDenKerkhof; Edge, Dana S.; Williamson, Tyler; Tranmer, Joan E.

    2014-01-01

    Rationale, aims and objectives Given the increasing emphasis being placed on managing patients with chronic diseases within primary care, there is a need to better understand which primary care organizational attributes affect the quality of care that patients with chronic diseases receive. This study aimed to identify, summarize and compare data collection tools that describe and measure organizational attributes used within the primary care setting worldwide. Methods Systematic search and r...

  18. Improving Confidence for Self Care in Patients with Depression and Chronic Illnesses

    OpenAIRE

    Ludman, Evette J; Peterson, Do; Katon, Wayne J; Lin, Elizabeth H. B.; Von Korff, Michael; Ciechanowski, Paul; Young, Bessie; Gensichen, Jochen

    2013-01-01

    The aim of this study was to examine whether patients who received a multi-condition collaborative care intervention for chronic illnesses and depression had greater improvement in self-care knowledge and efficacy, and whether greater knowledge and self-efficacy is positively associated with improved target outcomes. A randomized controlled trial with 214 patients with comorbid depression and poorly controlled diabetes and/or coronary heart disease tested a 12-month team-based intervention th...

  19. Improving Interprofessional and Coproductive Outcomes of Care for Patients with Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Moreo, Kathleen; Greene, Laurence; Sapir, Tamar

    2016-01-01

    In the U.S., suboptimal care quality for patients with chronic obstructive pulmonary disease (COPD) is reflected by high rates of emergency department visits and hospital readmissions, as well as excessive costs. Moreover, a substantial proportion of COPD patients do not receive guideline-directed therapies. In quality improvement (QI) programs, these types of health care problems are commonly addressed through interventions that primarily or exclusively support physicians in aligning their p...

  20. METHODS TO ANALYSE THE FINANCIAL BURDEN OF THE FAMILIAR CARE OF A PERSON WITH CHRONIC DISEASE

    OpenAIRE

    Mayorga-Álvarez Jorge Humberto; Montoya-Restrepo Luz Alexandra; Montoya-Restrepo Iván; Sánchez-Herrera Beatriz; Sandoval-Salcedo Natalia María

    2015-01-01

    Introduction: in Colombia, the study of the chronic disease (CD) has been declared as priority of investigation Objective: to determine a methodology for the analysis of the financial burden attributable to the familiar care of a person with CD. Methods: methodological study that proposes a way of analyses of the financial burden of the familiar care of a person with CD. It was developed in four phases: [A] Review of the literature. [B] Development of the survey “Financial c...

  1. Chronic low back pain patient groups in primary care - A cross sectional cluster analysis

    OpenAIRE

    Viniol, Annika; Jegan, Nikita; Hirsch, Oliver; Leonhardt, Corinna; Brugger, Markus; Strauch, Konstantin; Barth, Juergen; Baum, Erika; Becker, Annette

    2013-01-01

    Background Due to the heterogeneous nature of chronic low back pain (CLBP), it is necessary to identify patient groups and evaluate treatments within these groups. We aimed to identify groups of patients with CLBP in the primary care setting. Methods We performed a k-means cluster analysis on a large data set (n = 634) of primary care patients with CLBP. Variables of sociodemographic data, pain characteristics, psychological status (i.e., depression, anxiety, somatization), and the patient re...

  2. The efficiency of chronic disease care in sub-Saharan Africa.

    Science.gov (United States)

    Geldsetzer, Pascal; Ortblad, Katrina; Bärnighausen, Till

    2016-01-01

    The number of people needing chronic disease care is projected to increase in sub-Saharan Africa as a result of expanding human immunodeficiency virus (HIV) treatment coverage, rising life expectancies, and lifestyle changes. Using nationally representative data of healthcare facilities, Di Giorgio et al. found that many HIV clinics in Kenya, Uganda, and Zambia appear to have considerable untapped capacity to provide care for additional patients. These findings highlight the potential for increasing the efficiency of clinical processes for chronic disease care at the facility level. Important questions for future research are how estimates of comparative technical efficiency across facilities change, when they are adjusted for quality of care and the composition of patients by care complexity. Looking ahead, substantial research investment will be needed to ensure that we do not forgo the opportunity to learn how efficiency changes, as chronic care is becoming increasingly differentiated by patient type and integrated across diseases and health systems functions.Please see related article: http://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0653-z. PMID:27566531

  3. A new model of care collaboration for community-dwelling elders: findings and lessons learned from the NORC-health care linkage evaluation

    OpenAIRE

    Kyriacou, Corinne

    2009-01-01

    Purpose Providing care for older individuals with chronic illnesses in the community requires a model of service delivery that takes into account both physical health and social health needs. However, packaging care in this way does not fit into existing service or reimbursement structures in the US, and there are few financial incentives that encourage service coordination. Lack of coordinated care can negatively affect access to high quality, appropriate care, putting seniors' physical and ...

  4. Home Automated Telemanagement (HAT System to Facilitate Self-Care of Patients with Chronic Diseases

    Directory of Open Access Journals (Sweden)

    Joseph Finkelstein

    2003-06-01

    Full Text Available Successful patient self-management requires a multidisciplinary approach that includes regular patient assessment, disease-specific education, control of medication adherence, implementation of health behavior change models and social support. Existing systems for computer-assisted disease management do not provide this multidisciplinary patient support and do not address treatment compliance issues. We developed the Home Automated Telemanagement (HAT system for patients with different chronic health conditions to facilitate their self-care. The HAT system consists of a home unit, HAT server, and clinician units. Patients at home use a palmtop or a laptop connected with a disease monitor on a regular basis. Each HAT session consists of self-testing, feedback, and educational components. The self-reported symptom data and objective results obtained from disease-specific sensors are automatically sent from patient homes to the HAT server in the hospital. Any web-enabled device can serve as a clinician unit to review patient results. The HAT system monitors self-testing results and patient compliance. The HAT system has been implemented and tested in patients receiving anticoagulation therapy, patients with asthma, COPD and other health conditions. Evaluation results indicated high level of acceptance of the HAT system by the patients and that the system has a positive impact on main clinical outcomes and patient satisfaction with medical care.

  5. Barriers and facilitators to palliative care of patients with chronic heart failure in Germany: a study protocol

    Directory of Open Access Journals (Sweden)

    Stefan Köberich

    2015-07-01

    Full Text Available Background. Despite its high prevalence, similar symptoms and symptom burden, people suffering from chronic heart failure receive less palliative care than patients with malignant diseases. Internationally, numerous barriers to palliative care of patients with chronic heart failure are known, however, there are no credible data regarding barriers and facilitators to palliative care of people suffering from chronic heart failure available for Germany. Design and Methods. Tripartite study. First part of this study evaluates health care providers’ (physicians and nurses perceived barriers and facilitators to palliative care of patients with chronic heart failure using a qualitative approach. At least 18 persons will be interviewed. In the second part, based on the results of part one, a questionnaire about barriers and facilitators to palliative care of patients with chronic heart failure will be designed and applied to at least 150 physicians and nurses. In the last part a classic Delphi method will be used to develop specific measures to improve the palliative care for chronic heart failure patients. Expected Impact for Public Health. The results of this study will help to understand why patients with heart failure are seldom referred to palliative care and will provide solutions to overcome these barriers. Developed solutions will be the first step to improve palliative care in patients with heart failure in Germany. In addition, the results will help health care providers in other countries to take action to improve palliative care situations for heart failure patients.

  6. Readiness to tackle chronicity in Spanish health care organisations: a two-year experience with the Instrumento de Evaluación de Modelos de Atención ante la Cronicidad/Assessment of Readiness for Chronicity in Health Care Organisations instrument

    Science.gov (United States)

    Mira, José Joaquín; Fernández-Cano, Paloma; Contel, Joan Carlos; Guilabert-Mora, Mercedes; Solas-Gaspar, Olga

    2015-01-01

    Introduction: The Instrumento de Evaluación de Modelos de Atención ante la Cronicidad/Assessment of Readiness for Chronicity in Health Care Organisations instrument was developed to implement the conceptual framework of the Chronic Care Model in the Spanish national health system. It has been used to assess readiness to tackle chronicity in health care organisations. In this study, we use self-assessments at macro-, meso- and micro-management levels to (a) describe the two-year experience with the Instrumento de Evaluación de Modelos de Atención ante la Cronicidad/Assessment of Readiness for Chronicity in Health Care Organisations tool in Spain and (b) assess the validity and reliability of this instrument. Methods: The results from 55 organisational self-assessments were included and described. In addition to that, the internal consistency, reliability and construct validity of Instrumento de Evaluación de Modelos de Atención ante la Cronicidad/Assessment of Readiness for Chronicity in Health Care Organisations were examined using Cronbach's alpha, the Spearman–Brown coefficient and factorial analysis. Results: The obtained scores reflect opportunities for improvement in all dimensions of the instrument. Cronbach's alpha ranged between 0.90 and 0.95 and the Spearman–Brown coefficient ranged between 0.77 and 0.94. All 27 components converged in a second-order factorial solution that explained 53.8% of the total variance, with factorial saturations for the components of between 0.57 and 0.94. Conclusions: Instrumento de Evaluación de Modelos de Atención ante la Cronicidad/Assessment of Readiness for Chronicity in Health Care Organisations is an instrument that allows health care organisations to perform self-assessments regarding their readiness to tackle chronicity and to identify areas for improvement in chronic care.

  7. Clinical drug development using dynamic biomarkers to enable personalized health care in Chronic Obstructive Pulmonary Disease

    DEFF Research Database (Denmark)

    Bihlet, Asger R; Karsdal, Morten A; Bay-Jensen, Anne-Christine;

    2015-01-01

    Despite massive investments in development of novel treatments for heterogeneous diseases such as Chronic Obstructive Pulmonary Disease (COPD), the resources spent have only benefitted a fraction of the population treated. Personalized Health Care to guide selection of a suitable patient population...

  8. Home Care for Children with Chronic Illnesses and Severe Disabilities: A Bibliography and Resource Guide.

    Science.gov (United States)

    Wells, Alice; And Others

    The bibliography and resource guide summarizes relevant research and information on home care for children with disabilities and chronic illnesses, including those with such diagnoses as spina bifida, cerebral palsy, severe mental retardation, acquired immune deficiency syndrome (AIDS), hemophilia, sickle cell anemia, autism, or failure-to-thrive…

  9. Pharmacotherapeutic management of chronic noncancer pain in primary care: lessons for pharmacists

    Directory of Open Access Journals (Sweden)

    Jouini G

    2014-03-01

    on pharmacotherapy was based on an administrative provincial database and pharmacies' charts. Determinants of patients' satisfaction were identified using multivariate linear regression models.Results: Four hundred and eighty six patients participated. Their mean age was 58.4 years and they had had pain for a mean of 11.7 years (standard deviation, ±11.1 at an average pain intensity of 6.5 in the past week. Although 90% reported adverse gastrointestinal effects, 36.4% and 54.4% of these patients took no over-the-counter or prescribed medication for constipation or nausea, respectively. On a scale from 0–100, the mean overall satisfaction score was 64.7 (95% confidence interval [CI] =63.5–65.9. Patient satisfaction was low, particularly regarding the “information about pain and its treatment” (mean 50.6; 95% CI =47.6–53.7 and “treatment efficacy” (mean 53.6; 95% CI =51.5–55.6 subscales. The overall treatment satisfaction score decreased with more pain disability, probable depression and anxiety, more barriers to pain treatment, higher incidence of nausea, and use of over-the-counter analgesics.Conclusion: In primary care, patients’ level of satisfaction with their pain treatment is not optimal. This study underlines how the expanded scope of practice of community pharmacists may allow them to play a pivotal role in providing information, discussing barriers to pain treatment, and monitoring pain disability, and by appropriately managing pharmacotherapy to optimize effectiveness while minimizing adverse effects.Keywords: noncancer chronic pain, primary care, pharmacotherapy, analgesic, adverse effects, cohort study

  10. Chronic care management of globesity: promoting healthier lifestyles in traditional and mHealth based settings

    Directory of Open Access Journals (Sweden)

    Gianluca eCastelnuovo

    2015-10-01

    Full Text Available Obesity and being overweight could be real chronic conditions above all if there are other complications such as type 2 diabetes, cardiovascular diseases, hypertension, dyslipidemia, hypercholesterolemia, cancer and various psychosocial and psychopathological disorders,. Due to the multifactorial etiology of obesity, evidence-based interventions to improve weight loss, maintain a healthy weight, and reduce related comorbidities combine different treatment approaches: dietetic, nutritional, physical, behavioral, psychological, and, in some situations, pharmacological and surgical. There are significant limitations in this multidisciplinary chronic care management of obesity, most notably those regarding costs and long-term adherence and efficacy. Programs including eHealth platforms and new technologies could overcome limitations connected to the traditional in-patient chronic care management of obesity, thus providing promising opportunities in enhancing weight reduction and reducing complications in terms of long-term efficacy and effectiveness across clinical, organizational, and economic perspectives.

  11. Care plans and care planning in long term conditions: a conceptual model

    OpenAIRE

    Burt, J.; J. Rick; Blakeman, T; Protheroe, J; Roland, M; Bower, P.

    2013-01-01

    The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planni...

  12. [Using eHealth in the Continuity Care of Chronic Kidney Disease: Opportunities and Considerations].

    Science.gov (United States)

    Chen, Yu-Chi; Chang, Polun

    2016-04-01

    Kidney disease is a common complication of chronic diseases among adult and elderly populations. As early-stage chronic kidney disease (CKD) is asymptomatic, CKD patients are frequently unaware of their condition and fail to implement requisite self-care in a timely fashion. Furthermore, the shortage of case-management manpower and difficulties in follow-up have led to high incidence rates for CKD worldwide. Integrative and continuous care is key to preventing CKD. How to implement this care effectively is a challenge. However, innovative technologies, online information, and cloud technology are increasingly providing access to good-quality healthcare beyond the traditional limitations of time and location. This environment is not only increasing the participation of patients in their care and collaboration among healthcare team members but is also improving the continuity, accessibility, and promptness of care service in order to promote the effectiveness of disease management. While the primary aim of innovative technologies is to make healthcare more cost-effective, it is also causing disparities in healthcare. Within the high-tech e-healthcare system, the ability of patients to utilize these new services relates directly to their health behaviors and quality of care. Thus, emergent e-healthcare system services should be made as patient-centered as possible in order to maximize the benefits in terms of both cost and patient care. Furthermore, improving the eHealth literacy of patients is crucial to promoting innovative technology within healthcare services. PMID:27026552

  13. Continuity in care trajectories of older chronically ill patients in a battlefield of competing rationales

    DEFF Research Database (Denmark)

    Kjerholt, Mette; Wagner, L.; Delmar, C.;

    2014-01-01

    perspective in older, chronically ill patients' care as reflected in nursing staff's communication about the patients. DESIGN: Explorative Participatory Action Research (PAR). SETTING: An acute, general medical ward at a Danish university hospital. PARTICIPANTS: Hospital and municipality nurses (n = 29......BACKGROUND: Continuity is crucial when caring for older chronically ill patients. Research has shown that the integration of patients' own perspectives on their situation is of utmost importance for continuity and quality of care. Studies have, however, demonstrated a number of problems with health......). Nursing records (n = 12). METHOD: Field studies: observations, interviews, nursing records audits and logs. Data were subject to manifest and latent content analysis. RESULTS: Participants were aware of the importance of ensuring continuity, a comprehensive approach and integration of the patient...

  14. METHODS TO ANALYSE THE FINANCIAL BURDEN OF THE FAMILIAR CARE OF A PERSON WITH CHRONIC DISEASE

    Directory of Open Access Journals (Sweden)

    Mayorga-Álvarez Jorge Humberto

    2015-01-01

    Full Text Available Introduction: in Colombia, the study of the chronic disease (CD has been declared as priority of investigation Objective: to determine a methodology for the analysis of the financial burden attributable to the familiar care of a person with CD. Methods: methodological study that proposes a way of analyses of the financial burden of the familiar care of a person with CD. It was developed in four phases: [A] Review of the literature. [B] Development of the survey “Financial costs of the care of the chronic non-communicable disease”. [C] Structuring of a proposal of methodological approach for the analysis of the data. [D] Development of final details of the definitive version of the designed methodology by means of its application to the results of the survey of 30 Colombian families Results: according to the literature review and keeping in mind the obtained data by means of the application of the survey “Financial costs of the care of the chronic non-communicable disease”, a methodological proposal of the analysis of the familiar financial burden attributable to the care of a person with CD in Colombia was done and it was named: CARACOL. On having applied the methodology in a pilot study with the information of thirty families, it was found that the costs generates them a major financial burden in terms of health and transportation Conclusion: the CARACOL methodology is an original contribution that could allow analyzing the financial burden attributable to the familiar care of a person with CD from the variation generates in the effective real consumption. Rev.cienc.biomed. 2015;6(1:96-106 KEYWORDS Cost of Illness; health economics; chronic disease; methodology.

  15. End of life care in chronic obstructive pulmonary disease: in search of a good death

    Directory of Open Access Journals (Sweden)

    Anna Spathis

    2008-03-01

    Full Text Available Anna Spathis, Sara BoothPalliative Care Service, Cambridge University Hospitals NHS Foundation Trust, Cambridge, England, UKAbstract: Chronic obstructive pulmonary disease (COPD is an incurable, progressive illness that is the fourth commonest cause of death worldwide. Death tends to occur after a prolonged functional decline associated with uncontrolled symptoms, emotional distress and social isolation. There is increasing evidence that the end of life needs of those with advanced COPD are not being met by existing services. Many barriers hinder the provision of good end of life care in COPD, including the inherent difficulties in determining prognosis. This review provides an evidence-based approach to overcoming these barriers, summarising current evidence and highlighting areas for future research. Topics include end of life needs, symptom control, advance care planning, and service development to improve the quality of end of life care.Keywords: chronic obstructive pulmonary disease (MeSH, palliative care (MeSH, dyspnoea (MeSH, advance care planning (MeSH

  16. Chronic Kidney Disease – Where Next? Predicting Outcomes and Planning Care Pathways

    Directory of Open Access Journals (Sweden)

    Angharad Marks

    2014-07-01

    Full Text Available With the introduction of the National Kidney Foundation Kidney Disease Outcomes Quality Initiative chronic kidney disease (CKD guidelines, CKD has been identified as common, particularly in the elderly. The outcomes for those with CKD can be poor: mortality, initiation of renal replacement therapy, and progressive deterioration in kidney function, with its associated complications. In young people with CKD, the risk of poor outcome is high and the social cost substantial, but the actual number of patients affected is relatively small. In the elderly, the risk of poor outcome is substantially lower, but due to the high prevalence of CKD the actual number of poor outcomes attributable to CKD is higher. Predicting which patients are at greatest risk, and being able to tailor care appropriately, has significant potential benefits. Risk prediction models in CKD are being developed and show promise but thus far have limitations. In this review we describe the pathway for developing and evaluating risk prediction tools, and consider what models we have for CKD prediction and where next.

  17. Study of the effect of humanistic nursing care model wards in Children Caring Ward School on the nurses' caring ability

    Institute of Scientific and Technical Information of China (English)

    Jiao He; De-Ying Hu; Yi-Lan Liu; Li-Fen Wu; Lian Liu

    2016-01-01

    Objective: To understand the effect of humanistic nursing care model wards in Children Caring Ward School (CCWS) on the nurses' caring ability. Methods: Questionnaire 25 nurses of humanistic nursing care model wards in CCWS using the Nkongho Caring Ability Inventory (CAI) before and after implement the humanistic nursing care model, including reform the systems of nursing care, introduce humanistic care model, implement the humanistic care, to measure the nurses' caring ability. Results: The nurses' caring ability had significantly developed on total, cognition dimension, courage dimension and patience dimension after all measures considered (p Conclusions: The humanistic nursing care model wards in CCWS has a positive effect on the nurses' caring ability, not only to help build great relationships between nurses and patients but also to enhance the patients' satisfaction.

  18. Costs and health care resource utilization among chronic obstructive pulmonary disease patients with newly acquired pneumonia

    Directory of Open Access Journals (Sweden)

    Lin J

    2014-07-01

    Full Text Available Junji Lin,1 Yunfeng Li,2 Haijun Tian,2 Michael J Goodman,1 Susan Gabriel,2 Tara Nazareth,2 Stuart J Turner,2,3 Stephen Arcona,2 Kristijan H Kahler21Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA; 2Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 3Ernest Mario School of Pharmacy, Rutgers University, New Brunswick, NJ, USA Background: Patients with chronic obstructive pulmonary disease (COPD are at increased risk for lung infections and other pathologies (eg, pneumonia; however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia. Methods: A retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index, and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits, and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching. Results: In the baseline cohort (N=467,578, patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years and had higher Charlson Comorbidity Index scores (3.3 vs 2.6 than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely

  19. Managing painful chronic wounds: the Wound Pain Management Model

    DEFF Research Database (Denmark)

    Price, Patricia; Fogh, Karsten; Glynn, Chris;

    2007-01-01

    the wound should be handled as one of the main priorities in chronic wound management together with addressing the cause. Management of pain in chronic wounds depends on proper assessment, reporting and documenting patient experiences of pain. Assessment should be based on six critical dimensions of...... document persistent wound pain and not to develop a treatment and monitoring strategy to improve the lives of persons with chronic wounds. Unless wound pain is optimally managed, patient suffering and costs to health care systems will increase. Udgivelsesdato: 2007-Apr...

  20. Clinical outcomes of HIV care delivery models in the US: a systematic review.

    Science.gov (United States)

    Kimmel, April D; Martin, Erika G; Galadima, Hadiza; Bono, Rose S; Tehrani, Ali Bonakdar; Cyrus, John W; Henderson, Margaret; Freedberg, Kenneth A; Krist, Alexander H

    2016-10-01

    With over 1 million people living with HIV, the US faces national challenges in HIV care delivery due to an inadequate HIV specialist workforce and the increasing role of non-communicable chronic diseases in driving morbidity and mortality in HIV-infected patients. Alternative HIV care delivery models, which include substantial roles for advanced practitioners and/or coordination between specialty and primary care settings in managing HIV-infected patients, may address these needs. We aimed to systematically review the evidence on patient-level HIV-specific and primary care health outcomes for HIV-infected adults receiving outpatient care across HIV care delivery models. We identified randomized trials and observational studies from bibliographic and other databases through March 2016. Eligible studies met pre-specified eligibility criteria including on care delivery models and patient-level health outcomes. We considered all available evidence, including non-experimental studies, and evaluated studies for risk of bias. We identified 3605 studies, of which 13 met eligibility criteria. Of the 13 eligible studies, the majority evaluated specialty-based care (9 studies). Across all studies and care delivery models, eligible studies primarily reported mortality and antiretroviral use, with specialty-based care associated with mortality reductions at the clinician and practice levels and with increased antiretroviral initiation or use at the clinician level but not the practice level. Limited and heterogeneous outcomes were reported for other patient-level HIV-specific outcomes (e.g., viral suppression) as well as for primary care health outcomes across all care delivery models. No studies addressed chronic care outcomes related to aging. Limited evidence was available across geographic settings and key populations. As re-design of care delivery in the US continues to evolve, better understanding of patient-level HIV-related and primary care health outcomes, especially

  1. Primary care physicians’ perceived barriers and facilitators to conservative care for older adults with chronic kidney disease: design of a mixed methods study

    OpenAIRE

    Tam-Tham, Helen; Hemmelgarn, Brenda; Campbell, David; Thomas, Chandra; Quinn, Robert; Fruetel, Karen; King-Shier, Kathryn

    2016-01-01

    Background Guideline committees have identified the need for research to inform the provision of conservative care for older adults with stage 5 chronic kidney disease (CKD) who have a high burden of comorbidity or functional impairment. We will use both qualitative and quantitative methodologies to provide a comprehensive understanding of barriers and facilitators to care for these patients in primary care. Objectives Our objectives are to (1) interview primary care physicians to determine t...

  2. Quality of integrated chronic care measured by patient survey: identification, selection and application of most appropriate instruments

    NARCIS (Netherlands)

    Vrijhoef, Hubertus J.M.; Berbee, Rieneke; Wagner, Edward H.; Steuten, Lotte M.G.

    2009-01-01

    Objective  To identify the most appropriate generic instrument to measure experience and/or satisfaction of people receiving integrated chronic care. Background  Health care is becoming more user-centred and, as a result, the experience of users of care and evaluation of their experience and/or sat

  3. Understanding Business Models in Health Care.

    Science.gov (United States)

    Sharan, Alok D; Schroeder, Gregory D; West, Michael E; Vaccaro, Alexander R

    2016-05-01

    The increasing focus on the costs of care is forcing health care organizations to critically look at their basic set of processes and activities, to determine what type of value they can deliver. A business model describes the resources, processes, and cost assumptions that an organization makes that will lead to the delivery of a unique value proposition to a customer. As health care organizations are beginning to transform their structure in preparation for a value-based delivery system, understanding business model theory can help in the redesign process. PMID:27018909

  4. Striking a balance between in-person care and the use of eHealth to support the older rural population with chronic pain

    Directory of Open Access Journals (Sweden)

    Anne Roberts

    2015-09-01

    Full Text Available New and existing information communication technologies (ICT are playing an increasingly important role in the delivery of health and social care services. eHealth1 has the potential to supplement in-person home visits for older, rural adults with chronic pain. The Technology to support Older Adults' Personal and Social Interaction project—TOPS—examines interactions between older people and their health/social care providers and considers how eHealth could play a part in enhancing the life experiences of older people with chronic pain, who live in remote/rural areas. This paper reports findings from the TOPS study, drawing upon observations of health/social care home visits to chronic pain patients and interviews with patients and health/social care providers in rural Scotland. Patients and care professionals believe in-person care promotes the general well-being of older people with pain. However, our findings show that the potential recipients of eHealth are open to the use of such technologies and that although they cannot be expected to replace existing models of care, eHealth may provide opportunities to sustain and enhance these interactions.

  5. Chronic obstructive pulmonary disease involves substantial health-care service and social benefit costs

    DEFF Research Database (Denmark)

    Jensen, Martin Bach; Fenger-Grøn, Morten; Fonager, Kirsten;

    2013-01-01

    cohort study performed in Denmark during 2004-2006 were linked with national register data that identified the costs of social benefits and health-care services. The cohort comprised 546 participants with COPD (forced expiratory volume in the first sec. (FEV1)/forced vital capacity (FVC) ratio < 0.......7 following bronchodilator administration] and 3,995 without COPD (in addition, 9,435 invited participants were non-responders and 331 were excluded). The costs were adjusted for gender, age, co-morbidity and educational level. RESULTS: Health care-related costs were 4,779 (2,404- 7,154) Danish kroner (DKK......) higher for participants with COPD than for those without COPD, and 2,882 (556-5,208) DKK higher than for those for non-responders. The higher costs were mainly due to the cost of medicines and inpatient care. The health-care costs increased with disease severity Global Initiative for Chronic Obstructive...

  6. Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program

    Science.gov (United States)

    Lalonde, Lyne; Choinière, Manon; Martin, Elisabeth; Lévesque, Lise; Hudon, Eveline; Bélanger, Danielle; Perreault, Sylvie; Lacasse, Anaïs; Laliberté, Marie-Claude

    2015-01-01

    Purpose There is evidence that the management of chronic non-cancer pain (CNCP) in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care. Methods Using the Chronic Care Model as a conceptual framework, physicians (n=6), pharmacists (n=6), nurses (n=6), physiotherapists (n=6), psychologists (n=6), pain specialists (n=6), patients (n=3), family members (n=3), decision makers and managers (n=4), and pain researchers (n=7) took part in seven focus groups and five nominal groups. Results Challenges identified in focus group discussions were related to five dimensions: knowledge gap, “work in silos”, lack of awareness that CNCP represents an important clinical problem, difficulties in access to health professionals and services, and patient empowerment needs. Based on the nominal group discussions, the following priority interventions were identified: interdisciplinary continuing education, interdisciplinary treatment approach, regional expert leadership, creation and definition of care paths, and patient education programs. Conclusion Barriers to optimal management of CNCP in primary care are numerous. Improving its management cannot be envisioned without considering multifaceted interventions targeting several dimensions of the Chronic Care Model and focusing on both clinicians and patients. PMID:25995648

  7. What makes primary care effective for people in poverty living with multiple chronic conditions?: study protocol

    Directory of Open Access Journals (Sweden)

    Barbeau David

    2010-11-01

    Full Text Available Abstract Background The inverse care law persists: people living in poverty have the greatest needs and face considerable challenges in getting the care they need. Evidence reveals that GPs encounter difficulties in delivering care to poor patients, while many of those patients feel stigmatized by healthcare professionals. Patients living in poverty report negative healthcare experiences and unmet healthcare needs. Indeed, there is a growing recognition in primary care research of the importance of addressing the capabilities and social conditions of the poor when delivering care. Few studies have looked at the factors contributing to effective and "socially responsive" care for people living in poverty. Methods/Design Our study adopts a qualitative ethnographic approach in four healthcare organizations in deprived areas of metropolitan Montreal (Québec, Canada, using patient shadowing techniques and interviews. Data will be collected through fieldwork observations and informal interviews with patients before and after consultations. We will observe medical consultations, care organization activities, and waiting areas and reception of patients. We will conduct a total of 36 individual interviews with 12 GPs and 24 patients. The interviews will be audio-recorded and transcribed for purposes of analysis. The analysis consists of debriefing sessions, coding and interpretive analysis. Discussion This study aims to investigate how positive healthcare interactions between physicians and patients can improve the management of chronic conditions. We hypothesize that factors related to care organization, to healthcare professionals' experience and to patients may enhance the quality of healthcare interactions, which may have positive impacts for preventing and managing chronic conditions. Our study will provide a unique set of data grounded in the perspectives of healthcare professionals and of patients living in poverty.

  8. Identifying potentially cost effective chronic care programs for people with COPD

    Directory of Open Access Journals (Sweden)

    L M G Steuten

    2008-12-01

    Full Text Available L M G Steuten1, K M M Lemmens2, A P Nieboer2, H JM Vrijhoef31Maastricht University Medical Centre, School for Care and Public Health Research, Department of Health, Organisation, Policy and Economics, Maastricht, The Netherlands; 2Erasmus University Medical Centre, Institute of Health Policy and Management, Rotterdam, The Netherlands; 3Maastricht University Medical Centre, School for Care and Public Health Research, Department of Integrated Care, Maastricht, The NetherlandsObjective: To review published evidence regarding the cost effectiveness of multi-component COPD programs and to illustrate how potentially cost effective programs can be identified.Methods: Systematic search of Medline and Cochrane databases for evaluations of multi-component disease management or chronic care programs for adults with COPD, describing process, intermediate, and end results of care. Data were independently extracted by two reviewers and descriptively summarized.Results: Twenty articles describing 17 unique COPD programs were included. There is little evidence for significant improvements in process and intermediate outcomes, except for increased provision of patient self-management education and improved disease-specific knowledge. Overall, the COPD programs generate end results equivalent to usual care, but programs containing ≥3 components show lower relative risks for hospitalization. There is limited scope for programs to break-even or save money.Conclusion: Identifying cost effective multi-component COPD programs remains a challenge due to scarce methodologically sound studies that demonstrate significant improvements on process, intermediate and end results of care. Estimations of potential cost effectiveness of specific programs illustrated in this paper can, in the absence of ‘perfect data’, support timely decision-making regarding these programs. Nevertheless, well-designed health economic studies are needed to decrease the current decision

  9. Chronic obstructive pulmonary disease (COPD) rehabilitation at primary health‐care centres – the KOALA project

    DEFF Research Database (Denmark)

    Godtfredsen, Nina Skavlan; Grann, Ove; Larsen, Hanne Bormann;

    2012-01-01

    Background:  Implementation of pulmonary rehabilitation in primary health care in Denmark is a new challenge in the management of patients with chronic obstructive pulmonary disease (COPD). Objectives:  To assess the feasibility of introducing a nationwide web-based tool for data recording and...... health-care centres have been invited to participate. We present summary statistics and correlation analyses of the 1699 patients who have been enrolled so far. Results:  Thirty-three municipalities are currently engaged in the KOALA project. Descriptive analyses reveal that 33% of the patients do not...

  10. A proposed 'health literate care model' would constitute a systems approach to improving patients' engagement in care.

    Science.gov (United States)

    Koh, Howard K; Brach, Cindy; Harris, Linda M; Parchman, Michael L

    2013-02-01

    Improving health outcomes relies on patients' full engagement in prevention, decision-making, and self-management activities. Health literacy, or people's ability to obtain, process, communicate, and understand basic health information and services, is essential to those actions. Yet relatively few Americans are proficient in understanding and acting on available health information. We propose a Health Literate Care Model that would weave health literacy strategies into the widely adopted Care Model (formerly known as the Chronic Care Model). Our model calls for first approaching all patients with the assumption that they are at risk of not understanding their health conditions or how to deal with them, and then subsequently confirming and ensuring patients' understanding. For health care organizations adopting our model, health literacy would then become an organizational value infused into all aspects of planning and operations, including self-management support, delivery system design, shared decision-making support, clinical information systems to track and plan patient care, and helping patients access community resources. We also propose a measurement framework to track the impact of the new Health Literate Care Model on patient outcomes and quality of care. PMID:23381529

  11. Assessing patient-centred care for chronic pain: Validation of a new research paradigm

    OpenAIRE

    Paul-Savoie, Emilie; Bourgault, Patricia; Gosselin, Emilie; Potvin, Stéphane; Lafrenaye, Sylvie

    2015-01-01

    BACKGROUND: Chronic pain is a complex phenomenon resulting from biological, psychological and social factors, and the use of patient-centred care (PCC) appears to be a promising avenue for its treatment. Various methods have been used for measuring PCC in nurses and physicians (caregivers); however, methodological problems have been raised following the observation of real clinical encounters or standardized patient simulations. The development of new strategies is required. OBJECTIVE: To dev...

  12. The Interdisciplinary eHealth Team: Chronic Care for the Future

    OpenAIRE

    Wiecha, John; Pollard, Timothy

    2004-01-01

    An interdisciplinary clinical team is a consistent grouping of people from relevant clinical disciplines, ideally inclusive of the patient, whose interactions are guided by specific team functions and processes to achieve team-defined favorable patient outcomes. Teamwork supported by properly designed eHealth applications could help create more effective systems of care for chronic disease. Given its synchronous and asynchronous communication capacity and information-gathering and -sharing ca...

  13. Exploring Robust Methods for Evaluating Treatment and Comparison Groups in Chronic Care Management Programs

    OpenAIRE

    Wells, Aaron R.; Hamar, Brent; Bradley, Chastity; Gandy, William M.; Harrison, Patricia L.; Sidney, James A.; Coberley, Carter R.; Rula, Elizabeth Y.; Pope, James E

    2013-01-01

    Evaluation of chronic care management (CCM) programs is necessary to determine the behavioral, clinical, and financial value of the programs. Financial outcomes of members who are exposed to interventions (treatment group) typically are compared to those not exposed (comparison group) in a quasi-experimental study design. However, because member assignment is not randomized, outcomes reported from these designs may be biased or inefficient if study groups are not comparable or balanced prior ...

  14. Psychiatric Morbidity, Pain Perception, and Functional Status of Chronic Pain Patients in Palliative Care

    OpenAIRE

    Rajmohan, V.; Kumar, Suresh K

    2013-01-01

    Context: Psychological factors, such as that exist when we experience pain, can profoundly alter the strength of pain perception. Aim: The study aims to estimate the prevalence of psychiatric disorders, and its association with perception of pain and functional status in chronic patients in palliative care. Materials and Methods: The sample was selected via simple randomisation and post consent were assessed using (1) a semi- structured questionnaire to elicit socio-demographic inform...

  15. Improving the Differential Diagnosis of Chronic Obstructive Pulmonary Disease in Primary Care

    OpenAIRE

    Price, David B.; Yawn, Barbara P; Rupert C M Jones

    2010-01-01

    Chronic obstructive pulmonary disease (COPD) and asthma represent a substantial portion of primary care practice. In adults, differentiating asthma from COPD can be difficult but is important because of the marked differences in treatment, disease progression, and outcomes between the 2 conditions. Currently, clinical COPD is often misdiagnosed or undiagnosed until late in the disease. Earlier diagnosis could markedly reduce morbidity and improve quality of life. Establishing a diagnosis of C...

  16. Chronic morbidity and health care seeking behaviour amongst elderly population in rural areas of Uttarakhand

    OpenAIRE

    Surekha Kishore; Mr. Kapil Sharma; Richa Singh; Bhanu Pratap Singh Gaur; Rachana R Satish; Yatish Bhaskar; Ritu Bhaskar

    2015-01-01

    Background: Ageing is a natural process, always associated with physiological and biological decline. Global population is ageing; the proportion of older persons has been rising steadily, from 7% in 1950 to 11% in 2007, with an expected rise to reach 22 % in 2050. With improving knowledge and awareness the health care seeking behavior has shown an increasingly positive trend. With increasing age, morbidity,   especially those arising from chronic diseases also increases. On the contrary, hea...

  17. Spirometry use: detection of chronic obstructive pulmonary disease in the primary care setting

    OpenAIRE

    Barnes, T.

    2011-01-01

    Thomas A Barnes1, Len Fromer21Department of Cardiopulmonary Sciences, Northeastern University, Boston, MA, USA; 2David Geffen School of Medicine at UCLA, Los Angeles, CA, USAObjective: To describe a practical method for family practitioners to stage chronic obstructive pulmonary disease (COPD) by the use of office spirometry.Methods: This is a review of the lessons learned from evaluations of the use of office spirometry in the primary care setting to identify best practices using the most re...

  18. Effect of Orem self-care model on the SWB and self-esteem behavior of patients with chronic schizophrenia%Orem自我护理模式对慢性精神分裂症患者幸福感及自尊行为的影响

    Institute of Scientific and Technical Information of China (English)

    吴辉霞; 陈文霞; 卢雪珍; 邬东红; 张玉娥

    2014-01-01

    Objective:To explore the effect of Orem self-care model on the subjective well-being( SWB)and self-esteem behavior of patients with chronic schizophrenia. Methods:42 patients with chronic schizophrenia( admitted to hospital from February 2011 to January 2012 )were taken as the control group and other 44 patients with chronic schizophrenia( admitted to hospital from February 2012 to January 2013)were taken as the study group. The patients in the control group received routine psychiatric nursing care and Orem self-care model was adopted in the study group based on routine nursing care. The scores of NOSIE,SES and GWB were compared between the two groups before and after the intervention. Results:The scores of sociability,social interest and personal hygiene were higher in the study group than the control group after the intervention(P﹤0. 05);the scores of irritability,mental symptoms,social withdrawal and depression were lower in the study group than those in the control group(P﹤0. 05);the SES and GWB scores were higher in the study group than the control group after the intervention(P﹤0. 05). Conclusion:The Orem self-care model can effectively improve the self-esteem behavior,enhance the subjective well-being and improve the quality of life of patients with chronic schizophrenia.%目的:探讨Orem自我护理模式对慢性精神分裂症患者幸福感及自尊行为的影响。方法:选取2011年2月~2012年1月收治的42例慢性精神分裂症患者为对照组,开展常规精神科护理;选取2012年2月~2013年1月收治的44例慢性精神分裂症患者为研究组,在常规护理基础上采用Orem自我护理模式。比较两组干预前后观察量表( NOSIE)、自尊量表( SES)及总体幸福感量表(GWB)评分。结果:干预后研究组社会能力、社会兴趣、个人卫生评分高于对照组(P﹤0.05),激惹、精神症状、退缩及抑郁评分低于对照组(P﹤0.05

  19. Chronic obstructive pulmonary disease and heart failure: research and clinical practice in primary care

    Directory of Open Access Journals (Sweden)

    Francesco Chiumeo

    2015-12-01

    Full Text Available The treatment of chronic obstructive pulmonary disease (COPD and comorbidities, increasing with age, is the challenge that nowadays health care systems are facing to better care treat these patients. For this reason a clinical trial was conducted in the province of Trento by a group of 30 volunteer general practitioners members of SNAMID (Scientific Society for Continuing Medical Education of General Practitioners. The objectives were to identify: i prevalence of COPD in patients (65-98 years in the province of Trento; ii presence and incidence of heart failure (HF in COPD patients; iii early detection of other chronic diseases; and iv improving electronic medical records (EMR as an innovation way of professional care management. From May 2011 to October 2013, 17 doctors completed the two-year work using the EMR. The studied patients were men and women (65-98 years, suffering from COPD; the considered data included: anthropometric information, smoking status, International Classification of Diseases (ICD-9 diagnosis of COPD, HF and chronic diseases, specific blood and instrumental tests. The extracted results were then linked with data of sentinel therapies, collected by the EMR. The database obtained identified patients with COPD or HF not previously recognized with ICD-9 diagnosis. The study identified the sentinel drugs chosen for COPD and HF, excluding other drugs not selective for the study or confusing for a proper statistical evaluation.

  20. Divorce and Childhood Chronic Illness: A Grounded Theory of Trust, Gender, and Third-Party Care Providers.

    Science.gov (United States)

    Russell, Luke T; Coleman, Marilyn; Ganong, Lawrence H; Gayer, Debra

    2016-05-01

    Divorced parents face distinct challenges in providing care for chronically ill children. Children's residence in two households necessitates the development of family-specific strategies to ensure coparents' supervision of regimen adherence and the management of children's health care. Utilizing a risk and resilience perspective, a grounded theory study was conducted with 14 divorced parents of children with chronic illnesses. The importance of trust, gender, and relationships with third-party care providers emerged as key themes related to the development of effective coparenting relationships for maintaining children's health. Divorced parents were best able to support the management of their children's chronic conditions when care providers operated as neutral third parties and intermediaries. Collaborative family care may require health care practitioners to avoid being drawn into contentious inter-parental conflicts. PMID:27021310

  1. “What we want”: chronically ill adolescents’ preferences and priorities for improving health care

    Directory of Open Access Journals (Sweden)

    van Staa A

    2011-06-01

    Full Text Available AnneLoes van Staa1,2, Susan Jedeloo1, Heleen van der Stege1, On Your Own Feet Research Group1,31Expertise Center Transitions of Care, Rotterdam University, 2Institute of Health Policy and Management, Erasmus University Rotterdam, 3Department of Pediatrics, Sophia Children’s Hospital, Erasmus MC University Medical Center, Rotterdam, The NetherlandsBackground: As important users of health care, adolescents with chronic conditions deserve to be consulted about their experiences and expectations. This study aimed to explore chronically ill adolescents’ preferences regarding providers' qualities, and outpatient and inpatient care. Furthermore, suggestions for improvement of service delivery were collected.Methods: This research was a sequential mixed methods study in adolescents aged 12–19 years with various chronic conditions treated in a university children’s hospital. Methods comprised 31 face-to-face interviews at home, a hospital-based peer research project in which nine adolescents interviewed 34 fellow patients, and a web-based questionnaire (n = 990. Emerging qualitative themes were transformed into questionnaire items.Results: Having “a feeling of trust” and “voice and choice” in the hospital were central to these adolescents. Regarding providers’ qualities, “being an expert” and “being trustworthy and honest” were ranked highest, followed by "being caring and understanding”, "listening and showing respect", and “being focused on me”. Regarding outpatient consultations, preferences were ranked as follows: “answering all questions”; “attending to my and my parents’ needs”; and “clear communication”, while “limited waiting times” and “attractive outpatient surroundings” scored lowest. Regarding hospitalization, adolescents most preferred to “avoid pain and discomfort”, “keep in touch with home”, and “be entertained”, while “being hospitalized with peers” and “being heard

  2. Discontinuity of care for mothers with chronic hepatitis B diagnosed during pregnancy.

    Science.gov (United States)

    Rajbhandari, R; Barton, K; Juncadella, A C; Rubin, A K; Ajayi, T; Wu, Y; Ananthakrishnan, A N; Chung, R T

    2016-07-01

    Assiduous measures are taken to prevent perinatal transmission of hepatitis B virus (HBV) to infants; it is unclear whether the mothers receive appropriate care for their chronic HBV. We sought to assess the quality of HBV care in hepatitis B surface antigen (HBsAg)-positive mothers following pregnancy. HBsAg-positive women (n = 243) who had sought prenatal care at Massachusetts General Hospital were retrospectively identified and charts reviewed. The primary outcome was adherence to the American Association for the Study of Liver Diseases (AASLD) and American College of Obstetricians and Gynecologists guidelines. Over one-third (37%) of women were first diagnosed with HBV infection at a prenatal visit. One-third (32%) did not undergo timely liver function test measurements. HBV DNA was never measured in 26% and was untimely in 34% of patients. One-third (34%) of the women were at high-risk for HCC based on AASLD criteria, yet only 33% of these women underwent timely imaging. Nearly half (49%) never saw a liver specialist for their HBV care. In multivariate analysis, women were 3.7 times more likely to have a timely ALT and 8.1 times more likely to have a timely HBV DNA if they were followed by a liver specialist (P = 0.001, <0.001). We demonstrate remarkably inadequate and discontinuous HBV care for chronically infected mothers following pregnancy. As HBV infection is already being identified prenatally, quality improvement measures encompassing obstetricians, primary care providers and hepatologists are needed to ensure that HBV-infected women are linked to care postpregnancy. PMID:26940754

  3. Implementing Outcome Measures Within an Enhanced Palliative Care Day Care Model.

    LENUS (Irish Health Repository)

    Kilonzo, Isae

    2015-04-23

    Specialist palliative care day care (SPDC) units provide an array of services to patients and their families and can increase continuity of care between inpatient and homecare settings. A multidisciplinary teamwork approach is emphasized, and different models of day care exist. Depending on the emphasis of care, the models can be social, medical, therapeutic, or mixed. We describe our experience of introducing an enhanced therapeutic specialist day care model and using both patient- and carer-rated tools to monitor patient outcomes.

  4. Animal models for investigating chronic pancreatitis

    OpenAIRE

    Aghdassi Alexander A; Mayerle Julia; Christochowitz Sandra; Weiss Frank U; Sendler Matthias; Lerch Markus M

    2011-01-01

    Abstract Chronic pancreatitis is defined as a continuous or recurrent inflammatory disease of the pancreas characterized by progressive and irreversible morphological changes. It typically causes pain and permanent impairment of pancreatic function. In chronic pancreatitis areas of focal necrosis are followed by perilobular and intralobular fibrosis of the parenchyma, by stone formation in the pancreatic duct, calcifications in the parenchyma as well as the formation of pseudocysts. Late in t...

  5. Chronic pain: Model of psychosomatic disorder (review

    Directory of Open Access Journals (Sweden)

    Chernus N.P.

    2011-12-01

    Full Text Available The article presents a detailed review on epidemiology, pathogenesis and interrelation of serotonin neuromedia-tor metabolism in the central nervous system in state of chronic pain and depression. It has been demonstrated that neurophysiological conditions serve as psychological defense of an individual. That mechanism has been proved to «transform» serious emotions onto the inner level (body and it assists in the development of psychosomatic disorders — chronic pain syndrome

  6. Providing Continuity of Care for Chronic Diseases in the Aftermath of Katrina: From Field Experience to Policy Recommendations

    OpenAIRE

    Arrieta, Martha I.; Foreman, Rachel D.; Crook, Errol D.; Icenogle, Marjorie L.

    2009-01-01

    This study sought to elicit challenges and solutions in the provision of health care to those with chronic diseases after Hurricane Katrina in coastal Alabama and Mississippi. In-depth interviews with 30 health and social service providers (key informants) and 4 focus groups with patients with chronic diseases were conducted. Subsequently an advisory panel of key informants was convened. Findings were summarized and key informants submitted additional feedback. The chronic diseases identified...

  7. Preferences for health care and self-management among Dutch adolescents with chronic conditions: a Q-methodological investigation

    NARCIS (Netherlands)

    Jedeloo, S.; Staa, A.L. van; Latour, J.M.; Exel, N.J. van

    2009-01-01

    Adolescents with chronic conditions have to learn to self-manage their health in preparation for transitioning to adult care. Nurses often struggle with how to approach youth with chronic conditions successfully. Little is known about the preferences and attitudes of these young people themselves.

  8. Dutch Chronic Pancreatitis Registry (CARE) : Design and rationale of a nationwide prospective evaluation and follow-up

    NARCIS (Netherlands)

    Ali, U. Ahmed; Issa, Y.; van Goor, H.; van Eijck, C. H.; Nieuwenhuijs, V. B.; Keulemans, Y.; Fockens, P.; Busch, O. R.; Drenth, J. P.; Dejong, C. H.; van Dullemen, H. M.; van Hooft, J. E.; Siersema, P. D.; Spanier, B. W. M.; Poley, J. W.; Poen, A. C.; Timmer, R.; Seerden, T.; Tan, A. C.; Thijs, W. J.; Witteman, B. J. M.; Romkens, T. E. H.; Roeterdink, A. J.; Gooszen, H. G.; Van Santvoort, H. C.; Bruno, M. J.; Boermeester, M. A.

    2015-01-01

    Background: Chronic pancreatitis is a complex disease with many unanswered questions regarding the natural history and therapy. Prospective longitudinal studies with long-term follow-up are warranted. Methods: The Dutch Chronic Pancreatitis Registry (CARE) is a nationwide registry aimed at prospecti

  9. Social-Interaction Knowledge Translation for In-Home Management of Urinary Incontinence and Chronic Care.

    Science.gov (United States)

    Jansen, Lynn; McWilliam, Carol L; Forbes, Dorothy; Forchuk, Cheryl

    2013-12-01

    Although urinary incontinence (UI) can be managed conservatively, it is a principal reason for the breakdown of in-home family care. This study explored the social interaction processes of knowledge translation (KT) related to how UI management knowledge might be translated within in-home care. In-depth interview data were collected from a theoretical sample of 23 family caregivers, older home care recipients, and home care providers. Constant comparison and Glaser’s analysis criteria were used to create translating knowledge through relating , a substantive theory with 10 subthemes: living with the problem; building experiential knowledge; developing comfort; easing into a working relationship; nurturing mutuality; facilitating knowledge exchange; building confidence; fi ne-tuning knowledge; putting it all together; and managing in-home care. Findings inform both theory and practice of in-home UI KT, illuminating how intersubjectivity and bi-directional relational interactions are essential to translating in-home chronic care knowledge, which is largely tacit and experiential in nature. PMID:24063503

  10. Market Model of Care and Transnational Care Practices

    Czech Academy of Sciences Publication Activity Database

    Uhde, Zuzana

    Berlin: Fridrich Ebert Stiftung, 2015 - (Magbunduku, E.), s. 7-15 [Global Care Chains: Why should we care?. Berlin (DE), 22.10.2014-23.10.2014] Institutional support: RVO:68378025 Keywords : care * migration * gender Subject RIV: AO - Sociology, Demography http://www.fes.de/GPol/pdf/Global_Care_Chains_Conference_Reader2015.pdf

  11. The Island Hospice model of palliative care

    Science.gov (United States)

    Khumalo, Thembelihle; Maasdorp, Valerie

    2016-01-01

    There has been a substantial increase in cancer detections in Africa over years, and it has also been noted that higher number of individuals are affected by the later stages of cancer that lead to death. When it comes to cancer care, Zimbabwe is no exception with its ongoing palliative care related research, though still in its infancy. The need for advanced and more accessible palliative care to assist the vulnerable has been intensified by this increase in cancer prevalence. Island Hospice, which is a centre of excellence in palliative care has varying elements of the models that it employs to engage those most in need of palliative assistance, especially children and financially-challenged individuals.

  12. Implementation and effectiveness of 'care navigation', coordinated management for people with complex chronic illness: rationale and methods of a randomised controlled

    OpenAIRE

    Plant, Natalie; Mallitt, Kylie-Ann; Kelly, Patrick J.; Usherwood, Tim; Gillespie, James; Boyages, Steven; Jan, Stephen; McNab, Justin; Essue, Beverley M.; Gradidge, Kathy; Maranan, Nereus; Ralphs, David; Aspin, Clive; Leeder, Stephen

    2013-01-01

    Background Chronic illness is a significant driver of the global burden of disease and associated health care costs. People living with severe chronic illness are heavy users of acute hospital services; better coordination of their care could potentially improve health outcomes while reducing hospital use. The Care Navigation trial will evaluate an in-hospital coordinated care intervention on health service use and quality of life in chronically ill patients. Methods/Design A randomised contr...

  13. Interprofessional practice in primary care: development of a tailored process model

    OpenAIRE

    Stans SEA; Stevens JGA; Beurskens AJHM

    2013-01-01

    Steffy EA Stans, JG Anita Stevens, Anna JHM Beurskens Research Center of Autonomy and Participation for Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands Purpose: This study investigated the improvement of interprofessional practice in primary care by performing the first three steps of the implementation model described by Grol et al. This article describes the targets for improvement in a setting for children with complex care needs (step 1), the...

  14. Multimorbidity in chronic disease: impact on health care resources and costs

    Science.gov (United States)

    McPhail, Steven M

    2016-01-01

    Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied). There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to directly observe sustained and measurable health and quality of life benefits. Research in the field has indicated that the impact of multimorbidity on health care costs and resources will likely differ across health systems, regions, disease combinations, and person

  15. Multimorbidity in chronic disease: impact on health care resources and costs.

    Science.gov (United States)

    McPhail, Steven M

    2016-01-01

    Effective and resource-efficient long-term management of multimorbidity is one of the greatest health-related challenges facing patients, health professionals, and society more broadly. The purpose of this review was to provide a synthesis of literature examining multimorbidity and resource utilization, including implications for cost-effectiveness estimates and resource allocation decision making. In summary, previous literature has reported substantially greater, near exponential, increases in health care costs and resource utilization when additional chronic comorbid conditions are present. Increased health care costs have been linked to elevated rates of primary care and specialist physician occasions of service, medication use, emergency department presentations, and hospital admissions (both frequency of admissions and bed days occupied). There is currently a paucity of cost-effectiveness information for chronic disease interventions originating from patient samples with multimorbidity. The scarcity of robust economic evaluations in the field represents a considerable challenge for resource allocation decision making intended to reduce the burden of multimorbidity in resource-constrained health care systems. Nonetheless, the few cost-effectiveness studies that are available provide valuable insight into the potential positive and cost-effective impact that interventions may have among patients with multiple comorbidities. These studies also highlight some of the pragmatic and methodological challenges underlying the conduct of economic evaluations among people who may have advanced age, frailty, and disadvantageous socioeconomic circumstances, and where long-term follow-up may be required to directly observe sustained and measurable health and quality of life benefits. Research in the field has indicated that the impact of multimorbidity on health care costs and resources will likely differ across health systems, regions, disease combinations, and person

  16. Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review.

    Science.gov (United States)

    Kogan, Alexis Coulourides; Wilber, Kathleen; Mosqueda, Laura

    2016-01-01

    Person-centered care (PCC) shifts focus away from the traditional biomedical model in favor of embracing personal choice and autonomy for people receiving health services. It has become an important avenue for improving primary care, and older adults remain a priority target for PCC because they are more likely to have complex care needs than younger individuals. Nevertheless, despite a growing body of evidence regarding its use, PCC still lacks an agreed-upon definition. A literature review was conducted to explore extant scholarship on PCC for older adults, assess corresponding definitions of PCC, and identify important elements of quality PCC. Nearly 3,000 articles published between 1990 and 2014 were identified. Excluding search results outside the parameters of this study, the final review comprised 132 nonduplicate sources focused on patient-centered care or PCC in older adults. Fifteen descriptions of PCC were identified, addressing 17 central principles or values. The six most-prominent domains of PCC were holistic or whole-person care, respect and value, choice, dignity, self-determination, and purposeful living. The body of evidence reviewed suggests that PCC is an important area of growing interest. Although multiple definitions and elements of PCC abound-with many commonalities and some overlap-the field would benefit from a consensus definition and list of essential elements to clarify how to operationalize a PCC approach to health care and services for older adults. This work guided the development of a separate American Geriatrics Society expert panel statement presenting a standardized definition and a list of PCC elements for older adults with chronic conditions or functional impairment. PMID:26626408

  17. Improving confidence for self care in patients with depression and chronic illnesses.

    Science.gov (United States)

    Ludman, Evette J; Peterson, Do; Katon, Wayne J; Lin, Elizabeth H B; Von Korff, Michael; Ciechanowski, Paul; Young, Bessie; Gensichen, Jochen

    2013-01-01

    The aim of this study was to examine whether patients who received a multicondition collaborative care intervention for chronic illnesses and depression had greater improvement in self-care knowledge and efficacy, and whether greater knowledge and self-efficacy was positively associated with improved target outcomes. A randomized controlled trial with 214 patients with comorbid depression and poorly controlled diabetes and/or coronary heart disease tested a 12-month team-based intervention that combined self-management support and collaborative care management. At 6 and 12 month outcomes the intervention group showed significant improvements over the usual care group in confidence in ability to follow through with medical regimens important to managing their conditions and to maintain lifestyle changes even during times of stress. Improvements in self care-efficacy were significantly related to improvements in depression, and early improvements in confidence to maintain lifestyle changes even during times of stress explained part of the observed subsequent improvements in depression. PMID:23398269

  18. A First Step on the Journey to High-Quality Chronic Illness Care.

    Science.gov (United States)

    Wagner, Edward H

    2016-01-01

    The Atlantic Healthcare Collaboration (AHC) conducted a quality improvement initiative to improve chronic disease prevention and management for the four Atlantic provinces and their regional health authorities. Leaders and front-line teams carried out a range of projects, each suited to the needs of that region. This initiative helped build the case for improvement, increased the motivation to change, exposed participants to proven ideas for improvement and supported participating organizations in developing the capacity and culture to test, implement and spread improvements. The AHC also created a politically safe learning community with the potential to support and sustain the work of chronic care improvement over time. In carrying this initiative forward, the greatest challenge will be the magnitude of work to be done. PMID:27009640

  19. Case management for patients with chronic systolic heart failure in primary care: The HICMan exploratory randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Kunz Cornelia U

    2010-05-01

    Full Text Available Abstract Background Chronic (systolic heart failure (CHF represents a clinical syndrome with high individual and societal burden of disease. Multifaceted interventions like case management are seen as promising ways of improving patient outcomes, but lack a robust evidence base, especially for primary care. The aim of the study was to explore the effectiveness of a new model of CHF case management conducted by doctors' assistants (DAs, equivalent to a nursing role and supported by general practitioners (GPs. Methods This patient-randomised controlled trial (phase II included 31 DAs and employing GPs from 29 small office-based practices in Germany. Patients with CHF received either case management (n = 99 consisting of telephone monitoring and home visits or usual care (n = 100 for 12 months. We obtained clinical data, health care utilisation data, and patient-reported data on generic and disease-specific quality of life (QoL, SF-36 and KCCQ, CHF self-care (EHFScBS and on quality of care (PACIC-5A. To compare between groups at follow-up, we performed analyses of covariance and logistic regression models. Results Baseline measurement showed high guideline adherence to evidence-based pharmacotherapy and good patient self-care: Patients received angiotensin converting enzyme inhibitors (or angiotensin-2 receptor antagonists in 93.8% and 95%, and betablockers in 72.2% and 84%, and received both in combination in 68% and 80% of cases respectively. EHFScBS scores (SD were 25.4 (8.4 and 25.0 (7.1. KCCQ overall summary scores (SD were 65.4 (22.6 and 64.7 (22.7. We found low hospital admission and mortality rates. EHFScBS scores (-3.6 [-5.7;-1.6] and PACIC and 5A scores (both 0.5, [0.3;0.7/0.8] improved in favour of CM but QoL scores showed no significant group differences (Physical/Mental SF-36 summary scores/KCCQ-os [95%CI]: -0.3 [-3.0;2.5]/-0.1 [-3.4;3.1]/1.7 [-3.0;6.4]. Conclusions In this sample, with little room for improvement regarding evidence

  20. A Customizable Model for Chronic Disease Coordination: Lessons Learned From the Coordinated Chronic Disease Program

    Science.gov (United States)

    Sequeira, Sonia; Chavez, Amy Holmes

    2016-01-01

    In 2012, the Centers for Disease Control and Prevention provided funding and technical assistance to all states and territories to implement the Coordinated Chronic Disease Program, marking the first time that all state health departments had federal resources to coordinate chronic disease prevention and control programs. This article describes lessons learned from this initiative and identifies key elements of a coordinated approach. We analyzed 80 programmatic documents from 21 states and conducted semistructured interviews with 7 chronic disease directors. Six overarching themes emerged: 1) focused agenda, 2) identification of functions, 3) comprehensive planning, 4) collaborative leadership and expertise, 5) managed resources, and 6) relationship building. These elements supported 4 essential activities: 1) evidence-based interventions, 2) strategic use of staff, 3) consistent communication, and 4) strong program infrastructure. On the basis of these elements and activities, we propose a conceptual model that frames overarching concepts, skills, and strategies needed to coordinate state chronic disease prevention and control programs. PMID:27032986

  1. A Customizable Model for Chronic Disease Coordination: Lessons Learned From the Coordinated Chronic Disease Program.

    Science.gov (United States)

    Voetsch, Karen; Sequeira, Sonia; Chavez, Amy Holmes

    2016-01-01

    In 2012, the Centers for Disease Control and Prevention provided funding and technical assistance to all states and territories to implement the Coordinated Chronic Disease Program, marking the first time that all state health departments had federal resources to coordinate chronic disease prevention and control programs. This article describes lessons learned from this initiative and identifies key elements of a coordinated approach. We analyzed 80 programmatic documents from 21 states and conducted semistructured interviews with 7 chronic disease directors. Six overarching themes emerged: 1) focused agenda, 2) identification of functions, 3) comprehensive planning, 4) collaborative leadership and expertise, 5) managed resources, and 6) relationship building. These elements supported 4 essential activities: 1) evidence-based interventions, 2) strategic use of staff, 3) consistent communication, and 4) strong program infrastructure. On the basis of these elements and activities, we propose a conceptual model that frames overarching concepts, skills, and strategies needed to coordinate state chronic disease prevention and control programs. PMID:27032986

  2. Direct costs of chronic obstructive pulmonary disease among managed care patients

    Directory of Open Access Journals (Sweden)

    An

    2010-09-01

    Full Text Available Anand A Dalal1, Laura Christensen2, Fang Liu3, Aylin A Riedel31US Health Outcomes, GlaxoSmithKline, Research Triangle Park, NC, USA; 2Health Economics Outcomes Research, i3 Innovus, Ann Arbor, MI, USA; 3Health Economics Outcomes Research, i3 Innovus, Eden Prairie, MN, USAPurpose: To estimate patient- and episode-level direct costs of chronic obstructive pulmonary disease (COPD among commercially insured patients in the US.Methods: In this retrospective claims-based analysis, commercial enrollees with evidence of COPD were grouped into five mutually exclusive cohorts based on the most intensive level of COPD-related care they received in 2006, ie, outpatient, urgent outpatient (outpatient care in addition to a claim for an oral corticosteroid or antibiotic within seven days, emergency department (ED, standard inpatient admission, and intensive care unit (ICU cohorts. Patient-level COPD-related annual health care costs, including patient- and payer-paid costs, were compared among the cohorts. Adjusted episode-level costs were calculated.Results: Of the 37,089 COPD patients included in the study, 53% were in the outpatient cohort, 37% were in the urgent outpatient cohort, 3% were in the ED cohort, and the standard admission and ICU cohorts together comprised 6%. Mean (standard deviation, SD annual COPD-related health care costs (2008 US$ increased across the cohorts (P < 0.001, ranging from $2003 ($3238 to $43,461 ($76,159 per patient. Medical costs comprised 96% of health care costs for the ICU cohort. Adjusted mean (SD episode-level costs were $305 ($310 for an outpatient visit, $274 ($336 for an urgent outpatient visit, $327 ($65 for an ED visit, $9745 ($2968 for a standard admission, and $33,440 for an ICU stay.Conclusion: Direct costs of COPD-related care for commercially insured patients are driven by hospital stays with or without ICU care. Exacerbation prevention resulting in reduced need for inpatient care could lower costs

  3. Improving Self-Care of Patients with Chronic Disease using Online Personal Health Record

    Directory of Open Access Journals (Sweden)

    Amol Wagholikar

    2012-09-01

    Full Text Available Background Effective management of chronic diseases such as prostate cancer is important. Research suggests a tendency to use self-care treatment options such as over-the-counter (OTC complementary medications among prostate cancer patients. The current trend in patient-driven recording of health data in an online Personal Health Record (PHR presents an opportunity to develop new data-driven approaches for improving prostate cancer patient care. However, the ability of current online solutions to share patients’ data for better decision support is limited. An informatics approach may improve online sharing of self-care interventions among these patients. It can also provide better evidence to support decisions made during their self-managed care.Aims To identify requirements for an online system and describe a new case-based reasoning (CBR method for improving self-care of advanced prostate cancer patients in an online PHR environment. Method A non-identifying online survey was conducted to understand self-care patterns among prostate cancer patients and to identify requirements for an online information system. The pilot study was carried out between August 2010 and December 2010. A case-base of 52 patients was developed. Results The data analysis showed self-care patterns among the prostate cancer patients. Selenium (55% was the common complementary supplement used by the patients. Paracetamol (about 45% was the commonly used OTC by the patients. Conclusion The results of this study specified requirements for an online case-based reasoning information system. The outcomes of this study are being incorporated in design of the proposed Artificial Intelligence (AI driven patient journey browser system. A basic version of the proposed system is currently being considered for implementation.

  4. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne

    2012-01-01

    which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved.......The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources are...

  5. Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care.

    LENUS (Irish Health Repository)

    Cullen, Walter

    2009-01-01

    BACKGROUND: Although multimorbidity has important implications for patient care in general practice, limited research has examined chronic illness and health service utilisation among problem drug users. This study aimed to determine chronic illness prevalence and health service utilisation among problem drug users attending primary care for methadone treatment, to compare these rates with matched \\'controls\\' and to develop and pilot test a valid study instrument. METHODS: A cross-sectional study of patients attending three large urban general practices in Dublin, Ireland for methadone treatment was conducted, and this sample was compared with a control group matched by practice, age, gender and General Medical Services (GMS) status. RESULTS: Data were collected on 114 patients. Fifty-seven patients were on methadone treatment, of whom 52(91%) had at least one chronic illness (other then substance use) and 39(68%) were prescribed at least one regular medication. Frequent utilisation of primary care services and secondary care services in the previous six months was observed among patients on methadone treatment and controls, although the former had significantly higher chronic illness prevalence and primary care contact rates. The study instrument facilitated data collection that was feasible and with minimal inter-observer variation. CONCLUSION: Multimorbidity is common among problem drug users attending general practice for methadone treatment. Primary care may therefore have an important role in primary and secondary prevention of chronic illnesses among this population. This study offers a feasible study instrument for further work on this issue. (238 words).

  6. Chronic illness and multimorbidity among problem drug users: a comparative cross sectional pilot study in primary care.

    LENUS (Irish Health Repository)

    Cullen, Walter

    2012-02-01

    BACKGROUND: Although multimorbidity has important implications for patient care in general practice, limited research has examined chronic illness and health service utilisation among problem drug users. This study aimed to determine chronic illness prevalence and health service utilisation among problem drug users attending primary care for methadone treatment, to compare these rates with matched \\'controls\\' and to develop and pilot test a valid study instrument. METHODS: A cross-sectional study of patients attending three large urban general practices in Dublin, Ireland for methadone treatment was conducted, and this sample was compared with a control group matched by practice, age, gender and General Medical Services (GMS) status. RESULTS: Data were collected on 114 patients. Fifty-seven patients were on methadone treatment, of whom 52(91%) had at least one chronic illness (other then substance use) and 39(68%) were prescribed at least one regular medication. Frequent utilisation of primary care services and secondary care services in the previous six months was observed among patients on methadone treatment and controls, although the former had significantly higher chronic illness prevalence and primary care contact rates. The study instrument facilitated data collection that was feasible and with minimal inter-observer variation. CONCLUSION: Multimorbidity is common among problem drug users attending general practice for methadone treatment. Primary care may therefore have an important role in primary and secondary prevention of chronic illnesses among this population. This study offers a feasible study instrument for further work on this issue. (238 words).

  7. The Patients Assessment Chronic Illness Care (PACIC questionnaire in The Netherlands: a validation study in rural general practice

    Directory of Open Access Journals (Sweden)

    Hermsen Jan

    2008-09-01

    Full Text Available Abstract Background Many patients with chronic illness receive health care in primary care settings, so a challenge is to provide well-structured chronic care in these settings. Our aim was to develop and test a Dutch version of the PACIC questionnaire, a measure for patient reported structured chronic care. Methods Observational study in 165 patients with diabetes or COPD from four general practices (72% response rate. Patients completed a written questionnaire, which included instruments for assessing chronic illness care (PACIC, evaluations of general practice (Europep, enablement (PEI, and individual characteristics. Results The patients had a mean age of 68.0 years and 47% comprised of women. Twenty-two to 35% of responding patients did not provide answers to specific items in the PACIC. In 11 items the lowest answering category was used by 30% or more of the responders and in 6 items the highest answering category was used by this number of responders. Principal factor analysis identified the previously defined five domains reasonably well. Cronbach's alpha per domain varied from 0.71 to 0.83, and the intraclass coefficient from 0.66 to 0.91. Diabetes patients reported higher presence of structured chronic care for 14 out of the 20 PACIC items. The effect of patient evaluations of general practice on the PACIC score was positive (b = 0.72, p Conclusion A translated and validated Dutch version of the PACIC questionnaire is now available. Further research on its validity is recommended.

  8. Frozen in time: life in the face of chronic care cutbacks.

    Science.gov (United States)

    Cook, K

    1999-04-01

    Kathy Cook won the $750 first prize in CMAJ's 7th Annual Amy Chouinard Memorial Essay Contest. The deadline for entries to the contest, which is designed to stimulate interest in medical writing among journalism students, is June 1. Entries should be forwarded to the news and features editor. In her winning essay, Cook explores the frustrations and quality-of-life issues that arise in a chronic care institution that is trying to operate in the midst of serious funding cuts. PMID:10207348

  9. Current state of chronic wound care in Kazakhstan: focus on topical treatments

    Directory of Open Access Journals (Sweden)

    Alma Akhmetova

    2015-02-01

    Full Text Available Background — The presence of chronic hard-to-heal wounds significantly affects patients’ quality of life causing pain, discomfort, decrease of mobility and consequently leads to social isolation and depression. This type of wound is more prevalent among older population. It has been estimated that up to 1-2% of the world population have this condition. The treatment of hard-to-heal wounds is expensive and long-term process, and, stresses healthcare systems of every country. Unfortunately, limited information is available about the situation with chronic wounds in Kazakhstan as the statistical data on such patients is not monitored and not registered in this country. Methods — The search was conducted by using available electronic sources, including Google Scholar, PubMed, Web of Sciences, Medline, Wiley Online Library, and Cochrane Library databases as well as hard copy versions of peer-reviewed publications in Russian, Kazakh, and English languages. Results — We have identified and analyzed current situation with wound care in the Republic of Kazakhstan. Research has demonstrated a variety of types of treatments utilized in the country, particularly the treatment of the diabetic foot.It also indicates the lack of statistics on wound care. Conclusions — The review highlights the mechanisms of wound healing process, methods for wound care, and encompasses the information available on wound healing in Republic of Kazakhstan. The article emphasizes the necessity of establishing the systemic monitoring of wound care and formation of electronic database. Apart from that, the importance of developing and manufacturing of domestic novel wound treatments have been also stressed out.

  10. Care Burden and Social Support Levels of Caregivers of Patients with Chronic Obstructive Pulmonary Disease.

    Science.gov (United States)

    Göriş, Songül; Klç, Züleyha; Elmal, Ferhan; Tutar, Nuri; Takc, Özlem

    2016-01-01

    This descriptive study was conducted to determine the care burden and social support levels of caregivers to patients with chronic obstructive pulmonary disease (COPD). The primary caregivers of 112 patients with COPD hospitalized in the chest diseases service of a university hospital were involved in the study. Data of the study were collected by using the Patient and Caregiver Information Form, which was prepared by reviewing the literature, Katz Index of Independence in Activities of Daily Living, Zarit Burden Interview, and Multidimensional Scale of Perceived Social Support. While the care burden mean score of caregivers of patients with COPD was 40.91 ± 20.58, the mean score of Multidimensional Scale of Perceived Social Support was 54.13 ± 18.84. In this study, it was determined that female caregivers, as well as individuals stating that their physical and psychological health was affected and those having difficulty giving care and needing help, had higher levels of care burden, whereas the spouses, as well as individuals with lower levels of income and those stating that their physical and psychological health was affected, had lower levels of social support. PMID:27309411

  11. Effectiveness of family training and life skills on caring chronic mental disorders in an Iranian population

    Directory of Open Access Journals (Sweden)

    Mohsen Dareke

    2013-05-01

    Full Text Available This research is semi-empirical study which is done to examiningthe effectiveness of family trainings and life skills on Caring Chronic Mental Disorders in Mashhad (Iran. 300 participants has been chosen in randomly from the families of chronic mental disorders who has been admitted in round the clock centers in Mashhad and who had been in waiting list and these participants has been divided to two groups of experiment and control randomly and we introduce family trainings and life skills to experiment group. There was no training to control group. These two groups were tested period to the beginning of trainings and post training with instruments such as California Social Adjustment Questionnaire; Families’ Attitude and Awareness about Life Skills and Family Trainings; Rosenberg Self-Esteem; General Health Questionnaire;and Symptom Checklist-90-Revised. Results indicated that training had no effect on the attitude of families toward taking care of mental disorder, but family member،s attitudetoward mental disorder has been changed. This training has been influential on changing family member،s attitude toward life skills, social adjustment, self esteem, mental health increase and reducing mental disorders.

  12. Measuring health-related quality of life in adults with chronic conditions in primary care settings

    Science.gov (United States)

    Hand, Carri

    2016-01-01

    Abstract Objective To describe health-related quality of life (HRQOL) conceptual frameworks, critically review 3 commonly used HRQOL scales relevant to adults with chronic conditions in primary care settings, and make recommendations for using HRQOL scales in primary care practice. Data sources Information was accessed regarding HRQOL conceptual and theoretical approaches. A comprehensive search strategy identified 3 commonly used scales that met the review criteria and evidence regarding use of the scales in adults with chronic conditions in community settings. Scale selection Scales were selected if they were designed for clinical use; were easy to administer; were generic and broad in content areas; and contained some individualized items. Scales were critiqued according to content development, theoretical basis, psychometric properties, scoring, feasibility, the concepts being measured, and the number of items that measured an individualized concept. Synthesis Early HRQOL approaches focused on health and functional status while recent approaches incorporate individualized concepts such as the person’s own values and the environment. The abbreviated World Health Organization Quality of Life Scale (WHOQOL-BREF), the 36-Item Short Form Health Survey (SF-36), and the Duke Health Profile were critiqued. All address physical, mental, and social domains, while the WHOQOL-BREF also addresses environment. Psychometric evidence supports use of the SF-36 and WHOQOL-BREF with this population. The SF-36 has the most evidence of responsiveness but has some floor and ceiling effects, while the WHOQOL-BREF does not appear to have floor or ceiling effects but has limited evidence of responsiveness. The WHOQOL-BREF has the highest proportion of individualized items. Conclusion Measurement of HRQOL in adults with chronic conditions can support patient management and contribute to primary care service evaluation. Scales that are based on a broad definition of health and that

  13. Game Maturity Model for Health Care.

    Science.gov (United States)

    de Boer, Jan C; Adriani, Paul; van Houwelingen, Jan Willem; Geerts, A

    2016-04-01

    This article introduces the Game Maturity Model for the healthcare industry as an extension to the general Game Maturity Model and describes the usage by two case studies of applied health games. The Game Maturity Model for healthcare provides a practical and value-adding method to assess existing games and to determine strategic considerations for application of applied health games. Our forecast is that within 5 years the use and development of applied games will have a role in our daily lives and the way we organize health care that will be similar to the role social media has today. PMID:26859720

  14. Cognitive screening in persons with chronic diseases in primary care: challenges and recommendations for practice.

    Science.gov (United States)

    Athilingam, Ponrathi; Visovsky, Constance; Elliott, Amanda F; Rogal, Philip J

    2015-09-01

    An integrative literature review was performed to identify the challenges in current cognitive screening. The aim of the review was to serve as an evaluative resource to guide clinicians in the selection of the best available cognitive screening measures for early assessment of mild cognitive impairment (MCI) in people with chronic diseases. The review classified the available cognitive screening measures according to purpose, time to administer, and cognitive domains assessed as: 1) simple/ brief cognitive screening measures, 2) disease specific screening measures, 3) domain specific screening measures, 4) self-administered screening measures, and 5) technology-based screening measures. There is no single optimal cognitive measure for all patient populations and settings. Although disease specific cognitive screening measures are optimal, there is a lack of validated screening measures for many chronic diseases. Technology-based screening measure is a promising avenue for increasing the accessibility of cognitive screening. Future work should focus on translating available screening measures to mobile technology format to enhance the utility in busy primary care settings. Early cognitive screening in persons with chronic disease should enhance appropriate referrals for detailed neurocognitive examination and cognitive interventions to preserve and or minimize cognitive decline. PMID:25794511

  15. Association between chronic low back pain, anxiety and depression in patients at a tertiary care centre

    International Nuclear Information System (INIS)

    Objective: To observe the prevalence of anxiety and depression in chronic low back pain population at a tertiary care centre. Methods: The prospective cross-sectional study was conducted using convenience sampling at the Department of Neurosurgery, at Liaquat National Hospital, Karachi, Pakistan, from January to June 2010. The prevalence of anxiety and depression in chronic low back pain patients was studied according to specified age and gender groups using Hospital Anxiety and Depression Scale. Results: Of the 140 patients in the study, 66 (47.14%) were females and 74 (52.85%) were males. The average age of the patients was 43.02+-13.34 years. The average duration of symptoms was 4.29+-3.3 years. Abnormal level of anxiety and depression were found in 77 (55%) and 68 (48.57%) patients respectively. Out of them 54 (38.5%) and 51 (36.4%) were borderline abnormal for anxiety and depression respectively, while 23 (16.4%) and 17 (12.1%) were abnormal for anxiety and depression respectively. Among the males, there were 20 (14.28%) and 23 (16.42%) patients with abnormal levels of the corresponding numbers among the females were 57 (40.71%) and 45 (32.14%). There was a significant association in anxiety (p0.05). Conclusion: Individuals with chronic low back pain were at high risk to experience anxiety and depression. This risk was higher for females. (author)

  16. A Model of Chronic Nutrient Infusion in the Rat

    OpenAIRE

    Fergusson, Grace; Ethier, Mélanie; Zarrouki, Bader; Fontés, Ghislaine; Poitout, Vincent

    2013-01-01

    Chronic exposure to excessive levels of nutrients is postulated to affect the function of several organs and tissues and to contribute to the development of the many complications associated with obesity and the metabolic syndrome, including type 2 diabetes. To study the mechanisms by which excessive levels of glucose and fatty acids affect the pancreatic beta-cell and the secretion of insulin, we have established a chronic nutrient infusion model in the rat. The procedure consists of cathete...

  17. Is chronic pelvic pain a comfortable diagnosis for primary care practitioners: a qualitative study

    Directory of Open Access Journals (Sweden)

    Creed Francis

    2010-01-01

    Full Text Available Abstract Background Chronic pelvic pain (CPP has a prevalence similar to asthma and chronic back pain, but little is known about how general practitioners (GPs and practice nurses manage women with this problem. A clearer understanding of current management is necessary to develop appropriate strategies, in keeping with current health care policy, for the supported self-management of patients with long term conditions. The aim of this study was to explore GPs' and practice nurses' understanding and perspectives on the management of chronic pelvic pain. Methods Data were collected using semi-structured interviews with a purposive sample of 21 GPs and 20 practice nurses, in three primary care trusts in the North West of England. Data were analysed using the principles of Framework analysis. Results Analysis suggests that women who present with CPP pose a challenge to GPs and practice nurses. CPP is not necessarily recognized as a diagnostic label and making the diagnosis was achieved only by exclusion. This contrasts with the relative acceptability of labels such as irritable bowel syndrome (IBS. GPs expressed elements of therapeutic nihilism about the condition. Despite practice nurses taking on increasing responsibilities for the management of patients with long term conditions, respondents did not feel that CPP was an area that they were comfortable in managing. Conclusions The study demonstrates an educational/training need for both GPs and practice nurses. GPs described a number of skills and clinical competencies which could be harnessed to develop a more targeted management strategy. There is potential to develop facilitated self- management for use in this patient group, given that this approach has been successful in patients with similar conditions such as IBS.

  18. Self-care 3 months after attending chronic obstructive pulmonary disease patient education: a qualitative descriptive analysis

    DEFF Research Database (Denmark)

    Mousing, Camilla Askov; Lomborg, Kirsten

    2012-01-01

    life. Talking to health care professionals focused the patients' attention on their newly acquired skills and the research interview made them more aware of their enhanced self-care. Conclusion: Patients' self-care may be enhanced through group education, even though the patients are not always able to...... see the immediate outcome. Some patients may require professional help to implement their newly acquired knowledge and skills in everyday life. A planned dialogue concentrating on self-care in everyday life 3 months after finishing the course may enhance patients' awareness and appraisal of their......Purpose: The authors performed a qualitative descriptive analysis to explore how group patient education influences the self-care of patients with chronic obstructive pulmonary disease. Patients and methods: In the period 2009–2010, eleven patients diagnosed with chronic obstructive pulmonary...

  19. Primary care practice-based care management for chronically ill patients (PraCMan: study protocol for a cluster randomized controlled trial [ISRCTN56104508

    Directory of Open Access Journals (Sweden)

    Baldauf Annika

    2011-06-01

    Full Text Available Abstract Background Care management programmes are an effective approach to care for high risk patients with complex care needs resulting from multiple co-occurring medical and non-medical conditions. These patients are likely to be hospitalized for a potentially "avoidable" cause. Nurse-led care management programmes for high risk elderly patients showed promising results. Care management programmes based on health care assistants (HCAs targeting adult patients with a high risk of hospitalisation may be an innovative approach to deliver cost-efficient intensified care to patients most in need. Methods/Design PraCMan is a cluster randomized controlled trial with primary care practices as unit of randomisation. The study evaluates a complex primary care practice-based care management of patients at high risk for future hospitalizations. Eligible patients either suffer from type 2 diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure or any combination. Patients with a high likelihood of hospitalization within the following 12 months (based on insurance data will be included in the trial. During 12 months of intervention patients of the care management group receive comprehensive assessment of medical and non-medical needs and resources as well as regular structured monitoring of symptoms. Assessment and monitoring will be performed by trained HCAs from the participating practices. Additionally, patients will receive written information, symptom diaries, action plans and a medication plan to improve self-management capabilities. This intervention is addition to usual care. Patients from the control group receive usual care. Primary outcome is the number of all-cause hospitalizations at 12 months follow-up, assessed by insurance claims data. Secondary outcomes are health-related quality of life (SF12, EQ5D, quality of chronic illness care (PACIC, health care utilisation and costs, medication adherence (MARS, depression

  20. Systems modelling for improving health care

    OpenAIRE

    Pitt, Martin; Monks, Thomas; Allen, Michael

    2016-01-01

    The growing complexity of health care coupled with the ever-increasing pressures to ensure efficient and effective use of limited resources have encouraged policy makers to turn to system modelling solutions. Such techniques have been available for decades, but despite ample research which demonstrates potential, their application in health services to date is limited. This presentation surveys the breadth of approaches available to support delivery and design across many areas and levels of ...

  1. Prescription Drug Use Among Adults With Chronic Conditions in South Korea: Dual Burden of Health Care Needs and Socioeconomic Vulnerability.

    Science.gov (United States)

    Jung, Youn; Byeon, Jinok; Chung, Haejoo

    2016-01-01

    The aim of this study is to identify the social determinants of prescription drug use among adults with chronic diseases by examining the associations between socioeconomic position and prescription medicine use and perceived burden for pharmaceutical expenditure, using a sample of the Korean population from the 2008 Korea Health Panel, with 4 analytic models. Controlled with health status and the type of health insurance, the probability of using prescription drugs and overall spending on drugs significantly increased with rising income level, while perceived burden for out-of-pocket payment significantly decreased. These results imply that the poor are likely to underuse prescription drugs compared with their wealthier counterparts with the same need for health care, probably due to economic barriers. PMID:26512028

  2. [Integration of mental health and chronic non-communicable diseases in Peru: challenges and opportunities for primary care settings].

    Science.gov (United States)

    Diez-Canseco, Francisco; Ipince, Alessandra; Toyama, Mauricio; Benate-Galvez, Ysabel; Galán-Rodas, Edén; Medina-Verástegui, Julio César; Sánchez-Moreno, David; Araya, Ricardo; Miranda, J Jaime

    2014-01-01

    In this article, the relationship between mental health and chronic non-communicable diseases is discussed as well as the possibility to address them in a comprehensive manner in the Peruvian health system. First, the prevalence estimates and the burden of chronic non-communicable diseases and mental disorders worldwide and in Peru are reviewed. Then, the detrimental impact of depression in the early stages as well as the progress of diabetes and cardiovascular diseases is described. Additionally, the gap between access to mental health care in Peru is analyzed. Lastly, the alternatives to reduce the gap are explored. Of these alternatives, the integration of mental health into primary care services is emphasized; as a feasible way to meet the care needs of the general population, and people with chronic diseases in particular, in the Peruvian context. PMID:24718538

  3. Bridging the chronic care gap: HealthOne Mt Druitt, Australia

    Directory of Open Access Journals (Sweden)

    Justin McNab

    2015-09-01

    Full Text Available HealthOne was part of a state-wide initiative to invest in new community-based facilities for collocating services. The HealthOne Mount Druitt is a virtual hub and spoke organisation established in 2006 in a socially disadvantaged part of Western Sydney based out of a new community health hub. The model is based on ‘virtual’ care planning and aims to improve coordination of care for older people with complex health needs, reduce unnecessary hospitalisations and ensure appropriate referral to community and specialist health services. General practitioner liaison nurses (GPLNs work closely with clients as well as general practitioners (GPs and other health care providers. Primary health care providers reported improved communication and coordination of services, and there have been lower levels of utilisation of the emergency department (ED for patients following enrolment in the programme. HealthOne provides an example of how a virtual organisation together with highly skilled care coordinators can overcome some of the barriers to providing integrated care created by fragmented funding streams and care delivery systems.

  4. Bridging the chronic care gap: HealthOne Mt Druitt, Australia.

    Science.gov (United States)

    McNab, Justin; Gillespie, James A

    2015-01-01

    HealthOne was part of a state-wide initiative to invest in new community-based facilities for collocating services. The HealthOne Mount Druitt is a virtual hub and spoke organisation established in 2006 in a socially disadvantaged part of Western Sydney based out of a new community health hub. The model is based on 'virtual' care planning and aims to improve coordination of care for older people with complex health needs, reduce unnecessary hospitalisations and ensure appropriate referral to community and specialist health services. General practitioner liaison nurses (GPLNs) work closely with clients as well as general practitioners (GPs) and other health care providers. Primary health care providers reported improved communication and coordination of services, and there have been lower levels of utilisation of the emergency department (ED) for patients following enrolment in the programme. HealthOne provides an example of how a virtual organisation together with highly skilled care coordinators can overcome some of the barriers to providing integrated care created by fragmented funding streams and care delivery systems. PMID:26417210

  5. NHF-McMaster Guideline on Care Models for Haemophilia Management.

    Science.gov (United States)

    Pai, M; Key, N S; Skinner, M; Curtis, R; Feinstein, M; Kessler, C; Lane, S J; Makris, M; Riker, E; Santesso, N; Soucie, J M; Yeung, C H T; Iorio, A; Schünemann, H J

    2016-07-01

    This guideline was developed to identify evidence-based best practices in haemophilia care delivery, and discuss the range of care providers and services that are most important to optimize outcomes for persons with haemophilia (PWH) across the United States. The guideline was developed following specific methods described in detail in this supplement and based on the GRADE (Grading of Recommendations, Assessment, Development and Evaluation approach). Direct evidence from published literature and the haemophilia community, as well as indirect evidence from other chronic diseases, were reviewed, synthesized and applied to create evidence-based recommendations. The Guideline panel suggests that the integrated care model be used over non-integrated care models for PWH (conditional recommendation, moderate certainty in the evidence). For PWH with inhibitors and those at high risk for inhibitor development, the same recommendation was graded as strong, with moderate certainty in the evidence. The panel suggests that a haematologist, a specialized haemophilia nurse, a physical therapist, a social worker and round-the-clock access to a specialized coagulation laboratory be part of the integrated care team, over an integrated care team that does not include all of these components (conditional recommendation, very low certainty in the evidence). Based on available evidence, the integrated model of care in its current structure, is suggested for optimal care of PWH. There is a need for further appropriately designed studies that address unanswered questions about specific outcomes and the optimal structure of the integrated care delivery model in haemophilia. PMID:27348396

  6. Rehabilitation of women from the Middle East living with chronic pain--perceptions from health care professionals.

    Science.gov (United States)

    Zander, Viktoria; Eriksson, Henrik; Christensson, Kyllike; Müllersdorf, Maria

    2015-01-01

    Meeting patients from other countries constitutes a challenge for health care. The purpose of this study was to increase knowledge about tacit understandings of treatment in practice by determining the perceptions of chronic pain and rehabilitation directed to resettled women from the Middle East, from a variety of health care professionals within primary care. Based on the results, we find a need to support and increase knowledge among health care professionals to involve the patient and consider her beliefs, expectations, background, current life situation, and spirituality, and to involve family in rehabilitation. PMID:25513750

  7. Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

    OpenAIRE

    Turner Barbara J; Granieri Evelyn; Papaleontiou Maria; Moore Alison A; Spitz Aerin; Reid M

    2011-01-01

    Abstract Background The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Methods Six focus groups were conduct...

  8. Self-care and risk reduction habits in older injection drug users with chronic wounds: a cross-sectional study

    OpenAIRE

    Smith, Maria Elisa; Robinowitz, Natanya; Chaulk, Patrick; Johnson, Kristine E.

    2014-01-01

    Background We surveyed a population of injection drug users (IDUs) frequenting the mobile Baltimore City Needle Exchange Program (BNEP) to investigate self-care factors associated with chronic wounds, a significant cause of morbidity especially among older IDUs. Methods Participants ≥18 years old completed a survey regarding chronic wounds (duration ≥8 weeks), injection and hygiene practices. Study staff visually verified the presence of wounds. Participants were categorized into four groups ...

  9. Managing severe burn injuries: challenges and solutions in complex and chronic wound care

    Directory of Open Access Journals (Sweden)

    Rogers AD

    2016-06-01

    Full Text Available Alan D Rogers, Marc G Jeschke Ross Tilley Burn Centre, Division of Plastic and Reconstructive Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada Abstract: Encountered regularly by health care providers across both medical and surgical fields and an increasing socioeconomic burden globally, wound care is severely neglected. Practice is heavily influenced by anecdote rather than evidence-based protocols and industry-biased literature rather than robust randomized controlled trials. Burn units are well placed to address this considerable need, as a result of their infrastructure, their multispecialty staffing, and their need to evolve in light of the declining incidence of major burn injury in developed countries. The aim of this review is to evaluate some of the ideological and practical challenges facing wound practitioners and burn surgeons while managing chronic and complex wounds. It also includes an approach to wound assessment and how to conceptualize and implement dressing strategies and new and existing multimodal therapies. Keywords: negative pressure wound therapy, instillation, antiseptic solutions, dressings, multidisciplinary wound care, stem cells, surgery, autograft, allograft, reconstructive ladder

  10. Amount of health care and self-care following a randomized clinical trial comparing flexion-distraction with exercise program for chronic low back pain

    Directory of Open Access Journals (Sweden)

    Keenum Michael

    2006-08-01

    Full Text Available Abstract Background Previous clinical trials have assessed the percentage of participants who utilized further health care after a period of conservative care for low back pain, however no chiropractic clinical trial has determined the total amount of care during this time and any differences based on assigned treatment group. The objective of this clinical trial follow-up was to assess if there was a difference in the total number of office visits for low back pain over one year after a four week clinical trial of either a form of physical therapy (Exercise Program or a form of chiropractic care (Flexion Distraction for chronic low back pain. Methods In this randomized clinical trial follow up study, 195 participants were followed for one year after a four-week period of either a form of chiropractic care (FD or a form of physical therapy (EP. Weekly structured telephone interview questions regarded visitation of various health care practitioners and the practice of self-care for low back pain. Results Participants in the physical therapy group demonstrated on average significantly more visits to any health care provider and to a general practitioner during the year after trial care (p Conclusion During a one-year follow-up, participants previously randomized to physical therapy attended significantly more health care visits than those participants who received chiropractic care.

  11. Comparison of acute physiology and chronic health evaluation II and acute physiology and chronic health evaluation IV to predict intensive care unit mortality

    Directory of Open Access Journals (Sweden)

    Bashu Dev Parajuli

    2015-01-01

    Full Text Available Context: Clinical assessment of severity of illness is an essential component of medical practice to predict the outcome of critically ill-patient. Acute Physiology and Chronic Health Evaluation (APACHE model is one of the widely used scoring systems. Aims: This study was designed to evaluate the Performance of APACHE II and IV scoring systems in our Intensive Care Unit (ICU. Settings and Design: A prospective study in 6 bedded ICU, including 76 patients all above 15 years. Subjects and Methods: APACHE II and APACHE IV scores were calculated based on the worst values in the first 24 h of admission. All enrolled patients were followed, and outcome was recorded as survivors or nonsurvivors. Statistical Analysis Used: SPSS version 17. Results: The mean APACHE score was significantly higher among nonsurvivors than survivors (P < 0.005. Discrimination for APACHE II and APACHE IV was fair with area under receiver operating characteristic curve of 0.73 and 0.79 respectively. The cut-off point with best Youden index for APACHE II was 17 and for APACHE IV was 85. Above cut-off point, mortality was higher for both models (P < 0.005. Hosmer-Lemeshow Chi-square coefficient test showed better calibration for APACHE II than APACHE IV. A positive correlation was seen between the models with Spearman′s correlation coefficient of 0.748 (P < 0.01. Conclusions: Discrimination was better for APACHE IV than APACHE II model however Calibration was better for APACHE II than APACHE IV model in our study. There was good correlation between the two models observed in our study.

  12. A meta-analysis of hypnosis for chronic pain problems: a comparison between hypnosis, standard care, and other psychological interventions.

    Science.gov (United States)

    Adachi, Tomonori; Fujino, Haruo; Nakae, Aya; Mashimo, Takashi; Sasaki, Jun

    2014-01-01

    Hypnosis is regarded as an effective treatment for psychological and physical ailments. However, its efficacy as a strategy for managing chronic pain has not been assessed through meta-analytical methods. The objective of the current study was to conduct a meta-analysis to assess the efficacy of hypnosis for managing chronic pain. When compared with standard care, hypnosis provided moderate treatment benefit. Hypnosis also showed a moderate superior effect as compared to other psychological interventions for a nonheadache group. The results suggest that hypnosis is efficacious for managing chronic pain. Given that large heterogeneity among the included studies was identified, the nature of hypnosis treatment is further discussed. PMID:24256477

  13. A chronic ulcerative colitis model in rats

    Institute of Scientific and Technical Information of China (English)

    Li Zheng; Zhen Qiang Gao; Shu Xian Wang

    2000-01-01

    @@ INTRODUCTION In recent years, there have been many reports about animal model to investigate drugs for inflammatory bowel diseases (IBD). The experimental animal model often used is acetic acid-induced damage of colonic muscosa. In the present study, this animal model was investigated by administering various concentrations of TNBS.

  14. Chronic subordinate colony housing (CSC as a model of chronic psychosocial stress in male rats.

    Directory of Open Access Journals (Sweden)

    Kewir D Nyuyki

    Full Text Available Chronic subordinate colony housing (CSC is an adequate and reliable mouse model of chronic psychosocial stress, resulting in reduced body weight gain, reduced thymus and increased adrenal weight, long-lasting anxiety-like behaviour, and spontaneous colitis. Furthermore, CSC mice show increased corticotrophin (ACTH responsiveness to acute heterotypic stressors, suggesting a general mechanism which allows a chronically-stressed organism to adequately respond to a novel threat. Therefore, the aim of the present study was to extend the CSC model to another rodent species, namely male Wistar rats, and to characterize relevant physiological, immunological, and behavioural consequences; placing particular emphasis on changes in hypothalamo-pituitary-adrenal (HPA axis responsiveness to an acute heterotypic stressor. In line with previous mouse data, exposure of Wistar rats to 19 days of CSC resulted in a decrease in body weight gain and absolute thymus mass, mild colonic barrier defects and intestinal immune activation. Moreover, no changes in stress-coping behaviour or social preference were seen; again in agreement with the mouse paradigm. Most importantly, CSC rats showed an increased plasma corticosterone response to an acute heterotypic stressor (open arm, 5 min despite displaying similar basal levels and similar basal and stressor-induced plasma ACTH levels. In contrast to CSC mice, anxiety-related behaviour and absolute, as well as relative adrenal weights remained unchanged in CSC rats. In summary, the CSC paradigm could be established as an adequate model of chronic psychosocial stress in male rats. Our data further support the initial hypothesis that adrenal hyper-responsiveness to ACTH during acute heterotypic stressors represents a general adaptation, which enables a chronically-stressed organism to adequately respond to novel challenges.

  15. Leadership models in health care - a case for servant leadership.

    Science.gov (United States)

    Trastek, Victor F; Hamilton, Neil W; Niles, Emily E

    2014-03-01

    Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients. PMID:24486078

  16. Psychometric properties of the patient assessment of chronic illness care measure: acceptability, reliability and validity in United Kingdom patients with long-term conditions

    Directory of Open Access Journals (Sweden)

    Rick Jo

    2012-08-01

    Full Text Available Abstract Background The Patient Assessment of Chronic Illness Care (PACIC is a US measure of chronic illness quality of care, based on the influential Chronic Care Model (CCM. It measures a number of aspects of care, including patient activation; delivery system design and decision support; goal setting and tailoring; problem-solving and contextual counselling; follow-up and coordination. Although there is developing evidence of the utility of the scale, there is little evidence about its performance in the United Kingdom (UK. We present preliminary data on the psychometric performance of the PACIC in a large sample of UK patients with long-term conditions. Method We collected PACIC, demographic, clinical and quality of care data from patients with long-term conditions across 38 general practices, as part of a wider longitudinal study. We assess rates of missing data, present descriptive and distributional data, assess internal consistency, and test validity through confirmatory factor analysis, and through associations between PACIC scores, patient characteristics and related measures. Results There was evidence that rates of missing data were high on PACIC (9.6% - 15.9%, and higher than on other scales used in the same survey. Most PACIC sub-scales showed reasonable levels of internal consistency (alpha = 0.68 – 0.94, responses did not demonstrate high skewness levels, and floor effects were more frequent (up to 30.4% on the follow up and co-ordination subscale than ceiling effects (generally Conclusion The importance of improving care for long-term conditions means that the development and validation of measures is a priority. The PACIC scale has demonstrated potential utility in this regard, but further assessment is required to assess low levels of completion of the scale, and to explore the performance of the scale in predicting outcomes and assessing the effects of interventions.

  17. Expanded Medical Home Model Works for Children in Foster Care

    Science.gov (United States)

    Jaudes, Paula Kienberger; Champagne, Vince; Harden, Allen; Masterson, James; Bilaver, Lucy A.

    2012-01-01

    The Illinois Child Welfare Department implemented a statewide health care system to ensure that children in foster care obtain quality health care by providing each child with a medical home. This study demonstrates that the Medical Home model works for children in foster care providing better health outcomes in higher immunization rates. These…

  18. Opportunities to diagnose chronic obstructive pulmonary disease in routine care in the UK

    DEFF Research Database (Denmark)

    Jones, Rupert C M; Price, David; Ryan, Dermot;

    2014-01-01

    BACKGROUND: Patterns of health-care use and comorbidities present in patients in the period before diagnosis of chronic obstructive pulmonary disease (COPD) are unknown. We investigated these factors to inform future case-finding strategies. METHODS: We did a retrospective analysis of a clinical......,856 (58%) of 22,286 in the 6-10 years before diagnosis, in 3943 (42%) of 9351 in the 11-15 years before diagnosis; and in 95 (8%) of 1167 in the 16-20 years before diagnosis. Between 1990 and 2009, we noted decreases in the age at diagnosis (0·05 years of age per year, 95% CI 0·03-0·07) and yearly...

  19. Catastrophic Health Care Expenditure among Older People with Chronic Diseases in 15 European Countries

    Science.gov (United States)

    Arsenijevic, Jelena; Pavlova, Milena; Rechel, Bernd; Groot, Wim

    2016-01-01

    Introduction It is well-known that the prevalence of chronic diseases is high among older people, especially those who are poor. Moreover, chronic diseases can result in catastrophic health expenditure. The relationship between chronic diseases and their financial burden on households is thus double-sided, as financial difficulties can give rise to, and result from, chronic diseases. Our aim was to examine the levels of catastrophic health expenditure imposed by private out-of-pocket payments among older people diagnosed with diabetes mellitus, cardiovascular diseases and cancer in 15 European countries. Methods The SHARE dataset for individuals aged 50+ and their households, collected in 2010–2012 was used. The total number of participants included in this study was N = 51,661. The sample consisted of 43.8% male and 56.2% female participants. The average age was 67 years. We applied an instrumental variable approach for binary instrumented variables known as a treatment-effect model. Results We found that being diagnosed with diabetes mellitus and cardiovascular diseases was associated with catastrophic health expenditure among older people even in comparatively wealthy countries with developed risk-pooling mechanisms. When compared to the Netherlands (the country with the lowest share of out-of-pocket payments as a percentage of total health expenditure in our study), older people diagnosed with diabetes mellitus in Portugal, Poland, Denmark, Italy, Switzerland, Belgium, the Czech Republic and Hungary were more likely to experience catastrophic health expenditure. Similar results were observed for diagnosed cardiovascular diseases. In contrast, cancer was not associated with catastrophic health expenditure. Discussion Our study shows that older people with diagnosed chronic diseases face catastrophic health expenditure even in some of the wealthiest countries in Europe. The effect differs across chronic diseases and countries. This may be due to different socio

  20. Primary care physicians’ perspectives on computer-based health risk assessment tools for chronic diseases: a mixed methods study

    OpenAIRE

    Teja Voruganti; Mary Ann O'Brien; Straus, Sharon E; McLaughlin, John R.; Eva Grunfeld

    2015-01-01

    Background Health risk assessment tools compute an individual’s risk of developing a disease. Routine use of such tools by primary care physicians (PCPs) is potentially useful in chronic disease prevention. We sought physicians’ awareness and perceptions of the usefulness, usability and feasibility of performing assessments with computer-based risk assessment tools in primary care settings.Methods Focus groups and usability testing with a computer-based risk assessment tool were conducted wit...

  1. Knowledge, Attitudes and Beliefs about Chronic Noncancer Pain in Primary Care: a Canadian Survey of Physicians and Pharmacists

    OpenAIRE

    Lyne Lalonde; Vincent Leroux-Lapointe; Manon Choinière; Elisabeth Martin; David Lussier; Djamal Berbiche; Diane Lamarre; Robert Thiffault; Ghaya Jouini; Sylvie Perreault

    2014-01-01

    BACKGROUND: Primary care providers’ knowledge, attitudes and beliefs (KAB) regarding chronic noncancer pain (CNCP) are a barrier to optimal management. OBJECTIVES: To evaluate and identify the determinants of the KAB of primary care physicians and pharmacists, and to document clinician preferences regarding the content and format of a continuing education program (CEP). METHOD: Physicians and pharmacists of 486 CNCP patients participated. Physicians completed the original version of the KnowP...

  2. Managing Complexity in Chronic Care: An overview of the VA State-of-the-Art (SOTA) Conference

    OpenAIRE

    Weiss, Kevin B.

    2007-01-01

    Introduction The aging of the population and the increasing prevalence of multiple chronic illnesses, along with multiplying options for clinical management, pose great challenges to both the Veterans Health Administration (VHA) and the broader US health care system. Developing effective and efficient health care for persons with complex and multiple medical conditions is a national priority. Therefore, research in this area is critically important. In 2006, the VHA Health Services Research a...

  3. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions.

    Science.gov (United States)

    Darkins, Adam; Ryan, Patricia; Kobb, Rita; Foster, Linda; Edmonson, Ellen; Wakefield, Bonnie; Lancaster, Anne E

    2008-12-01

    Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Demographic changes in the veteran population necessitate VHA increase its noninstitutional care (NIC) services 100% above its 2007 level to provide care for 110,000 NIC patients by 2011. By 2011, CCHT will meet 50% of VHA's anticipated NIC provision. CCHT involves the systematic implementation of health informatics, home telehealth, and disease management technologies. It helps patients live independently at home. Between 2003 and 2007, the census figure (point prevalence) for VHA CCHT patients increased from 2,000 to 31,570 (1,500% growth). CCHT is now a routine NIC service provided by VHA to support veteran patients with chronic conditions as they age. CCHT patients are predominantly male (95%) and aged 65 years or older. Strict criteria determine patient eligibility for enrollment into the program and VHA internally assesses how well its CCHT programs meet standardized clinical, technology, and managerial requirements. VHA has trained 5,000 staff to provide CCHT. Routine analysis of data obtained for quality and performance purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrolment into the program. The cost of CCHT is $1,600 per patient per annum, substantially less than other NIC programs and nursing home care. VHA's experience is that an enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings. PMID:19119835

  4. Primary care providers' perspective on prescribing opioids to older adults with chronic non-cancer pain: A qualitative study

    Directory of Open Access Journals (Sweden)

    Turner Barbara J

    2011-07-01

    Full Text Available Abstract Background The use of opioid medications as treatment for chronic non-cancer pain remains controversial. Little information is currently available regarding healthcare providers' attitudes and beliefs about this practice among older adults. This study aimed to describe primary care providers' experiences and attitudes towards, as well as perceived barriers and facilitators to prescribing opioids as a treatment for chronic pain among older adults. Methods Six focus groups were conducted with a total of 23 physicians and three nurse practitioners from two academically affiliated primary care practices and three community health centers located in New York City. Focus groups were audiotape recorded and transcribed. The data were analyzed using directed content analysis; NVivo software was used to assist in the quantification of identified themes. Results Most participants (96% employed opioids as therapy for some of their older patients with chronic pain, although not as first-line therapy. Providers cited multiple barriers, including fear of causing harm, the subjectivity of pain, lack of education, problems converting between opioids, and stigma. New barriers included patient/family member reluctance to try an opioid and concerns about opioid abuse by family members/caregivers. Studies confirming treatment benefit, validated tools for assessing risk and/or dosing for comorbidities, improved conversion methods, patient education, and peer support could facilitate opioid prescribing. Participants voiced greater comfort using opioids in the setting of delivering palliative or hospice care versus care of patients with chronic pain, and expressed substantial frustration managing chronic pain. Conclusions Providers perceive multiple barriers to prescribing opioids to older adults with chronic pain, and use these medications cautiously. Establishing the long-term safety and efficacy of these medications, generating improved prescribing methods

  5. Psychiatric morbidity, pain perception, and functional status of chronic pain patients in palliative care

    Directory of Open Access Journals (Sweden)

    V Rajmohan

    2013-01-01

    Full Text Available Context: Psychological factors, such as that exist when we experience pain, can profoundly alter the strength of pain perception. Aim: The study aims to estimate the prevalence of psychiatric disorders, and its association with perception of pain and functional status in chronic patients in palliative care. Materials and Methods: The sample was selected via simple randomisation and post consent were assessed using (1 a semi- structured questionnaire to elicit socio-demographic information and medical data (2 Brief Pain Inventory (3 ICD-10 Symptom Checklist (4 ICD-10-Diagnostic Criteria for Research (DCR (5 Montgomery Asberg Depression Rating Scale (MADRS (6 Covi Anxiety Rating Scale (7 Karnofsky Performance Status Scale. Data was analysed using independent sample t test and chi square test. Results: The psychiatric morbidity was 67% with depression and adjustment disorders being the major diagnosis. There was a significant association between psychiatric morbidity pain variables (P = 0.000. Psychiatric morbidity significantly impaired activity, mood, working, walk, sleep, relationship, and enjoyment. There was no association between aetiology of pain, type of cancer, treatment for primary condition and treatment for pain and psychiatric morbidity. The functional status of cancer patients was also poorer in patients with psychiatric morbidity (P = 0.008. Conclusion: There is a high prevalence of psychiatric illness in chronic pain patients of any aetiology. Psychiatric morbidity is associated with increased pain perception, impairment in activity and poor functional status.

  6. A mHealth Application for Chronic Wound Care: Findings of a User Trial

    Directory of Open Access Journals (Sweden)

    Marcia R. Friesen

    2013-11-01

    Full Text Available This paper reports on the findings of a user trial of a mHealth application for pressure ulcer (bedsore documentation. Pressure ulcers are a leading iatrogenic cause of death in developed countries and significantly impact quality of life for those affected. Pressure ulcers will be an increasing public health concern as the population ages. Electronic information systems are being explored to improve consistency and accuracy of documentation, improve patient and caregiver experience and ultimately improve patient outcomes. A software application was developed for Android Smartphones and tablets and was trialed in a personal care home in Western Canada. The software application provides an electronic medical record for chronic wounds, replacing nurses’ paper-based charting and is positioned for integration with facility’s larger eHealth framework. The mHealth application offers three intended benefits over paper-based charting of chronic wounds, including: (1 the capacity for remote consultation (telehealth between facilities, practitioners, and/or remote communities, (2 data organization and analysis, including built-in alerts, automatically-generated text-based and graph-based wound histories including wound images, and (3 tutorial support for non-specialized caregivers. The user trial yielded insights regarding the software application’s design and functionality in the clinical setting, and highlighted the key role of wound photographs in enhancing patient and caregiver experiences, enhancing communication between multiple healthcare professionals, and leveraging the software’s telehealth capacities.

  7. Nursing care gestion of chronically ill elderly people. Policlinico 2, year 2007

    Directory of Open Access Journals (Sweden)

    Liudmila Carbonell Sanamé

    2009-01-01

    Full Text Available A descriptive prospective study was made to those patients aged more than 60 years who are attended in the Policlinico 2 “Leonilda Tamayo Matos” in Isla de la Juventud during the year 2007. The study population was 1254 and 700 chronically ill elderly people were taken as representative sample, using a simple random sampling. The Mini Mental State Examination and a satisfaction survey was made to old people, all these with their informed consent. The main variables to study were: sex, age, race, civil state, educational level, work, assistance to the Grandparent’s Circle and satisfaction level. There exists a feminine predominance (61% over male, as well as the age group from 60 to 64 years old. Mixed race is the most common one (43%, followed by black (35%. 43% of these elders have secondary studies, and 64% of them are retired. The assistance to the Grandparent’s Circle is good, 338 of all the elders studied (48.2% assist to it. The results were expressed with real numbers and percentages, and were represented in bar and pie charts. There exists a predominance of arterial hypertension and diabetes mellitus in the elders studied. The quality of the nursing cares to the chronically ill old people of the policlinic 2 in 2007 was good.

  8. Caring for patients with chronic kidney disease: a joint opinion of the ambulatory care and the nephrology practice and research networks of the American College of Clinical Pharmacy.

    Science.gov (United States)

    Zillich, Alan J; Saseen, Joseph J; Dehart, Renee M; Dumo, Peter; Grabe, Darren W; Gilmartin, Cheryl; Hachey, David M; Hudson, Joanna Q; Pruchnicki, Maria C; Joy, Melanie S

    2005-01-01

    An increasing number of patients are developing chronic kidney disease (CKD). Appropriate care for patients with CKD must occur in the earliest stages, preferably before CKD progresses to more severe stages. Therefore, recognition and treatment of CKD and its associated complications must occur in primary care settings. Patients with CKD often have comorbid conditions such as diabetes mellitus, hypertension, and dyslipidemia, creating specific considerations when treating these diseases. Also, these patients have CKD-related conditions, including anemia and renal osteodystrophy, that are not traditionally evaluated and monitored by the primary care practitioner. Collectively, many opportunities exist for pharmacists who practice in the primary care setting to improve the care of patients with CKD. PMID:15767229

  9. Predictive validity of behavioural animal models for chronic pain

    OpenAIRE

    Berge, Odd-Geir

    2011-01-01

    Rodent models of chronic pain may elucidate pathophysiological mechanisms and identify potential drug targets, but whether they predict clinical efficacy of novel compounds is controversial. Several potential analgesics have failed in clinical trials, in spite of strong animal modelling support for efficacy, but there are also examples of successful modelling. Significant differences in how methods are implemented and results are reported means that a literature-based comparison between precl...

  10. Sex differences in the chronic mild stress model of depression.

    Science.gov (United States)

    Franceschelli, Anthony; Herchick, Samantha; Thelen, Connor; Papadopoulou-Daifoti, Zeta; Pitychoutis, Pothitos M

    2014-09-01

    A large volume of clinical and experimental evidence documents sex differences in brain anatomy, chemistry, and function, as well as in stress and drug responses. The chronic mild stress model (CMS) is one of the most extensively investigated animal models of chronic stress. However, only a limited number of studies have been conducted in female rodents despite the markedly higher prevalence of major depression among women. Herein, we review CMS studies conducted in rats and mice of both sexes and further discuss intriguing sex-dependent behavioral and neurobiological findings. The PubMed literature search engine was used to find and collect all relevant articles analyzed in this review. Specifically, a multitermed search was performed with 'chronic mild stress', 'chronic unpredictable stress' and 'chronic variable stress' as base terms and 'sex', 'gender', 'females' and 'depression' as secondary terms in various combinations. Male and female rodents appear to be differentially affected by CMS application, depending on the behavioral, physiological, and neurobiological indices that are being measured. Importantly, the CMS paradigm, despite its limitations, has been successfully used to assess a constellation of interdisciplinary research questions in the sex differences field and has served as a 'silver bullet' in assessing the role of sex in the neurobiology of major depression. PMID:25025701

  11. [Family-centered care: A model for approaching dementia care in the community].

    Science.gov (United States)

    Esandi, Nuria; Canga, Ana

    2016-04-01

    Along with ageing population, there has been an increase in the prevalence and incidence of chronic and debilitating conditions, such as dementia which, in turn, has increased the demands for long term care in the community. This is challenging current health care systems that wish to provide an appropriate response whilst intensify its efforts to contain costs. This paper, through a critical reflection, argues for an integrative, positive, and systemic care approach, focused not only on the person with dementia but also on the entire family unit. For this purpose, it approaches the impact that dementia has for the family, and therefore for Primary Health Care professional. In addition care strategies aimed at strengthening the whole family system are suggested. PMID:26968688

  12. The Chronic Kidney Disease Model: A General Purpose Model of Disease Progression and Treatment

    Directory of Open Access Journals (Sweden)

    Patel Uptal D

    2011-06-01

    Full Text Available Abstract Background Chronic kidney disease (CKD is the focus of recent national policy efforts; however, decision makers must account for multiple therapeutic options, comorbidities and complications. The objective of the Chronic Kidney Disease model is to provide guidance to decision makers. We describe this model and give an example of how it can inform clinical and policy decisions. Methods Monte Carlo simulation of CKD natural history and treatment. Health states include myocardial infarction, stroke with and without disability, congestive heart failure, CKD stages 1-5, bone disease, dialysis, transplant and death. Each cycle is 1 month. Projections account for race, age, gender, diabetes, proteinuria, hypertension, cardiac disease, and CKD stage. Treatment strategies include hypertension control, diabetes control, use of HMG-CoA reductase inhibitors, use of angiotensin converting enzyme inhibitors, nephrology specialty care, CKD screening, and a combination of these. The model architecture is flexible permitting updates as new data become available. The primary outcome is quality adjusted life years (QALYs. Secondary outcomes include health state events and CKD progression rate. Results The model was validated for GFR change/year -3.0 ± 1.9 vs. -1.7 ± 3.4 (in the AASK trial, and annual myocardial infarction and mortality rates 3.6 ± 0.9% and 1.6 ± 0.5% vs. 4.4% and 1.6% in the Go study. To illustrate the model's utility we estimated lifetime impact of a hypothetical treatment for primary prevention of vascular disease. As vascular risk declined, QALY improved but risk of dialysis increased. At baseline, 20% and 60% reduction: QALYs = 17.6, 18.2, and 19.0 and dialysis = 7.7%, 8.1%, and 10.4%, respectively. Conclusions The CKD Model is a valid, general purpose model intended as a resource to inform clinical and policy decisions improving CKD care. Its value as a tool is illustrated in our example which projects a relationship between

  13. Primary care direct access MRI for the investigation of chronic headache

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, T.R., E-mail: timt@nhs.net [Queens Medical Centre, Nottingham (United Kingdom); Evangelou, N. [Queens Medical Centre, Nottingham (United Kingdom); Porter, H. [Nottingham Cripps Health Centre, Nottingham (United Kingdom); Lenthall, R. [Queens Medical Centre, Nottingham (United Kingdom)

    2012-01-15

    Aim: To assess the efficacy of a primary-care imaging pathway for neurology outpatients, from inception to deployment, compared with traditional outpatient referral. Materials and methods: After local agreement, guidelines were generated providing pathways for diagnosis and treatment of common causes of headache, highlighting 'red-flag' features requiring urgent neurology referral, and selecting patients for direct magnetic resonance imaging (MRI) referral. In addition, reports were clarified and standardized. To evaluate the efficacy of the access pathway, a retrospective sequential review of 100 MRI investigations was performed comparing general practitioner (GP) referral, with traditional neurology referral plus imaging, acquired before the pathway started. Results: No statistically significant difference in rates of major abnormalities, incidental findings or ischaemic lesions were identified between the two cohorts. Reported patient satisfaction was high, with a cost reduction for groups using the pathway. Conclusion: The findings of the present study suggest that a defined access pathway for imaging to investigate chronic headache can be deployed appropriately in a primary-care setting.

  14. Models for Reactive and Chronic Depression in Infancy.

    Science.gov (United States)

    Field, Tiffany

    1986-01-01

    Presents studies on primates and human infants suggesting that maternal depression may predispose the infant to chronic depression. Findings also suggest that the effect of early separations from the mother may provide a model for reactive depression in the infant. (Author/BB)

  15. A Novice User of Pediatric Emergency Point-of-Care Ultrasonography Avoids Misdiagnosis in a Case of Chronic Abdominal Distention.

    Science.gov (United States)

    Pe, Marybelle; Dickman, Eitan; Tessaro, Mark

    2016-02-01

    A 13-year-old adolescent girl with chronic abdominal distention was referred to the pediatric emergency department after the outpatient workup suggested moderate ascites. Point-of-care ultrasonography performed by the emergency physicians ruled out ascites, instead demonstrating a well-circumscribed cystic mass subsequently identified as an ovarian mucinous cystadenoma. PMID:26835571

  16. Explanatory model for nursing and care 2007

    OpenAIRE

    Jedid-Jah Jonker; Klarita Sadiraj; Isolde Woittiez; Michiel Ras; Meike Morren

    2007-01-01

    Original title: Verklaringsmodel verpleging en verzorging 2007. Population ageing means the demand for and take-up of care is likely to increase sharply in the coming years. Older people make particularly heavy use of home care, nursing homes and care homes, collectively referred to as 'nursing and care'. The Dutch Ministry of Health, Welfare and Sport is therefore interested in the likely trend in nursing and care in the coming decades. This study presents forecasts of the demand for and tak...

  17. Accuracy of diagnostic registers and management of chronic obstructive pulmonary disease: the Devon primary care audit

    Directory of Open Access Journals (Sweden)

    Marks Dawn

    2008-08-01

    Full Text Available Abstract Background Guidelines on COPD diagnosis and management encourage primary care physicians to detect the disease at an early stage and to treat patients according to their condition and needs. Problems in guideline implementation include difficulties in diagnosis, using spirometry and the disputed role of reversibility testing. These lead to inaccurate diagnostic registers and inadequacy of administered treatments. This study represents an audit of COPD diagnosis and management in primary care practices in Devon. Methods Six hundred and thirty two patients on COPD registers in primary care practices were seen by a visiting Respiratory Specialist Nurse. Diagnoses were made according to the NICE guidelines. Reversibility testing was carried out either routinely or based on clinical indication in two sub-samples. Dyspnoea was assessed. Data were entered into a novel IT-based software which computed guideline-based treatment recommendations. Current and recommended treatments were compared. Results Five hundred and eighty patients had spirometry. Diagnoses of COPD were confirmed in 422 patients (73%. Thirty nine patients were identified as asthma only, 94 had normal spirometry, 23 were restrictive and 2 had a cardiac disorder. Reversibility testing changed diagnosis of 11% of patients with airflow obstruction, and severity grading in 18%. Three quarters of patients with COPD had been offered practical help with smoking cessation. Short and long-acting anticholinergics and long acting beta-2 agonists had been under-prescribed; in 15–18% of patients they were indicated but not received. Inhaled steroids had been over-prescribed (recommended in 17%; taken by 60%, whereas only 4% of patients with a chronic productive cough were receiving mucolytics. Pulmonary rehabilitation was not available in some areas and was under-used in other areas. Conclusion Diagnostic registers of COPD in primary care contain mistakes leading to inaccurate prevalence

  18. Going to Scale: Re-Engineering Systems for Primary Care Treatment of Depression

    OpenAIRE

    Dietrich, Allen J.; Oxman, Thomas E.; Williams, John W.; Kroenke, Kurt; Schulberg, H. Charles; Bruce, Martha; Barry, Sheila L.

    2004-01-01

    BACKGROUND Recent trials have shown improved depression outcomes with chronic care models. We report the methods of a project that assesses the sustainability and transportability of a chronic care model for depression and change strategy.

  19. Models for Primary Eye Care Services in India

    Directory of Open Access Journals (Sweden)

    Vasundhra Misra

    2015-01-01

    In the current situation, an integrated health care system with primary eye care promoted by government of India is apparently the best answer. This model is both cost effective and practical for the prevention and control of blindness among the underprivileged population. Other models functioning with the newer technology of tele-ophthalmology or mobile clinics also add to the positive outcome in providing primary eye care services. This review highlights the strengths and weaknesses of various models presently functioning in the country with the idea of providing useful inputs for eye care providers and enabling them to identify and adopt an appropriate model for primary eye care services.

  20. Model of Independency Mother in Caring for Preterm Infant Based on Experiential Learning Care (ELC)

    Science.gov (United States)

    Saudah, Noer; Nursalam; Meriana; Sulistyono, Agus

    2015-01-01

    The role of parents has done less during the preterm infant care in hospitals caused dependence in caring for the baby. The objective of the research was to development a model of independence of the mother in the care of preterm infants with experiential learning approach based theory of goal attainment. Research's design used analytic…

  1. Sonic hedgehog expression in a rat model of chronic pancreatitis

    Science.gov (United States)

    Wang, Luo-Wei; Lin, Han; Lu, Yi; Xia, Wei; Gao, Jun; Li, Zhao-Shen

    2014-01-01

    AIM: To analyze the activation of sonic hedgehog (SHh) signaling pathways in a rat model of chronic pancreatitis. METHODS: Forty Wistar rats were randomly divided into 2 groups: experimental group and control group (20 rats in each group). Dibutyltin dichloride was infused into the tail vein of the rats to induce chronic pancreatitis in the experimental group. The same volume of ethanol and glycerol mixture was infused in the control group. The expression of Ptch, Smo and Gli were analyzed using immunohistochemistry, and real-time reverse transcription polymerase chain reaction (RT-PCR). RESULTS: Compared with the control group, significant histological changes in terms of the areas of abnormal architecture, glandular atrophy, fibrosis, pseudo tubular complexes, and edema were observed at week 4 in the experimental group. The expression of Ptch1, Smo and Gli1 in the pancreatic tissue increased significantly in the experimental group. Using RT-PCR, mRNA levels of Ptch, Smo and Gli in the experimental group increased significantly compared with the control group. CONCLUSION: The SHh signaling pathway is aberrantly activated in rats with chronic pancreatitis. The SHh signaling pathway plays an important role in the development of chronic pancreatitis. These results may be helpful in studies focusing on the relationship between chronic pancreatitis and pancreatic cancer. PMID:24782623

  2. Low documentation of chronic kidney disease among high-risk patients in a managed care population: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    McClellan William

    2009-09-01

    Full Text Available Abstract Background Early detection of chronic kidney disease (CKD is sub-optimal among the general population and among high risk patients. The prevalence and impact of major CKD risk factors, diabetes (DM and hypertension (HTN, on CKD documentation among managed care populations have not been previously reported. We examined this issue in a Kaiser Permanente Georgia (KPG CKD cohort. Methods KPG enrollees were included in the CKD cohort if they had eGFRs between 60 and 365 days apart that were 2. CKD documentation was defined as a presenting diagnosis of CKD by a primary care physician or nephrologist using ICD-9 event codes. The association between CKD documentation and DM and HTN were assessed with multivariate logistic regression models. Results Of the 50,438 subjects within the overall KPG CKD cohort, 20% (N = 10,266 were eligible for inclusion in the current analysis. Overall, CKD diagnosis documentation was low; only 14.4% of subjects had an event-based CKD diagnosis at baseline. Gender and types 2 diabetes interacted on CKD documentation. The prevalence of CKD documentation increased with the presence of hypertension and/or type 2 diabetes, but type 2 diabetes had a lower effect on CKD documentation. In multivariate analysis, significant predictors of CKD documentation were eGFR, hypertension, type 2 diabetes, congestive heart failure, peripheral artery disease, statin use, age and gender. CKD documentation was lower among women than similarly affected men. Conclusion Among patients with an eGFR 10-59, documentation of CKD diagnosis by primary and subspecialty providers is low within a managed care patient cohort. Gender disparities in CKD documentation observed in the general population were also present among KPG CKD enrollees.

  3. A better model for care — virtual care coordination

    OpenAIRE

    Herbert, Chris; Medd, Claire

    2012-01-01

    Telehealth is a proven tool for reducing costs, improving quality of life, reducing hospital visits/length of stay and enhancing relationships between patients and community nurses. There have been many trials demonstrating these benefits, and findings have always demonstrated return on investment. However, uptake has been slow—68% of providers have no plans to roll out a telehealth solution in the next 24 months. Through a decade of ethnographic research, Care Innovations has visited 20 coun...

  4. Strengthening Health Systems for Chronic Care: Leveraging HIV Programs to Support Diabetes Services in Ethiopia and Swaziland

    Directory of Open Access Journals (Sweden)

    Miriam Rabkin

    2012-01-01

    Full Text Available The scale-up of HIV services in sub-Saharan Africa has catalyzed the development of highly effective chronic care systems. The strategies, systems, and tools developed to support life-long HIV care and treatment are locally owned contextually appropriate resources, many of which could be adapted to support continuity care for noncommunicable chronic diseases (NCD, such as diabetes mellitus (DM. We conducted two proof-of-concept studies to further the understanding of the status of NCD programs and the feasibility and effectiveness of adapting HIV program-related tools and systems for patients with DM. In Swaziland, a rapid assessment illustrated gaps in the approaches used to support DM services at 15 health facilities, despite the existence of chronic care systems at HIV clinics in the same hospitals, health centers, and clinics. In Ethiopia, a pilot study found similar gaps in DM services at baseline and illustrated the potential to rapidly improve the quality of care and treatment for DM by adapting HIV-specific policies, systems, and tools.

  5. The implementation of integrated care: the empirical validation of the Development Model for Integrated Care

    OpenAIRE

    Ahaus Kees TB; Vermeulen Robbert P; Minkman Mirella MN; Huijsman Robbert

    2011-01-01

    Abstract Background Integrated care is considered as a strategy to improve the delivery, efficiency, client outcomes and satisfaction rates of health care. To integrate the care from multiple providers into a coherent client-focused service, a large number of activities and agreements have to be implemented like streamlining information flows and patient transfers. The Development Model for Integrated care (DMIC) describes nine clusters containing in total 89 elements that contribute to the i...

  6. Serum 1H-NMR metabolomic fingerprints of acute-on-chronic liver failure in intensive care unit patients with alcoholic cirrhosis.

    Directory of Open Access Journals (Sweden)

    Roland Amathieu

    Full Text Available INTRODUCTION: Acute-on-chronic liver failure is characterized by acute deterioration of liver function in patients with compensated or decompensated, but stable, cirrhosis. However, there is no accurate definition of acute-on-chronic liver failure and physicians often use this term to describe different clinical entities. Metabolomics investigates metabolic changes in biological systems and identifies the biomarkers or metabolic profiles. Our study assessed the metabolomic profile of serum using proton nuclear magnetic resonance ((1H-NMR spectroscopy to identify metabolic changes related to acute-on-chronic liver failure. PATIENTS: Ninety-three patients with compensated or decompensated cirrhosis (CLF group but stable liver function and 30 patients with cirrhosis and hospitalized for the management of an acute event who may be responsible of acute-on-chronic liver failure (ACLF group, were fully analyzed. Blood samples were drawn at admission, and sera were separated and stored at -80°C until (1H-NMR spectral analysis. Using orthogonal projection to latent-structure discriminant analyses, various metabolites contribute to the complete separation between these both groups. RESULTS: The predictability of the model was 0.73 (Q(2 Y and the explained variance was 0.63 (R(2 Y. The main metabolites that had increased signals related to acute-on-chronic liver failure were lactate, pyruvate, ketone bodies, glutamine, phenylalanine, tyrosine, and creatinine. High-density lipids were lower in the ALCF group than in CLF group. CONCLUSION: A serum metabolite fingerprint for acute-on-chronic liver failure, obtained with (1H-NMR, was identified. Metabolomic profiling may aid clinical evaluation of patients with cirrhosis admitted into intensive care units with acute-on-chronic liver failure, and provide new insights into the metabolic processes involved in acute impairment of hepatic function.

  7. Caring as Career: An Alternative Model for Educational Administration.

    Science.gov (United States)

    Marshall, Catherine; And Others

    This paper identifies four models of educational administration--the rational, mechanistic, organic, and bargaining models--and argues that a fifth model of leadership--a caring model--is needed. The ethic of caring (Nodding, 1986) is reciprocal, natural, and ethical and emphasizes connection, responsibilities, and relationships. Creating a model…

  8. The Role of Social Workers in Spiritual Care to Facilitate Coping With Chronic Illness and Self-Determination in Advance Care Planning.

    Science.gov (United States)

    Francoeur, Richard B; Burke, Nancy; Wilson, Alicia M

    2016-01-01

    Spiritual values and beliefs of patients and families influence resilience during chronic illness and shape patient choices during advance care planning. The spiritual needs of Baby Boomers will be more diverse than previous generations, in connection with the questioning, experimental mind-set of this group and the fact that it includes a higher proportion of immigrant populations outside the Judeo-Christian tradition. Social workers are trained explicitly to intervene with diverse populations and are well positioned to offer spiritual support in ways that do not necessarily conform to traditional religions. To the extent of their individual expertise and competence, social workers should assess and provide spiritual care to clients, including those who either are underserved or prefer not to seek assistance from clergy or chaplains because they feel alienated from religious institutions and representatives. They should also be aware of ethical dilemmas in consulting with spiritual care professionals in developing spiritual interventions. Social work education should address clients' humanistic and existential concerns, beliefs and behaviors of the major religions, and forms of nontraditional religious and spiritual experiences; it should also provide experiential opportunities for engaging with grief and earlier advance care planning. There should be attention to different theodical perspectives of the major religions regarding the problem of good and evil, which may preoccupy even clients who no longer participate in organized religion, because these unresolved existential issues may weaken client coping with chronic conditions and may diminish clarity and self-awareness for engaging authentically and effectively in advance care planning. PMID:27187806

  9. Traumatization and chronic pain: a further model of interaction.

    Science.gov (United States)

    Egloff, Niklaus; Hirschi, Anna; von Känel, Roland

    2013-01-01

    Up to 80% of patients with severe posttraumatic stress disorder are suffering from "unexplained" chronic pain. Theories about the links between traumatization and chronic pain have become the subject of increased interest over the last several years. We will give a short summary about the existing interaction models that emphasize particularly psychological and behavioral aspects of this interaction. After a synopsis of the most important psychoneurobiological mechanisms of pain in the context of traumatization, we introduce the hypermnesia-hyperarousal model, which focuses on two psychoneurobiological aspects of the physiology of learning. This hypothesis provides an answer to the hitherto open question about the origin of pain persistence and pain sensitization following a traumatic event and also provides a straightforward explanatory model for educational purposes. PMID:24231792

  10. Role of community pharmacists in asthma – Australian research highlighting pathways for future primary care models

    OpenAIRE

    Saini B; Krass I.; Smith L; Bosnic-Anticevich S; Armour C

    2011-01-01

    Asthma is one of the most common chronic conditions affecting the Australian population. Amongst primary healthcare professionals, pharmacists are the most accessible and this places pharmacists in an excellent position to play a role in the management of asthma. Globally, trials of many community pharmacy-based asthma care models have provided evidence that pharmacist delivered interventions can improve clinical, humanistic and economic outcomes for asthma patients. In Australia, a decade o...

  11. Protocol and baseline data from The Inala Chronic Disease Management Service evaluation study: a health services intervention study for diabetes care

    OpenAIRE

    Ware Robert S; Jackson Claire L; Askew Deborah A; Russell Anthony

    2010-01-01

    Abstract Background Type 2 Diabetes Mellitus is one of the most disabling chronic conditions worldwide, resulting in significant human, social and economic costs and placing huge demands on health care systems. The Inala Chronic Disease Management Service aims to improve the efficiency and effectiveness of care for patients with type 2 diabetes who have been referred by their general practitioner to a specialist diabetes outpatient clinic. Care is provided by a multidisciplinary, integrated t...

  12. [Part II. Scientific evidence in end-stage chronic organ failure. A position paper on shared care planning].

    Science.gov (United States)

    Gristina, Giuseppe R; Orsi, Luciano; Carlucci, Annalisa; Causarano, Ignazio R; Formica, Marco; Romanò, Massimo

    2014-01-01

    The therapeutic options related to chronic organ failure are interconnected to the variability of human biological responses and the personal history and choices of the chronically ill patient on one hand, and with the variable human answers to therapies on the other hand. All these aspects may explain the small number and low quality of studies aimed to define the clinical criteria useful in identifying end-stage chronically ill patients, as highlighted through the 2012-2013 Medline survey performed by the task force. These results prevented the grading of scientific evidence. However, taking into account the evidence based medicine definition, the task force believes the clinical reasoning and the individual experience of clinicians as well as the patients and families preferences cannot be replaced "tout court" with a strict methodological research. Accordingly, the working method selected by the task force members was to draw up a set of clinical parameters based on the available scientific literature, submitting it to a peer review process carried out by an expert panel. This paper discusses a set of clinical parameters included in the clinical decision-making algorithm and shared by nine medical societies. For each chronic organ failure these clinical parameters should be intended not as a rigid cutoff system to make a choice between two selected care options (intensive vs palliative), rather as the starting point for a joint and careful consideration regarding the opportunity to adopt the clinical decision-making algorithm care proposed in Part I. PMID:24553593

  13. Development of an Automated Healthcare Kiosk for the Management of Chronic Disease Patients in the Primary Care Setting.

    Science.gov (United States)

    Ng, Grace; Tan, Nicolette; Bahadin, Juliana; Shum, Eugene; Tan, Sze Wee

    2016-07-01

    An increase in the prevalence of chronic disease has led to a rise in the demand for primary healthcare services in many developed countries. Healthcare technology tools may provide the leverage to alleviate the shortage of primary care providers. Here we describe the development and usage of an automated healthcare kiosk for the management of patients with stable chronic disease in the primary care setting. One-hundred patients with stable chronic disease were recruited from a primary care clinic. They used a kiosk in place of doctors' consultations for two subsequent follow-up visits. Patient and physician satisfaction with kiosk usage were measured on a Likert scale. Kiosk blood pressure measurements and triage decisions were validated and optimized. Patients were assessed if they could use the kiosk independently. Patients and physicians were satisfied with all areas of kiosk usage. Kiosk triage decisions were accurate by the 2nd month of the study. Blood pressure measurements by the kiosk were equivalent to that taken by a nurse (p = 0.30, 0.14). Independent kiosk usage depended on patients' language skills and educational levels. Healthcare kiosks represent an alternative way to manage patients with stable chronic disease. They have the potential to replace physician visits and improve access to primary healthcare. Patients welcome the use of healthcare technology tools, including those with limited literacy and education. Optimization of environmental and patient factors may be required prior to the implementation of kiosk-based technology in the healthcare setting. PMID:27240840

  14. Systematic age-related differences in chronic disease management in a population-based cohort study: a new paradigm of primary care is required.

    Directory of Open Access Journals (Sweden)

    Alessandra Buja

    Full Text Available BACKGROUND: Our interest in chronic conditions is due to the fact that, worldwide, chronic diseases have overtaken infectious diseases as the leading cause of death and disability, so their management represents an important challenge for health systems. The aim of this study was to compare the performance of primary health care services in managing diabetes, congestive heart failure (CHF and coronary heart disease (CHD, by age group. METHODS: This population-based retrospective cohort study was conducted in Italy, enrolling 1,948,622 residents ≥ 16 years old. A multilevel regression model was applied to analyze compliance to care processes with explanatory variables at both patient and district level, using age group as an independent variable, and adjusting for sex, citizenship, disease duration, and Charlson index on the first level, and for District Health Unit on the second level. RESULTS: The quality of chronic disease management showed an inverted U-shaped relationship with age. In particular, our findings indicate lower levels for young adults (16-44 year-olds, adults (45-64, and oldest old (+85 than for patients aged 65-74 in almost all quality indicators of CHD, CHF and diabetes management. Young adults (16-44 y, adults (45-64 y, the very old (75-84 y and the oldest old (+85 y patients with CHD, CHF and diabetes are less likely than 65-74 year-old patients to be monitored and treated using evidence-based therapies, with the exceptions of echocardiographic monitoring for CHF in young adult patients, and renal monitoring for CHF and diabetes in the very old. CONCLUSION: Our study shows that more effort is needed to ensure that primary health care systems are sensitive to chronic conditions in the young and in the very elderly.

  15. Comparative Effectiveness of Risk-Stratified Care Management in Reducing Readmissions in Medicaid Adults With Chronic Disease.

    Science.gov (United States)

    Hewner, Sharon; Wu, Yow-Wu Bill; Castner, Jessica

    2016-01-01

    Hospitalized adult Medicaid recipients with chronic disease are at risk for rehospitalization within 90 days of discharge, but most research has focused on the Medicare population. The purpose of this study is to examine the impact of population-based care management intensity on inpatient readmissions in Medicaid adults with pre-existing chronic disease. Retrospective analyses of 2,868 index hospital admissions from 2012 New York State Medicaid Data Warehouse claims compared 90-day post-discharge utilization in populations with and without transitional care management interventions. High intensity managed care organization interventions were associated with higher outpatient and lower emergency department post-discharge utilization than low intensity fee-for-service management. However, readmission rates were higher for the managed care cases. Shorter time to readmission was associated with managed care, diagnoses that include heart and kidney failure, shorter length of stay for index hospitalization, and male sex; with no relationship to age. This unexpected result flags the need to re-evaluate readmission as a quality indicator in the complex Medicaid population. Quality improvement efforts should focus on care continuity during transitions and consider population-specific factors that influence readmission. Optimum post-discharge utilization in the Medicaid population requires a balance between outpatient, emergency and inpatient services to improve access and continuity. PMID:26730804

  16. Predictive models for ocular chronic graft-versus-host disease diagnosis and disease activity in transplant clinical practice.

    Science.gov (United States)

    Curtis, Lauren M; Datiles, Manuel B; Steinberg, Seth M; Mitchell, Sandra A; Bishop, Rachel J; Cowen, Edward W; Mays, Jacqueline; McCarty, John M; Kuzmina, Zoya; Pirsl, Filip; Fowler, Daniel H; Gress, Ronald E; Pavletic, Steven Z

    2015-09-01

    Ocular chronic graft-versus-host disease is one of the most bothersome common complications following allogeneic hematopoietic stem cell transplantation. The National Institutes of Health Chronic Graft-versus-Host Disease Consensus Project provided expert recommendations for diagnosis and organ severity scoring. However, ocular chronic graft-versus-host disease can be diagnosed only after examination by an ophthalmologist. There are no currently accepted definitions of ocular chronic graft-versus-host disease activity. The goal of this study was to identify predictive models of diagnosis and activity for use in clinical transplant practice. A total of 210 patients with moderate or severe chronic graft-versus-host disease were enrolled in a prospective, cross-sectional, observational study (clinicaltrials.gov identifier: 00092235). Experienced ophthalmologists determined presence of ocular chronic graft-versus-host disease, diagnosis and activity. Measures gathered by the transplant clinician included Schirmer's tear test and National Institutes of Health 0-3 Eye Score. Patient-reported outcome measures were the ocular subscale of the Lee Chronic Graft-versus-Host Disease Symptom Scale and Chief Eye Symptom Intensity Score. Altogether, 157 (75%) patients were diagnosed with ocular chronic graft-versus-host disease; 133 of 157 patients (85%) had active disease. In a multivariable model, the National Institutes of Health Eye Score (Pscore (P=0.027). These results support the use of selected transplant clinician- and patient-reported outcome measures for ocular chronic graft-versus-host disease screening when providing care to allogeneic hematopoietic stem cell transplantation survivors with moderate to severe chronic graft-versus-host disease. Prospective studies are needed to determine if the Lee ocular subscale demonstrates adequate responsiveness as a disease activity outcome measure. PMID:26088932

  17. Assessing Quality of Life and Medical Care in Chronic Angina: An Internet Survey

    Science.gov (United States)

    2016-01-01

    Background Angina is a clinical syndrome whose recognition relies heavily on self-report, so its identification can be challenging. Most data come from cohorts identified by physicians and nurses at the point of care; however, current widespread access to the Internet makes identification of community cohorts feasible and offers a complementary picture of angina. Objective To describe a population self-identified as experiencing chronic angina by use of an Internet survey. Methods Using email and an Internet portal, we invited individuals with a diagnosis of angina and recent symptoms to complete an Internet survey on treatment and quality of life (QOL). In total, 1147 surveys were received. The main analysis was further limited to those reporting a definite coronary heart disease (CHD) history (N=646, 56% of overall). Results Overall, about 15% reported daily angina and 40% weekly angina. Those with more frequent angina were younger, more often depressed, and reported a shorter time since diagnosis. They also had substantially worse treatment satisfaction, physical function, and overall QOL. Fewer than 40% were on ≥ 2 anti-anginals, even with daily angina. The subjects without a history of definite CHD had unexpectedly low use of antianginal and evidence-based medicines, suggesting either a lack of specificity in the use of self-reported angina to identify patients with CHD or lack of access to care. Conclusions Use of inexpensive electronic tools can identify community-based angina cohorts for clinical research. Limitation to subjects with a definite history of CHD lends diagnostic face validity to the approach; however, other symptomatic individuals are also identified. PMID:27125492

  18. Chronic gastritis rat model and role of inducing factors

    Institute of Scientific and Technical Information of China (English)

    Zun Xiang; Jian-Min Si; Huai-De Huang

    2004-01-01

    AIM: To establish an experimental animal model of chronic gastritis in a short term and to investigate the effects of several potential inflammation-inducing factors on rat gastric mucosa.METHODS: Twenty-four healthy, male SD rats were treated with intragastric administration of 600 mL/L alcohol, 20mmol/L sodium deoxycholate and 0.5 g/L ammonia (factor A), forage containing low levels of vitamins (factor B), and/or indomethacin (factor C), according to an L8(27)orthogonal design. After 12 wk, gastric antral and body mucosae were pathologically examined.RESULTS: Chronic gastritis model was successfully induced in rats treated with factor A for 12 wk. After the treatment of animals, the gastric mucosal inflammation was significantly different from that in controls, and the number of pyloric glands at antrum and parietal cells at body were obviously reduced (P<0.01). Indomethacin induced gastritis but without atrophy, and short-term vitamin deficiency failed to induce chronic gastritis and gastric atrophy, In addition,indomethacin and vitamin deficiency had no synergistic effect in inducing gastritis with the factor A. No atypical hyperplasia and intestinal metaplasia in the gastric antrum and body were observed in all rats studied.CONCLUSION: Combined intragastric administration of 600 mL/L alcohol, 20 mmol/L sodium deoxycholate and 0.5 g/L ammonia induces chronic gastritis and gastric atrophy in rats. Indomethacin induces chronic gastritis only.The long-term roles of these factors in gastric inflammation and carcinogenesis need to be further elucidated.

  19. Implementation of an active aging model in Mexico for prevention and control of chronic diseases in the elderly

    Directory of Open Access Journals (Sweden)

    Correa-Muñoz Elsa

    2009-08-01

    Full Text Available Abstract Background World Health Organization cites among the main challenges of populational aging the dual disease burden: the greater risk of disability, and the need for care. In this sense, the most frequent chronic diseases during old age worldwide are high blood pressure, type 2 diabetes mellitus, cancer, arthritis, osteoporosis, depression, and dementia. Chronic disease-associated dependency represents an onerous sanitary and financial burden for the older adult, the family, and the health care system. Thus, it is necessary to propose community-level models for chronic disease prevention and control in old age. The aim of the present work is to show our experience in the development and implementation of a model for chronic disease prevention and control in old age at the community level under the active aging paradigm. Methods/Design A longitudinal study will be carried out in a sample of 400 elderly urban and rural-dwelling individuals residing in Hidalgo State, Mexico during five years. All participants will be enrolled in the model active aging. This establishes the formation of 40 gerontological promoters (GPs from among the older adults themselves. The GPs function as mutual-help group coordinators (gerontological nuclei and establish self-care and self-promotion actions for elderly well-being and social development. It will be conformed a big-net of social network of 40 mutual-help groups of ten elderly adults each one, in which self-care is a daily practice for chronic disease prevention and control, as well as for achieving maximal well-being and life quality in old age. Indicators of the model's impact will be (i therapeutic adherence; (ii the incidence of the main chronic diseases in old age; (iii life expectancy without chronic diseases at 60 years of age; (iv disability adjusted life years lost; (v years of life lost due to premature mortality, and (vi years lived with disability. Discussion We propose that the

  20. Interprofessional practice in primary care: development of a tailored process model

    Directory of Open Access Journals (Sweden)

    Stans SEA

    2013-04-01

    Full Text Available Steffy EA Stans, JG Anita Stevens, Anna JHM Beurskens Research Center of Autonomy and Participation for Persons with a Chronic Illness, Zuyd University of Applied Sciences, Heerlen, The Netherlands Purpose: This study investigated the improvement of interprofessional practice in primary care by performing the first three steps of the implementation model described by Grol et al. This article describes the targets for improvement in a setting for children with complex care needs (step 1, the identification of barriers and facilitators influencing interprofessional practice (step 2, and the development of a tailored interprofessional process model (step 3. Methods: In step 2, thirteen qualitative semistructured interviews were held with several stakeholders, including parents of children, an occupational therapist, a speech and language therapist, a physical therapist, the manager of the team, two general practitioners, a psychologist, and a primary school teacher. The data were analyzed using directed content analysis and using the domains of the Chronic Care Model as a framework. In step 3, a project group was formed to develop helpful strategies, including the development of an interprofessional process through process mapping. Results: In step 2, it was found that the most important barriers to implementing interprofessional practice related to the lack of structure in the care process. A process model for interprofessional primary care was developed for the target group. Conclusion: The lack of a shared view of what is involved in the process of interprofessional practice was the most important barrier to its successful implementation. It is suggested that the tailored process developed, supported with the appropriate tools, may provide both professional staff and their clients, in this setting but also in other areas of primary care, with insight to the care process and a clear representation of "who should do what, when, and how." Keywords

  1. An evaluation of gender equity in different models of primary care practices in Ontario

    Directory of Open Access Journals (Sweden)

    Russell Grant

    2010-03-01

    Full Text Available Abstract Background The World Health Organization calls for more work evaluating the effect of health care reforms on gender equity in developed countries. We performed this evaluation in Ontario, Canada where primary care models resulting from reforms co-exist. Methods This cross sectional study of primary care practices uses data collected in 2005-2006. Healthcare service models included in the study consist of fee for service (FFS based, salaried, and capitation based. We compared the quality of care delivered to women and men in practices of each model. We performed multi-level, multivariate regressions adjusting for patient socio-demographic and economic factors to evaluate vertical equity, and adjusting for these and health factors in evaluating horizontal equity. We measured seven dimensions of health service delivery (e.g. accessibility and continuity and three dimensions of quality of care using patient surveys (n = 5,361 and chart abstractions (n = 4,108. Results Health service delivery measures were comparable in women and men, with differences ≤ 2.2% in all seven dimensions and in all models. Significant gender differences in the health promotion subjects addressed were observed. Female specific preventive manoeuvres were more likely to be performed than other preventive care. Men attending FFS practices were more likely to receive influenza immunization than women (Adjusted odds ratio: 1.75, 95% confidence intervals (CI 1.05, 2.92. There was no difference in the other three prevention indicators. FFS practices were also more likely to provide recommended care for chronic diseases to men than women (Adjusted difference of -11.2%, CI -21.7, -0.8. A similar trend was observed in Community Health Centers (CHC. Conclusions The observed differences in the type of health promotion subjects discussed are likely an appropriate response to the differential healthcare needs between genders. Chronic disease care is non equitable in FFS but

  2. Creating A Sustainable Model of Spine Care in Underserved Communities

    DEFF Research Database (Denmark)

    Haldeman, Scott; Nordin, Margareta; Outerbridge, Geoff;

    2015-01-01

    The world lacks sustainable models of care to manage spinal disorders in poor and underserved communities. The purpose of this article is to: (1) review the rationale and importance of developing a sustainable evidence-based model of care at low cost for people with spinal disorders in underserved...... with sound leadership, research and a model of care, there is an opportunity to help reduce the burden of the leading cause of disability in the world....

  3. Information and Communication Technology–Enabled Person-Centered Care for the “Big Five” Chronic Conditions: Scoping Review

    Science.gov (United States)

    Simonse, Lianne WL

    2015-01-01

    Background Person-centered information and communication technology (ICT) could encourage patients to take an active part in their health care and decision-making process, and make it possible for patients to interact directly with health care providers and services about their personal health concerns. Yet, little is known about which ICT interventions dedicated to person-centered care (PCC) and connected-care interactions have been studied, especially for shared care management of chronic diseases. The aim of this research is to investigate the extent, range, and nature of these research activities and identify research gaps in the evidence base of health studies regarding the “big 5” chronic diseases: diabetes mellitus, cardiovascular disease, chronic respiratory disease, cancer, and stroke. Objective The objective of this paper was to review the literature and to scope the field with respect to 2 questions: (1) which ICT interventions have been used to support patients and health care professionals in PCC management of the big 5 chronic diseases? and (2) what is the impact of these interventions, such as on health-related quality of life and cost efficiency? Methods This research adopted a scoping review method. Three electronic medical databases were accessed: PubMed, EMBASE, and Cochrane Library. The research reviewed studies published between January 1989 and December 2013. In 5 stages of systematic scanning and reviewing, relevant studies were identified, selected, and charted. Then we collated, summarized, and reported the results. Results From the initial 9380 search results, we identified 350 studies that qualified for inclusion: diabetes mellitus (n=103), cardiovascular disease (n=89), chronic respiratory disease (n=73), cancer (n=67), and stroke (n=18). Persons with one of these chronic conditions used ICT primarily for self-measurement of the body, when interacting with health care providers, with the highest rates of use seen in chronic

  4. Towards a wireless patient: chronic illness, scarce care and technological innovation in the United Kingdom.

    Science.gov (United States)

    May, Carl; Finch, Tracy; Mair, Frances; Mort, Maggie

    2005-10-01

    'Modernization' is a key health policy objective in the UK. It extends across a range of public service delivery and organizational contexts, and also means there are radical changes in perspective on professional behaviour and practice. New information and communications technologies have been seen as one of the key mechanisms by which these changes can be engendered. In particular, massive investment in information technologies promises the rapid distribution and deployment of patient-centred information across internal organizational boundaries. While the National Health Service (NHS) sits on the edge of a pound sterling 6 billion investment in electronic patient records, other technologies find their status as innovative vehicles for professional behaviour change and service delivery in question. In this paper, we consider the ways that telemedicine and telehealthcare systems have been constructed first as a field of technological innovation, and more recently, as management solutions to problems around the distribution of health care. We use NHS responses to chronic illness as a medium for understanding these shifts. In particular, we draw attention to the shifting definitions of 'innovation' and to the ways that these shifts define a move away from notions of technological advance towards management control. PMID:15893864

  5. Latex Allergy, a Special Risk for Patients with Chronic Illness and Health Care Workers

    Directory of Open Access Journals (Sweden)

    A.Zafer Caliskaner

    2008-06-01

    Full Text Available Natural rubber latex allergy is a new illness whose prevalence has reached epidemic proportions in highly exposed populations such as health care workers and who has chronic illness. After anaphylactic type reactions due to latex has been shown as case reports. The major risk factors in latex are intense exposure to latex allergens (surgical gloves, catheters, etc, atopy, hand eczema, female gender, history of multiple operations and dental interventions. An association between latex allergy and allergy to various fruits (banana, kiwi, avocado, pineapple, etc has been reported. Latex allergy is responsible for a wide spectrum of clinical symptoms ranging from a mild dermatitis to severe anaphylaxis. In this report, we present that latex related systemic allergic reactions cases; the first one is 24 years old nurse woman who is working at the blood bank in our hospital and the other one is 32 years old woman patient who has repeatative medical examination, and in vitro fertilisation therapy plan and suffered for systemic allergic reaction due to latex gloves which was used in her last concha operations. [TAF Prev Med Bull 2008; 7(3.000: 265-268

  6. Resveratrol Neuroprotection in a Chronic Mouse Model of Multiple Sclerosis

    OpenAIRE

    Zoe eFonseca-Kelly; Mayssa eNassrallah; Jorge eUribe; Khan, Reas S.; Kimberly eDine; Mahasweta eDutt; Shindler, Kenneth S.

    2012-01-01

    Resveratrol is a naturally-occurring polyphenol that activates SIRT1, an NAD-dependent deacetylase. SRT501, a pharmaceutical formulation of resveratrol with enhanced systemic absorption, prevents neuronal loss without suppressing inflammation in mice with relapsing experimental autoimmune encephalomyelitis (EAE), a model of multiple sclerosis. In contrast, resveratrol has been reported to suppress inflammation in chronic EAE, although neuroprotective effects were not evaluated. The current st...

  7. Establishing a cat model of chronic optic nerve compression injury

    Institute of Scientific and Technical Information of China (English)

    Feng Yu; Shaoji Yuan; Rongwei Zhang; Yicheng Lu; Meiqing Lou

    2009-01-01

    BACKGROUND:An animal model of chronic optic nerve injury is necessary to further understand the pathological mechanisms involved.OBJECTIVE:To establish a stabilized,chronic,optic nerve crush model,which is similar to the clinical situation to explore histopathological and optic electrophysiological changes involved in this injury.DESIGN,TIME AND SETTING:A randomized and controlled animal trial was performed at Shanghai Institute of Neurosurgery from May to October 2004.MATERIALS:A BAL3XRAY undetachable balloon and Magic-BD catheter were provided by BLAT,France;JX-2000 biological signal processing system by Second Military Medical University of Chinese PLA,China;inverted phase contrast microscopy by Olympus,Japan.METHODS:A total of twenty normal adult cats were randomly assigned to control (n = 5) and model (n = 15) groups,according to different doses of contrast agent injected through balloons as follows:0.2 mL injection,0.25 mL injection,and 0.35 mL injection,with each group containing 5 animals.Imitating the clinical pterion approach,the optic nerves were exposed using micro-surgical methods.An engorged undetachable balloon was implanted beneath the nerve and connected to a catheter.Balloon size was controlled with a contrast agent injection (0.1 mL/10 min) to form an occupying lesion model similar to sellar tumors.MAIN OUTCOME MEASURES:The visually evoked potential examination was used to study optical electrophysiology changes in pre-post chronic optical nerve injury.Ultrastructural pathological changes to the optic nerve were analyzed by electron microscopy.RESULTS:During the early period (day 11 after modeling),visually evoked potential demonstrated no significant changes.In the late period (day 51 after modeling),recorded VEP demonstrated that P1 wave latency was prolonged and P1 wave amplitude was obviously reduced.Following injury,the endoneurium,myelin sheath,lamella,axolemma,and axon appeared disordered.CONCLUSION:Results demonstrated that the chronic

  8. Health-care encounters create both discontinuity and continuity in daily life when living with chronic heart failure—A grounded theory study

    Directory of Open Access Journals (Sweden)

    Malin Östman

    2015-07-01

    Full Text Available Living with chronic heart failure (CHF often involves lifelong contact with health care, more or less frequently, depending on fluctuating health-generating disruptions in everyday life. To reduce the influence on continuity in life, health-care professionals should preferably focus on supporting patients in managing their daily lives, based on their perspective. The aim of this study was to describe how the interaction in health-care encounters contributes to either continuity or discontinuity in the daily life for persons with CHF. Interviews with 18 participants were carried out, using the grounded theory method, through data collection and analysis. Two core concepts were constructed from data which reveal a model that illuminates the characteristics of the encounters, the actions of health-care professionals and the normative discourse. Patient-centred agenda consists of the categories: “Experiencing a subordinate approach,” “Objectifying during the encounter” and “Expected to be compliant.” This describes how health-care professionals enhance discontinuity in daily life by using a paternalistic approach in the encounter. Person-centred agenda consists of the categories: “Experiencing an empowering approach,” “Person-centredness during the encounter” and “Expected to be capable.” It describes how participants perceive that health-care professionals enable them to deal with everyday life which enhances continuity. The findings highlight the importance of health-care professionals’ attitudes and communication in encounters with patients. Health care must be designed to support and promote patients’ own strategic thinking by strengthening their self-image to enhance continuity in everyday life. The experience of discontinuity is based on the prevailing health-care culture which focuses on disease and medical treatment and regards it as superior to the illness experience in an everyday life context. We therefore

  9. Monks' Health: Holistic Health Care Model by Community Participation

    Directory of Open Access Journals (Sweden)

    Decha Buates

    2010-01-01

    Full Text Available Problem statement: Monks’ health tended to be a continuous increased problem. They were groups who had limitations to access health services due to their monastic disciplines and their most importance for Buddhist institution. Without urgent solution, their normal way of life would have been affected. Approach: This research aimed to study current conditions and to develop monks’ holistic health care models by community participation in central region of Thailand. The study was a qualitative research conducted in 9 temples; 3 temples in urban area, 3 in semi-urban area and 3 in rural area. Samples were 224 persons; consisted of monks, public health officers from Department of Religious Affairs, local administrative organizations and people; selected by purposive sampling method. Observation form, survey form, interview form, focus group discussion and workshop were used as research tools while data was analyzed by descriptive research. Results: The result founded that in former time culture of monks’ health care was leaned on community, social, culture and tradition. People spoke in style of central Thai language and were in agricultural sector as well as had their belief in merit, sin and elder respect. Relation in communities was in form of generosity and living as similar as relatives. When some monk got sick, they would visit, take care and give foods and medicines. Most of medicines were household remedy and Thai herbal medicine that bought from drug stores in local market or grocery stores in village and monks were sent to hospital in case of severe illness. Temple was a part of community, so they had close relation. Nowadays people increasingly worked in manufactories that caused conflicts and alienations among them. Monks leaned on local markets for receiving foods offering and most of foods were cooked from flour, sugar, coconut milk and fat. These caused three-fourth of monks having chronic disease as diabetes

  10. Utilization of health care services by patients with chronic obstructive pulmonary disease.

    Science.gov (United States)

    O'Brien, J A; Ward, A J; Jones, M K C; McMillan, C; Lordan, N

    2003-01-01

    In order to identify healthcare resource use patterns associated with chronic obstructive pulmonary disease (COPD), resource utilization (RU) data collection was integrated into a randomized, double-blind placebo-controlled study of Viozan (sibenadet HCl). This study enrolled patients with symptomatic, smoking-related COPD, randomized to receive sibenadet or placebo for a 52-week treatment period. A questionnaire establishing typical pre-trial, COPD-related RU was completed by each patient. Subsequent data were collected by means of an Interactive Voice Response System (IVRS) at 30-day intervals (14 time points) during the study and in the follow-up period. The IVRS system facilitated data collection and minimized inconvenience to the patient. Compliance with the requirement to record details of the healthcare services during the year-long study was high. No overall trend for lower RU was associated with sibenadet therapy, which correlates with the lack of sustained clinical effect seen in studies conducted concurrently. These data do, however, provide valuable information on RU associated with COPD and insights into adjustments associated with changes in disease course. Physicians were seen to be the most common source of care for patients with COPD and more of the patients with severe COPD (stage III) than mild (stage I) were seen to utilize the most expensive resources (e.g. inpatient hospital care). For those patients who experienced an exacerbation during the trial (irrespective of treatment group), resource use was increased during the periods when an exacerbation was reported when compared with the periods before or after an exacerbation. The proportion of cases attending the physician doubled and with a trip to the Emergency Room (ER) increased approximately ninefold during the reporting period in which the exacerbation occurred compared with the previous month. This study has shown that use of an IVRS, even in elderly patients, is an effective means of

  11. Traumatization and chronic pain: a further model of interaction

    Directory of Open Access Journals (Sweden)

    Egloff N

    2013-11-01

    Full Text Available Niklaus Egloff,1 Anna Hirschi,2 Roland von Känel1 1Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, University Hospital, Bern, Switzerland; 2Outpatient Clinic for Victims of Torture and War, Swiss Red Cross, Bern-Wabern, Switzerland Abstract: Up to 80% of patients with severe posttraumatic stress disorder are suffering from “unexplained” chronic pain. Theories about the links between traumatization and chronic pain have become the subject of increased interest over the last several years. We will give a short summary about the existing interaction models that emphasize particularly psychological and behavioral aspects of this interaction. After a synopsis of the most important psychoneurobiological mechanisms of pain in the context of traumatization, we introduce the hypermnesia–hyperarousal model, which focuses on two psychoneurobiological aspects of the physiology of learning. This hypothesis provides an answer to the hitherto open question about the origin of pain persistence and pain sensitization following a traumatic event and also provides a straightforward explanatory model for educational purposes. Keywords: posttraumatic stress disorder, chronic pain, hypermnesia, hypersensitivity, traumatization

  12. The Effect of Orem’s Self-Care Model on Quality Of Life of Patients with Hypothyroid Goiter

    OpenAIRE

    A. Rahimi; SH Salehi; A Afrasiabifar

    2012-01-01

    Abstract Background & aim: Hypothyroid goiter, like other chronic diseases, can affect the patients’ quality of life (QOL). This study aimed to examine the effect of Orem’s Self-care Model Application on QOL of patients with hypothyroid goiter. Methods: In this interventional study, 70 patients with hypothyroid goiter referred to healthcare clinics of Yasuj were randomly divided into experimental and control groups (n=35). Data were collected by a questionnaire, evaluating self-care...

  13. The Impact of New Payment Models on Quality of Diabetes Care and Outcomes.

    Science.gov (United States)

    McGinley, Erin L; Gabbay, Robert A

    2016-06-01

    Historic changes in healthcare reimbursement and payment models due to the Affordable Care Act in the United States have the potential to transform how providers care for chronic diseases such as diabetes. Payment experimentation has provided insights into how changing incentives for primary care providers can yield improvements in the triple aim: improving patient experience, improving the health of populations, and reducing costs of healthcare. Much of this has involved leveraging widespread adoption of the patient-centered medical home (PCMH) with diabetes often the focus. While evidence is mounting that the PCMH can improve diabetes outcomes, some PCMH demonstrations have displayed mixed results. One of the first large-scale PCMH demonstrations developed around diabetes was conducted by the Commonwealth of Pennsylvania. Different payment models were employed across a series of staggered regional rollouts that provided a case study for the influence of innovative payment models. These learning laboratories provide insights into the role of reimbursement models and changes in how practice transformation is implemented. Ultimately, evolving payment systems focused on the total cost of care, such as Accountable Care Organizations, hold promise to transform diabetes care and produce significant cost savings through the prevention of complications. PMID:27091445

  14. The ties that bind us: how existing relationships, health and gender shape family care in chronic obstructive pulmonary disease

    Directory of Open Access Journals (Sweden)

    Janice G. Gullick

    2012-03-01

    Full Text Available Chronic obstructive pulmonary disease (COPD changes family roles and relationship dynamics and the experience of the disease is influenced by family functioning. Merleau- Ponty’s existential philosophy of the body provided the framework for this Heideggerian phenomenological inquiry. Fifteen people with COPD and 14 family members engaged in 58 semi-structured interviews either face-to-face or by telephone. This study identified a difference in the essence of the lived experiences between male and female carers, and between spousal and non-spousal carers in relation to severe COPD. Previous reciprocity framed the level of acceptance of the caring role and perception of care burden. The stories highlight the self-perceived need for women carers to be conscious micro-managers of illness. Male family members would care alongside, lending support and caring in a reactive way as specific needs or crises arose. Caring in COPD required a binding vigilance; a constant need of the carer to monitor the physical and emotional well-being of the sick person that bound them emotionally and cognitively to the task of caring. Carers were the managers of crises and families cared from a perspective of possible death. Family was perceived as the best thing in life. Health professionals should consider the influence of gender, family relationships and the impact of reciprocity when planning support for family caregivers. Further research is required to identify the similarities and differences in family caring between COPD and other chronic illnesses, and to further understand the specific needs of male carers.

  15. Establishment of health clinics as mass screening and referral systems for chronic non-communicable diseases in primary health care

    Directory of Open Access Journals (Sweden)

    Kamal Heidari

    2012-01-01

    Full Text Available Background: This study aimed to establish a comprehensive screening and referral system for chronic non-communicable diseases (CNCD in the routine primary health care, and to determine the prevalence of diabetes, pre-diabetes, metabolic syndrome, and dyslipidemia in adult population invited by public announcement to the Health clinics in Isfahan, Iran. Methods: This survey was conducted from March 2010, and the current paper presents data obtained until November 2011. To provide health services for prevention and control of CNCDs, with priority of type2 diabetes mellitus, Health clinics were established in different parts of Isfahan city with a population of approximately 2,100,000 in Iran. The general populations aged 30 years and above were invited to the Health clinics by public announcement. Results: A total of 198972 participants were screened. The mean age of participants was 47.8 years (48.5 men, 47.3 women, with a range of 1 to 95 years old and standard deviation of 12.3 years (12.7 men, 12.1 women. Overall, 22% of participants had impaired fasting glucose, 25% had hypercholesterolemia, 31% had hypertriglyceridemia, and 20% had metabolic syndrome. Conclusion: The high prevalence of dysglycemia and diabetes in our survey may serve as confirmatory evidence about the importance of mass screening and early diagnosis of CNCDs′ risk factors. Our model of establishing Health clinics, as a comprehensive referral system in the routine primary health care can be adopted by Middle Eastern countries, where CNCDs notably diabetes are an emerging health problem.

  16. A novel model of chronic wounds: importance of redox imbalance and biofilm-forming bacteria for establishment of chronicity.

    Directory of Open Access Journals (Sweden)

    Sandeep Dhall

    Full Text Available Chronic wounds have a large impact on health, affecting ∼6.5 M people and costing ∼$25B/year in the US alone. We previously discovered that a genetically modified mouse model displays impaired healing similar to problematic wounds in humans and that sometimes the wounds become chronic. Here we show how and why these impaired wounds become chronic, describe a way whereby we can drive impaired wounds to chronicity at will and propose that the same processes are involved in chronic wound development in humans. We hypothesize that exacerbated levels of oxidative stress are critical for initiation of chronicity. We show that, very early after injury, wounds with impaired healing contain elevated levels of reactive oxygen and nitrogen species and, much like in humans, these levels increase with age. Moreover, the activity of anti-oxidant enzymes is not elevated, leading to buildup of oxidative stress in the wound environment. To induce chronicity, we exacerbated the redox imbalance by further inhibiting the antioxidant enzymes and by infecting the wounds with biofilm-forming bacteria isolated from the chronic wounds that developed naturally in these mice. These wounds do not re-epithelialize, the granulation tissue lacks vascularization and interstitial collagen fibers, they contain an antibiotic-resistant mixed bioflora with biofilm-forming capacity, and they stay open for several weeks. These findings are highly significant because they show for the first time that chronic wounds can be generated in an animal model effectively and consistently. The availability of such a model will significantly propel the field forward because it can be used to develop strategies to regain redox balance that may result in inhibition of biofilm formation and result in restoration of healthy wound tissue. Furthermore, the model can lead to the understanding of other fundamental mechanisms of chronic wound development that can potentially lead to novel therapies.

  17. A crisis in chronic pain care: an ethical analysis. Part three: Toward an integrative, multi-disciplinary pain medicine built around the needs of the patient.

    Science.gov (United States)

    Giordano, James; Schatman, Michael E

    2008-01-01

    A number of variables have contributed to the current crisis in chronic pain care and are affected by, and affect, the philosophies and politics that influence the socio-economic climate of the American healthcare system. Thus, we posit that managing the crisis in chronic pain care in the United States is contingent upon the development of a multi-focal healthcare paradigm that more thoroughly enables and fortifies research, its translation (in education and practice), and the implementation of, and support for, both the curative and healing approaches in medicine in general, and pain care specifically. These steps necessitate re-examination, if not revision of the health care system and its economics. The ethical imperative to consider and prudently employ cutting-edge diagnostic and therapeutic technologies in pain medicine is obligatory. However, "supply side prudence" is of little value if "demand side accessibility" is lacking. Revisions to health insurance plans advocated by the in-coming administration seek to create uniformity in basic health care services based upon re-assessment of the clinical effectiveness (versus merely cost) of treatments, including those that are "high tech." These plans attempt to allow every patient a more complete ability to deliberatively work with physicians to access those services and resources that maximize health functioning and goals. But even given these revisions, authentic pain care must take into account the interactive contexts of the painient individual. The biopsychosocial model of chronic pain management may have significant practical and ethical worth in this regard. A system of pain treatment operating from a biopsychosocial perspective necessitates integrative multi-disciplinarity. We propose a tiered, multi-disciplinary paradigm based upon the differing needs of each specific patient. But establishing such a system does not guarantee access, and distribution of these services and resources requires economic

  18. Asthma, chronic obstructive pulmonary disease, or both? Diagnostic labeling and spirometry in primary care patients aged 40 years or more

    OpenAIRE

    Melbye H; Drivenes E; Dalbak LG; Leinan T; Høegh-Henrichsen S; Østrem A

    2011-01-01

    Hasse Melbye1, Elin Drivenes1, Lene G Dalbak2, Tone Leinan1, Svein Høegh-Henrichsen2, Anders Østrem21General Practice Research Unit, Department of Community Medicine, University of Tromsø, 2General Practice Research Unit, Department of Health and Society, University of Oslo, NorwayAims: To describe symptoms and lung function in patients registered with asthma or chronic obstructive pulmonary disease (COPD) in primary care and to examine how spirometry findings...

  19. Pharmacist-led management of chronic pain in primary care: costs and benefits in a pilot randomised controlled trial

    OpenAIRE

    Neilson, Aileen R; Bruhn, Hanne; Christine M. Bond; Elliott, Alison M; Smith, Blair H; Hannaford, Philip C; Holland, Richard; Amanda J Lee; Watson, Margaret; Wright, David; McNamee, Paul

    2015-01-01

    Objectives To explore differences in mean costs (from a UK National Health Service perspective) and effects of pharmacist-led management of chronic pain in primary care evaluated in a pilot randomised controlled trial (RCT), and to estimate optimal sample size for a definitive RCT. Design Regression analysis of costs and effects, using intention-to-treat and expected value of sample information analysis (EVSI). Setting Six general practices: Grampian (3); East Anglia (3). Participants 125 pat...

  20. Pharmacist-led management of chronic pain in primary care:results from a randomised controlled exploratory trial

    OpenAIRE

    Bruhn, Hanne; Christine M. Bond; Elliott, Alison M; Hannaford, Philip C; Amanda J Lee; McNamee, Paul; Smith, Blair H; Watson, Margaret C; Holland, Richard; Wright, David

    2013-01-01

    Objectives To compare the effectiveness of pharmacist medication review, with or without pharmacist prescribing, with standard care, for patients with chronic pain. Design An exploratory randomised controlled trial. Setting Six general practices with prescribing pharmacists in Grampian (3) and East Anglia (3). Participants Patients on repeat prescribed pain medication (4815) were screened by general practitioners (GPs), and mailed invitations (1397). 196 were randomised and 180 (92%) complete...

  1. Searching for the Holy Grail of Care Delivery Models.

    Science.gov (United States)

    Mensik, Jennifer

    2016-01-01

    Too often health care executives state the need for more research, knowledge, and information in staffing. Perhaps what we really need is education and support for innovation in operations. In looking for the holy grail of staffing solutions, focused attention will need to be placed on creating innovative care delivery models. Leaders who are tasked with developing innovative care delivery models must have a supportive environment and given time to be successful. PMID:27265951

  2. Determinants of access to pediatric hospice care: A conceptual model

    OpenAIRE

    Lindley, Lisa C.

    2015-01-01

    One of the many difficult moments for families of children with life-limiting illnesses is to make the decision to access pediatric hospice care. Although determinants that influence families’ decisions to access pediatric hospice care have been recently identified, the relationship between these determinants and access to pediatric hospice care have not been explicated or grounded in accepted healthcare theories or models. Using the Andersen Behavioral Healthcare Utilization Model, this arti...

  3. Towards a model for integrative medicine in Swedish primary care

    OpenAIRE

    Falkenberg Torkel; Warenmark Anders; Halpin Jeremy; Sundberg Tobias

    2007-01-01

    Abstract Background Collaboration between providers of conventional care and complementary therapies (CTs) has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM). The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care. Methods Investigative procedures involved research group and key informant meetings with multiple st...

  4. Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care.

    Science.gov (United States)

    Beaglehole, Robert; Epping-Jordan, Joanne; Patel, Vikram; Chopra, Mickey; Ebrahim, Shah; Kidd, Michael; Haines, Andy

    2008-09-13

    The burden of chronic diseases, such as heart disease, cancer, diabetes, and mental disorders is high in low-income and middle-income countries and is predicted to increase with the ageing of populations, urbanisation, and globalisation of risk factors. Furthermore, HIV/AIDS is increasingly becoming a chronic disorder. An integrated approach to the management of chronic diseases, irrespective of cause, is needed in primary health care. Management of chronic diseases is fundamentally different from acute care, relying on several features: opportunistic case finding for assessment of risk factors, detection of early disease, and identification of high risk status; a combination of pharmacological and psychosocial interventions, often in a stepped-care fashion; and long-term follow-up with regular monitoring and promotion of adherence to treatment. To meet the challenge of chronic diseases, primary health care will have to be strengthened substantially. In the many countries with shortages of primary-care doctors, non-physician clinicians will have a leading role in preventing and managing chronic diseases, and these personnel need appropriate training and continuous quality assurance mechanisms. More evidence is needed about the cost-effectiveness of prevention and treatment strategies in primary health care. Research on scaling-up should be embedded in large-scale delivery programmes for chronic diseases with a strong emphasis on assessment. PMID:18790317

  5. Mortality model based on delays in progression of chronic diseases: alternative to cause elimination model.

    OpenAIRE

    Manton, K G; Patrick, C H; Stallard, E

    1980-01-01

    For the analysis of the impact of major chronic diseases on a population, a life table model is proposed in which the age at death due to specific cause (chronic disease) is postponed. Even though many of the major causes of death related to intrinsic aging processes are impossible to eliminate, these causes might be significantly delayed or retarded. To illustrate the use of this model, the effects of a delay of 5, 10, and 15 years in deaths due to three chronic degenerative diseases (cancer...

  6. Comparison of primary care models in the prevention of cardiovascular disease - a cross sectional study

    Directory of Open Access Journals (Sweden)

    Hogg William

    2011-10-01

    Full Text Available Abstract Background Primary care providers play an important role in preventing and managing cardiovascular disease. This study compared the quality of preventive cardiovascular care delivery amongst different primary care models. Methods This is a secondary analysis of a larger randomized control trial, known as the Improved Delivery of Cardiovascular Care (IDOCC through Outreach Facilitation. Using baseline data collected through IDOCC, we conducted a cross-sectional study of 82 primary care practices from three delivery models in Eastern Ontario, Canada: 43 fee-for-service, 27 blended-capitation and 12 community health centres with salary-based physicians. Medical chart audits from 4,808 patients with or at high risk of developing cardiovascular disease were used to examine each practice's adherence to ten evidence-based processes of care for diabetes, chronic kidney disease, dyslipidemia, hypertension, weight management, and smoking cessation care. Generalized estimating equation models adjusting for age, sex, rurality, number of cardiovascular-related comorbidities, and year of data collection were used to compare guideline adherence amongst the three models. Results The percentage of patients with diabetes that received two hemoglobin A1c tests during the study year was significantly higher in community health centres (69% than in fee-for-service (45% practices (Adjusted Odds Ratio (AOR = 2.4 [95% CI 1.4-4.2], p = 0.001. Blended capitation practices had a significantly higher percentage of patients who had their waistlines monitored than in fee-for-service practices (19% vs. 5%, AOR = 3.7 [1.8-7.8], p = 0.0006, and who were recommended a smoking cessation drug when compared to community health centres (33% vs. 16%, AOR = 2.4 [1.3-4.6], p = 0.007. Overall, quality of diabetes care was higher in community health centres, while smoking cessation care and weight management was higher in the blended-capitation models. Fee-for-service practices

  7. Diffusion of a collaborative care model in primary care: a longitudinal qualitative study

    OpenAIRE

    Vedel Isabelle; Ghadi Veronique; De Stampa Matthieu; Routelous Christelle; Bergman Howard; Ankri Joel; Lapointe Liette

    2013-01-01

    Background Although collaborative team models (CTM) improve care processes and health outcomes, their diffusion poses challenges related to difficulties in securing their adoption by primary care clinicians (PCPs). The objectives of this study are to understand: (1) how the perceived characteristics of a CTM influenced clinicians' decision to adopt -or not- the model; and (2) the model's diffusion process. Methods We conducted a longitudinal case study based on the Diffusion of Innovations Th...

  8. Monitoring physical functioning as the sixth vital sign: evaluating patient and practice engagement in chronic illness care in a primary care setting--a quasi-experimental design

    Directory of Open Access Journals (Sweden)

    Richardson Julie

    2012-04-01

    Full Text Available Abstract Background In Canada, one in three adults or almost 9 million people report having a chronic condition. Over two thirds of total deaths result from cardiovascular disease, diabetes, cancer and respiratory illness and 77% of persons ≥65 years have at least one chronic condition. Persons with chronic disease are at risk for functional decline; as a result, there is an increased awareness of the significance of functional status as an important health outcome. The purpose of this study was to determine whether patients who receive a multi-component rehabilitation intervention, including online monitoring of function with feedback and self-management workshops, showed less functional decline than case matched controls who did not receive this intervention. In addition, we wanted to determine whether capacity building initiatives within the Family Health Team promote a collaborative approach to Chronic Disease Management. Methods A population-based multi-component rehabilitation intervention delivered to persons with chronic illnesses (≥ 44 yrs (n = 60 was compared to a group of age and sex matched controls (n = 60 with chronic illnesses receiving usual care within a primary healthcare setting. The population-based intervention consisted of four main components: (1 function-based individual assessment and action planning, (2 rehabilitation self-management workshops, (3 on-line self-assessment of function and (4 organizational capacity building. T-tests and chi-square tests were used for continuous and categorical variables respectively in baseline comparison between groups. Results Two MANOVA showed significant between group differences in patient reported physical functioning (Λ = 0.88, F = (2.86 = 5.97. p = 0.004 and for the physical performance measures collectively as the dependent variable (Λ = 0.80, F = (6.93 = 3.68. p = 0.0025. There were no within group differences for the capacity measures. Conclusion It is feasible to monitor

  9. Self-care 3 months after attending chronic obstructive pulmonary disease patient education: a qualitative descriptive analysis

    Directory of Open Access Journals (Sweden)

    Mousing C

    2012-01-01

    Full Text Available Camilla Askov Mousing1, Kirsten Lomborg21School of Health Sciences, Randers School of Nursing, VIA University College, Randers, Denmark; 2Department of Public Health, Nursing Science, Aarhus University, Aarhus, DenmarkPurpose: The authors performed a qualitative descriptive analysis to explore how group patient education influences the self-care of patients with chronic obstructive pulmonary disease.Patients and methods: In the period 2009–2010, eleven patients diagnosed with chronic obstructive pulmonary disease completed an 8-week group education program in a Danish community health center. The patients were interviewed 3 months after completion of the program.Findings: Patients reported that their knowledge of chronic obstructive pulmonary disease had increased, that they had acquired tools to handle their symptoms, and that the social aspect of patient education had motivated them to utilize their new habits after finishing the course. The data indicate that patients need a period of adjustment (a "ripening period": it took time for patients to integrate new habits and competencies into everyday life. Talking to health care professionals focused the patients' attention on their newly acquired skills and the research interview made them more aware of their enhanced self-care.Conclusion: Patients' self-care may be enhanced through group education, even though the patients are not always able to see the immediate outcome. Some patients may require professional help to implement their newly acquired knowledge and skills in everyday life. A planned dialogue concentrating on self-care in everyday life 3 months after finishing the course may enhance patients' awareness and appraisal of their newly acquired competencies.Keywords: COPD, education program, patient knowledge, patient perspective, patient skills, ripening period

  10. Improving the quality of nurse clinical documentation for chronic patients at primary care clinics: A multifaceted intervention

    Directory of Open Access Journals (Sweden)

    Ozayr H. Mahomed

    2015-02-01

    Full Text Available Background: Deficiencies in record keeping practices have been reported at primary care level in the public health sector in South Africa. These deficiencies have the potential to negatively impact patient health outcomes as the break in information may hinder continuity of care. This disruption in information management has particular relevance for patients with chronic diseases.Objectives: The aim of this study was to establish if the implementation of a structured clinical record (SCR as an adjunct tool to the algorithmic guidelines for chronic disease management improved the quality of clinical records at primary care level.Method: A quasi-experimental study (before and after study with a comparison group was conducted across 30 primary health care clinics (PHCs located in three districts in South Africa. Twenty PHCs that received the intervention were selected as intervention clinics and 10 facilities were selected as comparison facilities. The lot quality assurance sampling (LQAS method was used to determine the number of records required to be reviewed per diagnostic condition per facility.Results: There was a a statistically significant increase in the percentage of clinical records achieving compliance to the minimum criteria from the baseline to six months post-intervention for both HIV patients on antiretroviral treatment and patients with non-communicable diseases (hypertension and diabetes.Conclusions: A multifaceted intervention using a SCR to supplement the educational outreach component (PC 101 training has demonstrated the potential for improving the quality of clinical records for patients with chronic diseases at primary care clinics in South Africa.

  11. Further Effort is Needed to Improve Management of Chronic Pain in Primary Care. Results from the Arkys Project.

    Science.gov (United States)

    Piccinocchi, Gaetano; Piccinocchi, Roberto

    2016-04-26

    Treatment of chronic pain is challenging. The Arkys project was initiated in Italy to assist general practitioners (GPs) in the management of chronic pain. The main objective of this study was to determine the usefulness of Arkys for selecting new therapeutic strategies. An online interactive questionnaire for assessing pain and guiding therapeutic decisions was made available to GPs participating to Arkys. The GPs were invited to complete the questionnaire for each patient who presented moderate-severe chronic pain, and to decide on a new analgesic treatment based on the information provided by the questionnaire. Two hundred and forty four GPs participated with a total of 3035 patients. Patients (mean age 68.9 years) had mostly chronic non-cancer pain (87.7%). In 42.3%, pain had neuropathic components. Only 53.6% of patients were in treatment with analgesics (strong opioids, 38.9%; NSAIDs, 32.6%; weak opioids, 25.6%; anti-epileptics, 17.3%; paracetamol, 14.9%). Use of the questionnaire resulted in the prescription of analgesics to all patients and in increased prescription of strong opioids (69.7%). NSAID prescription decreased (12.8%), while anti-epileptics use remained stable. These findings show that current management of chronic pain in primary care is far from optimal and that efforts are needed to educate GPs and improve guideline implementation. PMID:27478585

  12. Further effort is needed to improve management of chronic pain in primary care. Results from the Arkys project

    Directory of Open Access Journals (Sweden)

    Gaetano Piccinocchi

    2016-06-01

    Full Text Available Treatment of chronic pain is challenging. The Arkys project was initiated in Italy to assist general practitioners (GPs in the management of chronic pain. The main objective of this study was to determine the usefulness of Arkys for selecting new therapeutic strategies. An online interactive questionnaire for assessing pain and guiding therapeutic decisions was made available to GPs participating to Arkys. The GPs were invited to complete the questionnaire for each patient who presented moderate-severe chronic pain, and to decide on a new analgesic treatment based on the information provided by the questionnaire. Two hundred and forty four GPs participated with a total of 3035 patients. Patients (mean age 68.9 years had mostly chronic non-cancer pain (87.7%. In 42.3%, pain had neuropathic components. Only 53.6% of patients were in treatment with analgesics (strong opioids, 38.9%; NSAIDs, 32.6%; weak opioids, 25.6%; anti-epileptics, 17.3%; paracetamol, 14.9%. Use of the questionnaire resulted in the prescription of analgesics to all patients and in increased prescription of strong opioids (69.7%. NSAID prescription decreased (12.8%, while anti-epileptics use remained stable. These findings show that current management of chronic pain in primary care is far from optimal and that efforts are needed to educate GPs and improve guideline implementation.

  13. Primary and tertiary health professionals’ views on the health-care of patients with co-morbid diabetes and chronic kidney disease – a qualitative study

    OpenAIRE

    Lo, Clement; Ilic, Dragan; Teede, Helena; Fulcher, Greg; Gallagher, Martin; Kerr, Peter G; Murphy, Kerry; Polkinghorne, Kevan; Russell, Grant; Usherwood, Timothy; Walker, Rowan; Zoungas, Sophia

    2016-01-01

    Background Health-care for co-morbid diabetes and chronic kidney disease (CKD) is often sub-optimal. To improve health-care, we explored the perspectives of general practitioners (GPs) and tertiary health-care professionals concerning key factors influencing health-care of diabetes and CKD. Methods A total of 65 health professionals were purposively sampled from Australia’s 2 largest cities to participate in focus groups and semi-structured interviews. Four focus groups were conducted with GP...

  14. Priority interventions to improve the management of chronic non-cancer pain in primary care: a participatory research of the ACCORD program

    Directory of Open Access Journals (Sweden)

    Lalonde L

    2015-04-01

    Full Text Available Lyne Lalonde,1–4 Manon Choinière,3,5 Elisabeth Martin,3 Lise Lévesque,3 Éveline Hudon,2,3,6 Danielle Bélanger,2 Sylvie Perreault,1,7 Anaïs Lacasse,8 Marie-Claude Laliberté1,9 1Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada; 2Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada; 3Centre de recherche, Centre hospitalier de l'Université de Montréal (CRCHUM, Montreal, QC, Canada; 4Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Faculty of Pharmacy, Université de Montréal and Centre de santé et de services sociaux de Laval, QC, Canada; 5Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 6Department of Family Medicine and Emergency, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 7Sanofi Aventis Endowment Chair in Drug Utilization, Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada; 8Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada; 9AbbVie Corporation, St-Laurent, QC, Canada Purpose: There is evidence that the management of chronic non-cancer pain (CNCP in primary care is far from being optimal. A 1-day workshop was held to explore the perceptions of key actors regarding the challenges and priority interventions to improve CNCP management in primary care. Methods: Using the Chronic Care Model as a conceptual framework, physicians (n=6, pharmacists (n=6, nurses (n=6, physiotherapists (n=6, psychologists (n=6, pain specialists (n=6, patients (n=3, family members (n=3, decision makers and managers (n=4, and pain researchers (n=7 took part in seven focus groups and five nominal groups. Results: Challenges identified in focus group discussions were related to five dimensions: knowledge gap, “work in silos”, lack of awareness that CNCP represents an important clinical problem

  15. Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population

    Directory of Open Access Journals (Sweden)

    Pasquale MK

    2012-11-01

    Full Text Available Margaret K Pasquale,1 Shawn X Sun,2 Frank Song,1 Heather J Hartnett,1 Stephen A Stemkowski11Competitive Health Analytics, Louisville, KY, USA; 2Health Economics and Outcomes Research, Forest Research Institute, Jersey City, NJ, USABackground: Exacerbations of chronic obstructive pulmonary disease (COPD lead to significant increases in resource utilization and cost to the health care system. COPD patients with chronic bronchitis and a history of exacerbations pose an additional burden to the system. This study examined health care utilization and cost among these patients.Methods: For this retrospective analysis, data were extracted from a large national health plan with a predominantly Medicare population. This study involved patients who were aged 40–89 years, had been enrolled continuously for 24 months or more, had at least two separate insurance claims for COPD with chronic bronchitis (International Classification of Diseases, Ninth Revision, Clinical Modification code 491.xx, and had pharmacy claims for COPD maintenance medications between January 1, 2007, and March 31, 2009. Two years of data were examined for each patient; the index date was defined as the first occurrence of COPD. Baseline characteristics were obtained from the first year of data, with health outcomes tracked in the second year. Severe exacerbation was defined by COPD-related hospitalization or death; moderate exacerbation was defined by oral or parenteral corticosteroid use. Adjusted numbers of exacerbations and COPD-related costs per patient were estimated controlling for demographic and clinical characteristics.Results: The final study sample involved 8554 patients; mean age was 70.1 ± 8.6 years and 49.8% of the overall population had exacerbation, 13.9% had a severe exacerbation only, 29.1% had a moderate exacerbation only, and 6.8% had both a severe and moderate exacerbation. COPD-related mean annual costs were $4069 (all figures given in US dollars for the

  16. Bioimpedance modeling to monitor astrocytic response to chronically implanted electrodes

    Science.gov (United States)

    McConnell, G. C.; Butera, R. J.; Bellamkonda, R. V.

    2009-10-01

    The widespread adoption of neural prosthetic devices is currently hindered by our inability to reliably record neural signals from chronically implanted electrodes. The extent to which the local tissue response to implanted electrodes influences recording failure is not well understood. To investigate this phenomenon, impedance spectroscopy has shown promise for use as a non-invasive tool to estimate the local tissue response to microelectrodes. Here, we model impedance spectra from chronically implanted rats using the well-established Cole model, and perform a correlation analysis of modeled parameters with histological markers of astroglial scar, including glial fibrillary acid protein (GFAP) and 4',6-diamidino-2- phenylindole (DAPI). Correlations between modeled parameters and GFAP were significant for three parameters studied: Py value, Ro and |Z|1 kHz, and in all cases were confined to the first 100 µm from the interface. Py value was the only parameter also correlated with DAPI in the first 100 µm. Our experimental results, along with computer simulations, suggest that astrocytes are a predominant cellular player affecting electrical impedance spectra. The results also suggest that the largest contribution from reactive astrocytes on impedance spectra occurs in the first 100 µm from the interface, where electrodes are most likely to record electrical signals. These results form the basis for future approaches where impedance spectroscopy can be used to evaluate neural implants, evaluate strategies to minimize scar and potentially develop closed-loop prosthetic devices.

  17. Preconception care: screening and management of chronic disease and promoting psychological health

    OpenAIRE

    Lassi, Zohra S; Imam, Ayesha M; Dean, Sohni V; Bhutta, Zulfiqar A.

    2014-01-01

    Introduction A large proportion of women around the world suffer from chronic diseases including mental health diseases. In the United States alone, over 12% of women of reproductive age suffer from a chronic medical condition, especially diabetes and hypertension. Chronic diseases significantly increase the odds for poor maternal and newborn outcomes in pregnant women. Methods A systematic review and meta-analysis of the evidence was conducted to ascertain the possible impact of preconceptio...

  18. Extending The P4P Agenda, Part 2: How Medicare Can Reduce Waste And Improve The Care Of The Chronically Ill: By targeting Americans with chronic illnesses, Medicare can begin to solidify a strategy of rewarding providers for truly improving care.

    OpenAIRE

    Wennberg, John E.; Fisher, Elliott S; Skinner, Jonathan S.; Bronner, Kristen K

    2007-01-01

    The care of Americans with severe chronic illnesses is disorganized, unnecessarily costly, and undisciplined by sound clinical science. The federal government should invest in a crash program to improve the scientific basis of managing chronic illness, and the Centers for Medicare and Medicaid Services (CMS) should extend its pay-for-performance (P4P) agenda to ensure that within ten years all Americans with severe chronic illnesses have access to accountable health care organizations providi...

  19. A Moral Hazard Model of Parental Care

    OpenAIRE

    Baomin Dong; Tianpeng Zhou

    2013-01-01

    One perplexing observation is that although men and women have different comparative advantages, cooperation is often only seen during child-bearing and rearing periods. One interpretation is that the juvenile offspring serves as an indivisible public goods to facilitate cooperation between opposite sexes of adults. We show that moral hazard in maternal parental care will either force the father to pay the mother a rent in order to induce optimal care (when the child is of intrinsic high qual...

  20. Chronic disease prevalence and care among the elderly in urban and rural Beijing, China - a 10/66 Dementia Research Group cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Sousa Renata

    2009-10-01

    Full Text Available Abstract Background Demographic ageing is occurring at an unprecedented rate in China. Chronic diseases and their disabling consequences will become much more common. Public policy has a strong urban bias, and older people living in rural areas may be especially vulnerable due to limited access to good quality healthcare, and low pension coverage. We aim to compare the sociodemographic and health characteristics, health service utilization, needs for care and informal care arrangements of representative samples of older people in two Beijing communities, urban Xicheng and rural Daxing. Methods A one-phase cross-sectional survey of all those aged 65 years and over was conducted in urban and rural catchment areas in Beijing, China. Assessments included questionnaires, a clinical interview, physical examination, and an informant interview. Prevalence of chronic diseases, self-reported impairments and risk behaviours was calculated adjusting for household clustering. Poisson working models were used to estimate the independent effect of rural versus urban residence, and to explore the predictors of health services utilization. Results We interviewed 1002 participants in rural Daxing, and 1160 in urban Xicheng. Those in Daxing were more likely to be younger, widowed, less educated, not receiving a pension, and reliant on family transfers. Chronic diseases were more common in Xicheng, when based on self-report rather than clinical assessment. Risk exposures were more common in Daxing. Rural older people were much less likely to access health services, controlling for age and health. Community health services were ineffective, particularly in Daxing, where fewer than 3% of those with hypertension were adequately controlled. In Daxing, care was provided by family, who had often given up work to do so. In Xicheng, 45% of those needing care were supported by paid caregivers. Caregiver strain was higher in Xicheng. Dementia was strongly associated with

  1. Children's health care assistance according to their families: a comparison between models of Primary Care

    Directory of Open Access Journals (Sweden)

    Vanessa Bertoglio Comassetto Antunes de Oliveira

    2015-02-01

    Full Text Available OBJECTIVE To compare the health assistance models of Basic Traditional Units (UBS with the Family Health Strategy (ESF units for presence and extent of attributes of Primary Health Care (APS, specifically in the care of children. METHOD A cross-sectional study of a quantitative approach with families of children attended by the Public Health Service of Colombo, Paraná. The Primary Care Assessment Tool (PCA-Tool was applied to parents of 482 children, 235 ESF units and 247 UBS units covering all primary care units of the municipality, between June and July 2012. The results were analyzed according to the PCA-Tool manual. RESULTS ESF units reached a borderline overall score for primary health care standards. However, they fared better in their attributes of Affiliation, Integration of care coordination, Comprehensiveness, Family Centeredness and Accessibility of use, while the attributes of Community Guidance/Orientation, Coordination of Information Systems, Longitudinality and Access attributes were rated as insufficient for APS. UBS units had low scores on all attributes. CONCLUSION The ESF units are closer to the principles of APS (Primary Health Care, but there is need to review actions of child care aimed at the attributes of APS in both care models, corroborating similar studies from other regions of Brazil.

  2. Can the Accountable Care Organization model facilitate integrated care in England?

    Science.gov (United States)

    Ahmed, Faheem; Mays, Nicholas; Ahmed, Naeem; Bisognano, Maureen; Gottlieb, Gary

    2015-10-01

    Following the global economic recession, health care systems have experienced intense political pressure to contain costs without compromising quality. One response is to focus on improving the continuity and coordination of care, which is seen as beneficial for both patients and providers. However, cultural and structural barriers have proved difficult to overcome in the quest to provide integrated care for entire populations. By holding groups of providers responsible for the health outcomes of a designated population, in the United States, Accountable Care Organizations are regarded as having the potential to foster collaboration across the continuum of care. They could have a similar role in England's National Health Service. However, it is important to consider the difference in context before implementing a similar model, adapted to suit the system's strengths. Working together, general practice federations and the Academic Health Science Networks could form the basis of accountable care in England. PMID:26079144

  3. Associations and Synergistic Effects for Psychological Distress and Chronic Back Pain on the Utilization of Different Levels of Ambulatory Health Care. A Cross-Sectional Study from Austria

    OpenAIRE

    Hoffmann, Kathryn; Peersman, Wim; George, Aaron; Dorner, Thomas Ernst

    2015-01-01

    The aim of this analysis was to assess the impact of chronic back pain and psychological distress on the utilization of primary and secondary levels of care in the ambulatory health care sector in Austria - a country without a gatekeeping system. Additionally, we aimed to determine if the joint effect of chronic back pain and psychological distress was higher than the impact of the sum of the two single conditions. The database used for this analysis was the Austrian Health Interview Survey, ...

  4. Preferences and experiences of chronically ill and disabled patients regarding shared decision-making: does the type of care to be decided upon matter?

    OpenAIRE

    Brink-Muinen, A. van den; Spreeuwenberg, P.; Rijken, M.

    2011-01-01

    OBJECTIVE: (1) To describe the importance chronically ill and disabled patients attach to involvement in decision-making when various care types are considered, and (2) to analyse the degree to which these patients are involved in shared decision-making (SDM) regarding these care types, and whether their involvement reflects the importance they attach to SDM. METHODS: The study sample consisted of 812 chronically ill and disabled patients who experienced a situation of decision-making during ...

  5. Chronic cough and a normal chest X-ray - a simple systematic approach to exclude common causes before referral to secondary care: a retrospective cohort study

    OpenAIRE

    Turner, Richard D; Bothamley, Graham H

    2016-01-01

    Chronic cough is common in the community and can cause significant morbidity. It is not clear how closely treatment guidelines are used in general practice, or how often specialist referral is indicated. We aimed to assess the management of chronic cough in primary care before referral to a cough clinic, and to assess the outcome of managing chronic cough with an approach of simple investigation and empirical treatment trials. Data were extracted from the records of all patients attending a d...

  6. A Model for Risk Assessment in Health Care.

    Science.gov (United States)

    Prijatelj, Vesna; Rajkovič, Vladislav; Šušteršič, Olga

    2016-01-01

    The purpose of our research is to reduce risks and hence prevent errors in the health care process. The aim is to design an organizational information model using error prevention methods for risk assessment in a clinical setting. The model is based on selected indicators of quality nursing care, resulting from the world-known theoretical and practical models combined with experience in the Slovenian health care. The proposed organizational information model and software solution has a significant impact on the professional attention, communication and information, critical thinking, experience and knowledge. PMID:27332383

  7. Acute exacerbations of chronic obstructive pulmonary disease provide a unique opportunity to take care of patients

    Directory of Open Access Journals (Sweden)

    Bianca Beghé

    2013-04-01

    Full Text Available Exacerbation of chronic obstructive pulmonary disease (ECOPD identifies the acute phase of COPD. The COPD patient is often frail and elderly with concomitant chronic diseases. This requires the physician not only looks at specific symptoms or organs, but to consider the patient in all his or her complexity.

  8. Life after the Shock! The Impact on Families of Caring for Young Children with Chronic Illness

    Science.gov (United States)

    Ashton, Jean

    2004-01-01

    The stresses experienced by most families include limitations on time, conditions of employment, financial burdens and sibling rivalry. For the families of a child with a chronic illness, these stresses are often compounded, making family functioning problematic. Chronic illness is marked by permanency and the need for ongoing vigilance with…

  9. Primary Health Care Models: A Review of the International Literature

    OpenAIRE

    Julia Abelson; Brian Hutchison

    1994-01-01

    A common element in many countries’ health system reform agenda is an emphasis on changes to the organization, financing and delivery of primary health care. Numerous objectives for primary health care reform have been cited in jurisdictions around the world with different approaches being taken toward achieving stated objectives. This paper reviews the literature which has described and evaluated experiences with different primary health care delivery models in Canadian and other jurisdictio...

  10. A model for supply of informal care to elderly parents

    OpenAIRE

    Fevang, Elisabeth; Kverndokk, Snorre; Røed, Knut

    2009-01-01

    This paper presents a model of informal care to parents. We assume that the child participates in the labour market and gains in utility from consumption and leisure. In addition it has altruistic motivation to give informal care to its elderly parent. We show how the labour income, labour supply and informal caregiving are affected by exogenous factors such as the education level, wage rate, other supply of care, travel distance and inheritance.

  11. Research of organization of integrated primary care: a conceptual model

    OpenAIRE

    Marc Bruijnzeels

    2011-01-01

    Introduction Primary health care in The Netherlands evolves from small general practices to multidisciplinary teams. Research on the effects on outcomes of organization of primary care is hardly available. Aims Develop a conceptual model to be able to systematically arrange empirical evidence on the effects of different types of organizations of integrated (primary) care. Methods During an expert meeting of directors of health centres we identified essential elements which they consider impor...

  12. Psychosocial Adaptation to Chronic Illness and Disability: A Virtue Based Model.

    Science.gov (United States)

    Kim, Jeong Han; McMahon, Brian T; Hawley, Carolyn; Brickham, Dana; Gonzalez, Rene; Lee, Dong-Hun

    2016-03-01

    Purpose Psychosocial adaptation to chronic illness and disability (CID) is an area of study where a positive psychology perspective, especially the study of virtues and character strengths, can be implemented within the rehabilitation framework. A carefully developed theory to guide future interdisciplinary research is now timely. Methods A traditional literature review between philosophy and rehabilitation psychology was conducted in order to develop a virtue-based psychosocial adaptation theory, merging important perspectives from the fields of rehabilitation and positive psychology. Results The virtue-based psychosocial adaptation model (V-PAM) to CID is proposed in the present study. Conclusions The model involves five qualities or constructs: courage, practical wisdom, commitment to action, integrity and emotional transcendence. Each of these components of virtue contributes to an understanding of psychosocial adaptation. The present study addresses the implications and applications of V-PAM that will advance this understanding. PMID:26781509

  13. Primary Care Physician-Pharmacist Collaborative Care Model: Strategies for Implementation.

    Science.gov (United States)

    Carter, Barry L

    2016-04-01

    The Collaboration Among Pharmacists and Physicians To Improve Outcomes Now (CAPTION) trial recently found that a pharmacist intervention for hypertension could be implemented in diverse medical offices. In this issue of Pharmacotherapy, the article by Brian Isetts and colleagues discusses the complexity of the patient population, the specific functions the pharmacists performed, and the time estimates from billing records used to quantify time spent during face-to-face patient encounters. This invited commentary will discuss findings from the CAPTION trial and provide recommendations for strategies to implement similar interventions for patients with other chronic medical conditions seen in primary care practices. PMID:26931738

  14. Providing continuity of care for chronic diseases in the aftermath of Katrina: from field experience to policy recommendations.

    Science.gov (United States)

    Arrieta, Martha I; Foreman, Rachel D; Crook, Errol D; Icenogle, Marjorie L

    2009-10-01

    This study sought to elicit challenges and solutions in the provision of health care to those with chronic diseases after Hurricane Katrina in coastal Alabama and Mississippi. In-depth interviews with 30 health and social service providers (key informants) and 4 focus groups with patients with chronic diseases were conducted. Subsequently an advisory panel of key informants was convened. Findings were summarized and key informants submitted additional feedback. The chronic diseases identified as medical management priorities by key informants were mental health, diabetes mellitus, hypertension, respiratory illness, end-stage renal disease, cardiovascular disease, and cancer. The most frequently mentioned barrier to providing care was maintaining continuity of medications. Contributing factors were inadequate information (inaccessible medical records, poor patient knowledge) and financial constraints. Implemented or suggested solutions included relaxation of insurance limitations preventing advance prescription refills; better predisaster patient education to improve medical knowledge; promotion of personal health records; support for information technology systems at community health centers, in particular electronic medical records; improved allocation of donated medications/medical supplies (centralized coordination, decentralized distribution); and networking between local responders and external aid. PMID:19865042

  15. Symptoms and impact of symptoms on function and health in patients with chronic obstructive pulmonary disease and chronic heart failure in primary health care

    Directory of Open Access Journals (Sweden)

    Theander K

    2014-07-01

    Full Text Available Kersti Theander,1,2 Mikael Hasselgren,2,3 Kristina Luhr,4 Jeanette Eckerblad,5 Mitra Unosson,5 Ingela Karlsson1 1Department of Nursing, Faculty of Health Science and Technology, Karlstad University, Karlstad, Sweden; 2Primary Care Research Unit, County Council of Värmland, Karlstad, Sweden; 3Department of Medicine, Örebro University, Örebro, Sweden; 4Family Medicine Research Centre, Örebro County Council, Örebro, Sweden; 5Department of Social and Welfare Studies, Faculty of Health Sciences, Linköping University, Linköping, Sweden Background: Patients with chronic obstructive pulmonary disease (COPD and chronic heart failure (CHF seem to have several symptoms in common that impact health. However, methodological differences make this difficult to compare. Aim: Comparisons of symptoms, impact of symptoms on function and health between patients with COPD and CHF in primary health care (PHC. Method: The study is cross sectional, including patients with COPD (n=437 and CHF (n=388, registered in the patient administrative systems of PHC. The patients received specific questionnaires – the Memorial Symptom Assessment Scale, the Medical Research Council dyspnea scale, and the Fatigue Impact Scale – by mail and additional questions about psychological and physical health. Results: The mean age was 70±10 years and 78±10 years for patients with COPD and CHF respectively (P=0.001. Patients with COPD (n=273 experienced more symptoms (11±7.5 than the CHF patients (n=211 (10±7.6. The most prevalent symptoms for patients with COPD were dyspnea, cough, and lack of energy. For patients with CHF, the most prevalent symptoms were dyspnea, lack of energy, and difficulty sleeping. Experience of dyspnea, cough, dry mouth, feeling irritable, worrying, and problems with sexual interest or activity were more common in patients with COPD while the experience of swelling of arms or legs was more common among patients with CHF. When controlling for background

  16. Consulting Psychiatry within an Integrated Primary Care Model

    OpenAIRE

    Schreiter, Elizabeth A. Zeidler; Pandhi, Nancy; Fondow, Meghan D. M.; Thomas, Chantelle; Vonk, Jantina; Reardon, Claudia L; Serrano, Neftali

    2013-01-01

    After implementation of an integrated consulting psychiatry model and psychology services within primary care at a federally qualified health center, patients have increased access to needed mental health services, and primary care clinicians receive the support and collaboration needed to meet the psychiatric needs of the population.

  17. [Development of a Conceptual Framework for the Assessment of Chronic Care in the Spanish National Health System].

    Science.gov (United States)

    Espallargues, Mireia; Serra-Sutton, Vicky; Solans-Domènech, Maite; Torrente, Elena; Moharra, Montse; Benítez, Dolors; Robles, Noemí; Domíngo, Laia; Escarrabill Sanglas, Joan

    2016-01-01

    The aim was to develop a conceptual framework for the assessment of new healthcare initiatives on chronic diseases within the Spanish National Health System. A comprehensive literature review between 2002 and 2013, including systematic reviews, meta-analysis, and reports with evaluation frameworks and/or assessment of initiatives was carried out; integrated care initiatives established in Catalonia were studied and described; and semistructured interviews with key stakeholders were performed. The scope and conceptual framework were defined by using the brainstorming approach.Of 910 abstracts identified, a total of 116 studies were included. They referred to several conceptual frameworks and/or assessment indicators at a national and international level. An overall of 24 established chronic care initiatives were identified (9 integrated care initiatives); 10 in-depth interviews were carried out. The proposed conceptual framework envisages: 1)the target population according to complexity levels; 2)an evaluation approach of the structure, processes, and outcomes considering the health status achieved, the recovery process and the maintenance of health; and 3)the dimensions or attributes to be assessed. The proposed conceptual framework will be helpful has been useful to develop indicators and implement them with a community-based and result-oriented approach and a territorial or population-based perspective within the Spanish Health System. This will be essential to know which are the most effective strategies, what are the key elements that determine greater success and what are the groups of patients who can most benefit. PMID:27382930

  18. A discrete choice model for labor supply and child care

    OpenAIRE

    Kornstad, Tom; Thoresen, Thor Olav

    2002-01-01

    Abstract: A discrete choice model for labor supply and child care for mothers of preschoolers is presented. The mothers are assumed to make choices from a finite set of job possibilities and from a finite set of child care options. The options in the markets for child care are characterized by opening hours, fees and a number of quality attributes, such as mode of care. Similarly, jobs are characterized by a (fixed) wage rate, working hours and a number of variables related to job satisfac...

  19. MICROBIAL SURVEILLANCE OF ACUTE AND CHRONIC DACRYOCYSTITIS IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Jithendra

    2015-01-01

    Full Text Available BACKGROUND : Dacryocystitis acute or chronic poses a constant threat to cornea and orbital soft tissue if neglected revealing the importance of the condition. Infection with microbes in these patients can cause severe morbidity. Hence it is important to know the pathogen wise in man agement of the condition. Our study was determined to know the bacterial and fungal etiology of both acute and chronic dacryocystitis and their invitro antibacterial susceptibility and resistance to commonly used antibacterial agents. METHODS : This hospita l based study was conducted during March 2011 to March 2013. Patients with suffering with acute and chronic dacrocystitis were included in the study. Specimens were collected from these patients, processing, isolation, identification and antibiogram of the isolates were done as per standard procedures. RESULTS : A total of 298 patients were included in the study based upon the inclusion criteria. Out of 298 patients 126(42.29% presented with acute dacryocystitis and 172(57.71% were with chronic dacryocysti tis. Single eye involvement was noticed in 184 (61.75% cases and 114 (38.25% presented with involvement of both eyes. Out of 298 cases pure growth was seen in 255(85.57% and 43(14.43% yielded no growth on culture. On observation more percentage of cult ure positivity was noticed in chronic cases (164 of 172, 95.34% and less in acute cases (91 of 126, 72.23% and the difference was also statistically significant. Single isolate was found in 218 cases, two/three isolates were recovered from 37 cases. All cases of polymicrobial growth were observed in chronic dacryocystitis. Staphylococcus aureus as the most common gram positive pathogen (43/77, 55.84% in acute, 34/77, 44.16% in chronic dacryocystitis followed by Staphylococcus epidermidis (38/64, 59.37% i n acute, 26/64, 40.63% in chronic dacryocystitis, Streptococcus pneumoniae ( 10/12, 83.34% in acute, 2/12, 16.67% in chronic dacryocystitis and least Micrococcus

  20. On the global dynamics of a chronic myelogenous leukemia model

    Science.gov (United States)

    Krishchenko, Alexander P.; Starkov, Konstantin E.

    2016-04-01

    In this paper we analyze some features of global dynamics of a three-dimensional chronic myelogenous leukemia (CML) model with the help of the stability analysis and the localization method of compact invariant sets. The behavior of CML model is defined by concentrations of three cellpopulations circulating in the blood: naive T cells, effector T cells specific to CML and CML cancer cells. We prove that the dynamics of the CML system around the tumor-free equilibrium point is unstable. Further, we compute ultimate upper bounds for all three cell populations and provide the existence conditions of the positively invariant polytope. One ultimate lower bound is obtained as well. Moreover, we describe the iterative localization procedure for refining localization bounds; this procedure is based on cyclic using of localizing functions. Applying this procedure we obtain conditions under which the internal tumor equilibrium point is globally asymptotically stable. Our theoretical analyses are supplied by results of the numerical simulation.

  1. Integration of healthcare rehabilitation in chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne; Høst, Dorte; Schnor, Helle;

    2010-01-01

    during the project period. The chronic care model was used as a framework for support of implementing and integration of the four rehabilitation programmes. CONCLUSION AND DISCUSSION: The chronic care model provided support for implementing rehabilitation programmes for four chronic conditions in...... rehabilitation programmes in four conditions. DESCRIPTION OF CARE PRACTICE: FOUR MULTIDISCIPLINARY REHABILITATION INTERVENTION PROGRAMMES, ONE FOR EACH CHRONIC CONDITION: chronic obstructive pulmonary disease, type 2 diabetes, chronic heart failure, and falls in elderly people were developed and implemented...... Bispebjerg University Hospital, the City of Copenhagen, and GPs' offices. New management practices were developed, known practices were improved to support integration, and known practices were used for implementation purposes. Several barriers to integrated care were identified....

  2. A person-focused model of care for the twenty-first century: a system-of-systems perspective.

    Science.gov (United States)

    Greene, Robert A; Dasso, Edwin; Ho, Sam; Genaidy, Ash M

    2014-06-01

    The US health care system is challenged to provide high-quality care and is burdened with unsustainable expenditures, making it difficult for health care participants (patients, payers, providers, caregivers) to create value. This communication presents the theoretical foundation for a person-focused model of care that addresses a number of these challenges. The model integrates aspects of prior models of chronic care with new empiric findings and complex adaptive system (CAS) theory. The model emphasizes the relationship among all health care stakeholders. The health care delivery process is examined in terms of the role of each stakeholder and the value each adds to and receives from the process. The authors present pilot results illustrating the implications of CAS theory in regard to multi-morbidity, disease management programs, multi-morbid households, and person- and household-focused care. The model incorporates the physical, mental, and social dimensions of health, and operationalizes an individual patient's health as a CAS, identifying CASs for each of the other stakeholders as well. Health care can then be conceptualized as a system-of-systems with a person's health as its output. Deploying the model need not require major infrastructure investments or changes. It can be implemented by repurposing, aligning, and better integrating currently available interventions. The authors believe that the model creates not only survival value (health) but also purposeful value. The model offers a unifying focus for all participants in the health care delivery process, thereby constructing a health care system that is structurally person-focused and meaningful for all participants. PMID:24720637

  3. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy

    Directory of Open Access Journals (Sweden)

    Forastiere Francesco

    2009-12-01

    Full Text Available Abstract Background A relationship between quality of primary health care and preventable hospitalizations has been described in the US, especially among the elderly. In Europe, there has been a recent increase in the evaluation of Ambulatory Care Sensitive Conditions (ACSC as an indicator of health care quality, but evidence is still limited. The aim of this study was to determine whether income level is associated with higher hospitalization rates for ACSC in adults in a country with universal health care coverage. Methods From the hospital registries in four Italian cities (Turin, Milan, Bologna, Rome, we identified 9384 hospital admissions for six chronic conditions (diabetes, hypertension, congestive heart failure, angina pectoris, chronic obstructive pulmonary disease, and asthma among 20-64 year-olds in 2000. Case definition was based on the ICD-9-CM coding algorithm suggested by the Agency for Health Research and Quality - Prevention Quality Indicators. An area-based (census block income index was used for each individual. All hospitalization rates were directly standardised for gender and age using the Italian population. Poisson regression analysis was performed to assess the relationship between income level (quintiles and hospitalization rates (RR, 95% CI separately for the selected conditions controlling for age, gender and city of residence. Results Overall, the ACSC age-standardized rate was 26.1 per 10.000 inhabitants. All conditions showed a statistically significant socioeconomic gradient, with low income people being more likely to be hospitalized than their well off counterparts. The association was particularly strong for chronic obstructive pulmonary disease (level V low income vs. level I high income RR = 4.23 95%CI 3.37-5.31 and for congestive heart failure (RR = 3.78, 95% CI = 3.09-4.62. With the exception of asthma, males were more vulnerable to ACSC hospitalizations than females. The risks were higher among 45-64 year

  4. A systematic review of interventions to enhance access to best practice primary health care for chronic disease management, prevention and episodic care

    Directory of Open Access Journals (Sweden)

    Comino Elizabeth

    2012-11-01

    Full Text Available Abstract Background Although primary health care (PHC is a key component of all health care systems, services are not always readily available, accessible or affordable. This systematic review examines effective strategies to enhance access to best practice processes of PHC in three domains: chronic disease management, prevention and episodic care. Methods An extensive search of bibliographic data bases to identify peer and non-peer reviewed literature was undertaken. Identified papers were screened to identify and classify intervention studies that measured the impact of strategies (singly or in combination on change in use or the reach of services in defined population groups (evaluated interventions. Results The search identified 3,148 citations of which 121 were intervention studies and 75 were evaluated interventions. Evaluated interventions were found in all three domains: prevention (n = 45, episodic care (n = 19, and chronic disease management (n = 11. They were undertaken in a number of countries including Australia (n = 25, USA (n = 25, and UK (n = 15. Study quality was ranked as high (31% of studies, medium (61% and low (8%. The 75 evaluated interventions tested a range of strategies either singly (n = 46 studies or as a combination of two (n = 20 or more strategies (n = 9. Strategies targeted both health providers and patients and were categorised to five groups: practice re-organisation (n = 43 studies, patient support (n = 29, provision of new services (n = 19, workforce development (n = 11, and financial incentives (n = 9. Strategies varied by domain, reflecting the complexity of care needs and processes. Of the 75 evaluated interventions, 55 reported positive findings with interventions using a combination of strategies more likely to report positive results. Conclusions This review suggests that multiple, linked strategies targeting different levels of the health care

  5. Non-disclosure of chronic kidney disease in primary care and the limits of instrumental rationality in chronic illness self-management.

    Science.gov (United States)

    Daker-White, Gavin; Rogers, Anne; Kennedy, Anne; Blakeman, Thomas; Blickem, Christian; Chew-Graham, Carolyn

    2015-04-01

    Early detection of long term conditions is predicated on assumptions that lifestyle changes and medications can be used to reduce or manage the risk of condition progression. However, ambiguity remains about the nature and place of diagnostic disclosure to people in newly recognised or asymptomatic 'pre' conditions such as early stage chronic kidney disease (CKD). The disclosure of a diagnosis is relevant to instigating strategies which rely on actively engaging patients as self-managers of their own care. Whilst primary care routinely records a diagnosis of early stage CKD, little is known about how patients learn about the fact that they have CKD or how they respond to this. This study aimed to explore patients' experiences of disclosure of CKD in primary care settings. A nested qualitative study of participants recruited to a trial of an intervention for CKD patients in Greater Manchester, UK was undertaken. A purposive sample of 26 patients, with a mean age of 72 years (range 59-89, median 71), were interviewed during 2012. Interview transcripts were analysed using constant comparative techniques. Narrative accounts reflected limited or partial disclosure of CKD; often cast in vague terms as "nothing to worry about". How patients described themselves in terms of participation and their tendencies towards 'active' or 'passive' involvement in consultations emerged as important components of narratives around disclosure. The findings illuminate the ways in which diagnosis is oriented in a context where it is possible to meet the requirements for remuneration under a pay for performance system of primary care, whilst apparently not disclosing a label or a diagnosis to patients. This challenges the presumptions inherent in wider health policy objectives that are increasingly built on the notion of responsible patients and the ethos of the active support of self-management for pre-conditions. PMID:25748112

  6. Self-care as Actualization of the Human Model in the Philosophy of Medicine

    Directory of Open Access Journals (Sweden)

    Radu BANDOL

    2015-06-01

    Full Text Available The study aims to argue that the humanist model of medicine approaches the practice of self-care, the latter being an actualization of the former concerning all those ideas and issues in which they overlap. The humanisitic model covers pacient-centred medicine and offers a holistic approach to the patient which involves treating him/her as a patient, not as a body (as in biomedicine, emphasizes the doctor-patient partnership atmosphere, a relational, communicational and informational environment. The concept of spatialization in philosophy came out as an empirical mecanicist model in sciences and influenced the appearance of the biomedical model. In the humanistic model, the patient can be, to a certain extent, the factor making decisions with regard to the chronic disease. Self-care matches especially the human medicine with regard to the outlook on the patient as a person (holism, the long-term partnership in the communication, information and correct decision-making for the disease, the empathic environment, the responsibility shared between two people, the assistance provided when making decisions for the patient’s “friendship”with the chronic disease.

  7. Public Health Nutrition: The Accord of Dietitian Providers in Managing Medicare Chronic Care Outpatients in Australia

    OpenAIRE

    Cant

    2010-01-01

    Medicare Australia: Chronic Disease Management program subsidizes allied health consultations for eligible outpatients with chronic disease or complex needs. In an evaluation study, private practice dietitians (n = 9) were interviewed to explore their patient management strategies including consultation time-allocation and fees. Time allocation was fee-based. Short first consultations were seen as meeting patients’ needs for low-cost services but were regarded by dietitians as ineffective, ho...

  8. Demographics and health care seeking behavior of Singaporean women with chronic constipation: implications for therapeutic management

    OpenAIRE

    Gwee KA; Setia S

    2012-01-01

    Kok Ann Gwee1,2, Sajita Setia31Gleneagles Hospital, 2Yong Loo Lin School of Medicine, National University of Singapore (NUS), 3Janssen, Johnson and Johnson Pte Ltd, SingaporeIntroduction: Chronic constipation is significantly more prevalent in women than men in Singapore. We carried out a survey to study patient demographics, symptom prevalence, healthcare-seeking behavior, and patient satisfaction with available treatment options in women with chronic constipation.Methods: Responses were col...

  9. Spectrum of acute and chronic leukemia at a tertiary care hospital, Haryana, India

    OpenAIRE

    Gajender Singh; Padam Parmar; Sant Prakash Kataria; Sunita Singh; Rajeev Sen

    2016-01-01

    Background: Leukemias are primary neoplasms arising from the malignant proliferations of blood cells or their precursors. Leukemias are classified into acute/chronic myeloid and lymphoid subtype. Typing of leukemia is essential for effective therapy because prognosis and survival rate are different for each type and sub-type. Methods: A total of 356 patients diagnosed to have acute/chronic leukemia were included in our study. Only newly diagnosed cases were included in this study and patie...

  10. Chronic Non-Communicable Cardiovascular and Pulmonary Disease in sub-Saharan Africa: An Academic Model for Countering the Epidemic

    Science.gov (United States)

    Bloomfield, Gerald S.; Kimaiyo, Sylvester; Carter, E. Jane; Binanay, Cynthia; Corey, G. Ralph; Einterz, Robert M.; Tierney, William M.; Velazquez, Eric J.

    2011-01-01

    Summary Non-communicable diseases are rapidly overtaking infectious, perinatal, nutritional and maternal diseases as the major causes of worldwide death and disability. It is estimated that within the next 10-15 years, the increasing burden of chronic diseases and the ageing of the population will expose the world to an unprecedented burden of chronic diseases. Preventing the potential ramifications of a worldwide epidemic of chronic non-communicable diseases in a sustainable manner requires coordinated, collaborative efforts. Herein we present our collaboration's strategic plan to understand, treat and prevent chronic cardiovascular and pulmonary disease in Western Kenya which builds on a two decade partnership between academic universities in North America and Kenya; the Academic Model Providing Access to Healthcare (AMPATH). We emphasize the importance of training Kenyan clinician-investigators who will ultimately lead efforts in cardiovascular and pulmonary disease care, education and research. This penultimate aim will be achieved by our five main goals. Our goals include creating an administrative core capable of managing operations, develop clinical and clinical research training curricula, enhancing existing technology infrastructure and implementing relevant research programs. Leveraging a strong international academic partnership with respective expertise in cardiovascular medicine, pulmonary medicine and medical informatics we have undertaken to understand and counter cardiovascular and pulmonary disease in Kenya by addressing patient care, teaching and clinical research. PMID:21570512

  11. Chronic noncommunicable cardiovascular and pulmonary disease in sub-Saharan Africa: an academic model for countering the epidemic.

    Science.gov (United States)

    Bloomfield, Gerald S; Kimaiyo, Sylvester; Carter, E Jane; Binanay, Cynthia; Corey, G Ralph; Einterz, Robert M; Tierney, William M; Velazquez, Eric J

    2011-05-01

    Noncommunicable diseases are rapidly overtaking infectious, perinatal, nutritional, and maternal diseases as the major causes of worldwide death and disability. It is estimated that, within the next 10 to 15 years, the increasing burden of chronic diseases and the aging of the population will expose the world to an unprecedented burden of chronic diseases. Preventing the potential ramifications of a worldwide epidemic of chronic noncommunicable diseases in a sustainable manner requires coordinated, collaborative efforts. Herein, we present our collaboration's strategic plan to understand, treat, and prevent chronic cardiovascular and pulmonary disease (CVPD) in western Kenya, which builds on a 2-decade partnership between academic universities in North America and Kenya, the Academic Model Providing Access to Healthcare. We emphasize the importance of training Kenyan clinician-investigators who will ultimately lead efforts in CVPD care, education, and research. This penultimate aim will be achieved by our 5 main goals. Our goals include creating an administrative core capable of managing operations, develop clinical and clinical research training curricula, enhancing existing technology infrastructure, and implementing relevant research programs. Leveraging a strong international academic partnership with respective expertise in cardiovascular medicine, pulmonary medicine, and medical informatics, we have undertaken to understand and counter CVPD in Kenya by addressing patient care, teaching, and clinical research. PMID:21570512

  12. Roles and responsibilities in the secondary level eye care model

    Directory of Open Access Journals (Sweden)

    Saibaba Saravanan

    2005-12-01

    Full Text Available In any secondary level eye care clinic, a number of tasks must be completed. In different countries and different settings, different people will carry out these tasks. The manager is responsible for ensuring that all the tasks are covered, that people are carefully selected to perform them, and that staff are supported and managed. The International Centre for Advancement of Rural Eye Care (ICARE, within the L.V. Prasad Eye Institute (LVPEI in India, has evolved an eye care team to provide secondary level eye care services to a population of 0.5 to 1 million. The ICARE model emphasises that all cadres of clinical and non-clinical personnel are equally important. Below is a description of the range of jobs at secondary level centres. The tertiary centre at LVPEI manages leadership and training for this model.

  13. Integration and continuity of Care in health care network models for frail older adults

    Science.gov (United States)

    Veras, Renato Peixoto; Caldas, Célia Pereira; da Motta, Luciana Branco; de Lima, Kenio Costa; Siqueira, Ricardo Carreño; Rodrigues, Renata Teixeira da Silva Vendas; Santos, Luciana Maria Alves Martins; Guerra, Ana Carolina Lima Cavaletti

    2014-01-01

    A detailed review was conducted of the literature on models evaluating the effectiveness of integrated and coordinated care networks for the older population. The search made use of the following bibliographic databases: Pubmed, The Cochrane Library, LILACS, Web of Science, Scopus and SciELO. Twelve articles on five different models were included for discussion. Analysis of the literature showed that the services provided were based on primary care, including services within the home. Service users relied on the integration of primary and hospital care, day centers and in-home and social services. Care plans and case management were key elements in care continuity. This approach was shown to be effective in the studies, reducing the need for hospital care, which resulted in savings for the system. There was reduced prevalence of functional loss and improved satisfaction and quality of life on the part of service users and their families. The analysis reinforced the need for change in the approach to health care for older adults and the integration and coordination of services is an efficient way of initiating this change. PMID:24897058

  14. Automated medical diagnosis with fuzzy stochastic models: monitoring chronic diseases.

    Science.gov (United States)

    Jeanpierre, Laurent; Charpillet, François

    2004-01-01

    As the world population ages, the patients per physician ratio keeps on increasing. This is even more important in the domain of chronic pathologies where people are usually monitored for years and need regular consultations. To address this problem, we propose an automated system to monitor a patient population, detecting anomalies in instantaneous data and in their temporal evolution, so that it could alert physicians. By handling the population of healthy patients autonomously and by drawing the physicians' attention to the patients-at-risk, the system allows physicians to spend comparatively more time with patients who need their services. In such a system, the interaction between the patients, the diagnosis module, and the physicians is very important. We have based this system on a combination of stochastic models, fuzzy filters, and strong medical semantics. We particularly focused on a particular tele-medicine application: the Diatelic Project. Its objective is to monitor chronic kidney-insufficient patients and to detect hydration troubles. During two years, physicians from the ALTIR have conducted a prospective randomized study of the system. This experiment clearly shows that the proposed system is really beneficial to the patients' health. PMID:15520535

  15. An Appraisal of End-of-Life Care in Persons with Chronic Kidney Disease Dying in Hospital Wards

    OpenAIRE

    Noble, Helen; Brown, Joan; Shields, Joanne; Fogarty, Damian; Maxwell, Alexander P.

    2015-01-01

    AIM: To review end-of-life care provided by renal healthcare professionals to hospital in-patients with chronic kidney disease, and their carers, over a 12-month period in Northern Ireland.METHODS: Retrospective review of 100 patients.RESULTS: Mean age at death was 72 years (19-95) and 56% were male. Eighty three percent of patients had a 'Not For Attempted Resuscitation' order during their last admission and this was implemented in 42%. Less than 20% of all patients died in a hospital ward. ...

  16. Latent class models for utilisation of health care

    OpenAIRE

    Teresa Bago d’Uva

    2005-01-01

    This paper explores different approaches to econometric modelling of count measures of health care utilisation, with an emphasis on latent class models. A new model is proposed that combines the features of the two most common approaches- the hurdle model and the finite mixture Negative Binomial. Additionally, the panel structure of the data is taken into account. The proposed model is shown to perform better than the existing models for a particular application with data from the RAND Health...

  17. Modeling of radiation doses from chronic aqueous releases

    International Nuclear Information System (INIS)

    A general model and corresponding computer code were developed to calculate personnel dose estimates from chronic releases via aqueous pathways. Potential internal dose pathways are consumption of water, fish, crustacean, and mollusk. Dose prediction from consumption of fish, crustacean, or mollusk is based on the calculated radionuclide content of the water and applicable bioaccumulation factor. 70-year dose commitments are calculated for whole body, bone, lower large intestine of the gastrointestinal tract, and six internal organs. In addition, the code identifies the largest dose contributor and the dose percentages for each organ-radionuclide combination in the source term. The 1974 radionuclide release data from the Savannah River Plant were used to evaluate the dose models. The dose predicted from the model was compared to the dose calculated from radiometric analysis of water and fish samples. The whole body dose from water consumption was 0.45 mrem calculated from monitoring data and 0.61 mrem predicted from the model. Tritium contributed 99 percent of this dose. The whole body dose from fish consumption was 0.20 mrem calculated from monitoring data and 0.14 mrem from the model. Cesium-134,137 was the principal contributor to the 70-year whole body dose from fish consumption

  18. A randomized controlled trial to evaluate an educational strategy involving community health volunteers in improving self-care in patients with chronic heart failure: Rationale, design and methodology

    OpenAIRE

    Siabani, Soraya; Driscoll, Tim; Davidson, Patricia M; Leeder, Stephen R

    2014-01-01

    Background Chronic heart failure (CHF) is an increasingly important health problem worldwide. Effective self-care can improve the outcomes and quality of life in patients with CHF. Acknowledging the important role of educational interventions for improving self-care, we sought to assess a new educational strategy involving community health volunteers (CHVs) that could reduce the cost and, hypothetically, increase the effectiveness of self-care education in patients with CHF. Methods/Design In...

  19. iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions

    OpenAIRE

    Parmanto, Bambang; Pramana, Gede; Yu, Daihua Xie; Fairman, Andrea D.; Dicianno, Brad E.; McCue, Michael P

    2013-01-01

    Background Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh...

  20. Evaluating Comparative Effectiveness Research Priorities for Care Coordination in Chronic Obstructive Pulmonary Disease: A Community-Based eDelphi Study

    OpenAIRE

    Stellefson, Michael; Alber, Julia; Paige, Samantha; Castro, Daniela; Singh, Briana

    2015-01-01

    Background Despite research supporting the use of care coordination in chronic obstructive pulmonary disease (COPD), there is relatively little known about the comparative effectiveness of different strategies used to organize care for patients. To investigate the most important COPD care coordination strategies, community-based stakeholder input is needed, especially from medically underserved populations. Web-based platforms are electronic tools now being used to bring together individuals ...

  1. [Chronic dependence on mechanical pulmonary ventilation in pediatric care: a necessary debate for Brazil's Unified Health System].

    Science.gov (United States)

    Costa, Maria Tereza Fonseca da; Gomes, Maria Auxiliadora; Pinto, Márcia

    2011-10-01

    People with prolonged dependence on mechanical ventilation require permanent care and the use of equipment that can result in longer term hospital internment. This can lead to difficulty of access for patients with acute injuries, as well as personal difficulties and stress with reduced quality of life for their families or caregivers due to such longer hospital internment. This critical review of publications dealing with dependence on mechanical ventilation among children and adolescents aimed at making information organized in a systematic manner available in order to support discussion on the subject. It should be borne in mind that changes in epidemiological profile and growing technological access determine needs such as intensive therapy hospital beds and complex home care for chronic patients, which still have limits of supply and regulatory restrictions in the Brazilian public health system. PMID:22031144

  2. The Pediatric Home Care/Expenditure Classification Model (P/ECM): A Home Care Case-Mix Model for Children Facing Special Health Care Challenges

    OpenAIRE

    Phillips, Charles D

    2015-01-01

    Case-mix classification and payment systems help assure that persons with similar needs receive similar amounts of care resources, which is a major equity concern for consumers, providers, and programs. Although health service programs for adults regularly use case-mix payment systems, programs providing health services to children and youth rarely use such models. This research utilized Medicaid home care expenditures and assessment data on 2,578 children receiving home care in one large sta...

  3. Chronic Disease Prevalence and Healthy Lifestyle Behaviors Among US Health Care Professionals.

    Science.gov (United States)

    Dayoub, Elias; Jena, Anupam B

    2015-12-01

    Although health care professionals may be assumed to make healthier lifestyle choices and have better health outcomes than others because of their greater health literacy, little is known about how actual health outcomes of health care professionals compare with those of the overall population. We analyzed how trends in obesity, diabetes, hypertension, and coronary artery disease prevalence as well as several health behaviors (smoking, alcohol use, and exercise) varied between health care professionals and the general US population from 2002 to 2013, using nationally representative data collected by the National Health Interview Survey. We estimated multivariate logistic regressions of each disease and behavior adjusted for age, race, sex, geographic region, and year. Although rates of obesity, diabetes, and hypertension were lower among health care professionals compared with the overall population, disease was still common among health care professionals and increased over time at a rate similar to that of the overall population. For example, obesity prevalence was lower among health care professionals but increased similarly from 2002 to 2013 (health care professionals, 20.5% in 2002 to 22.1% in 2013; other occupations, 28.4% to 31.7%; P=.64 for difference in trend). Diabetes prevalence was modestly lower among health care professionals but increased at a similar rate (health care professionals, 7.4% in 2005 to 8.6% in 2013; other occupations, 8.7% to 9.9%; P=.67 for difference in trend). Similar patterns were noted in hypertension. Coronary artery disease prevalence declined over time among health care professionals but increased for others. Health care professionals reported better health behaviors than others in smoking and physical activity but not in moderate to heavy alcohol use. PMID:26422242

  4. Systematic review of integrated models of health care delivered at the primary-secondary interface: how effective is it and what determines effectiveness?

    Science.gov (United States)

    Mitchell, Geoffrey K; Burridge, Letitia; Zhang, Jianzhen; Donald, Maria; Scott, Ian A; Dart, Jared; Jackson, Claire L

    2015-01-01

    Integrated multidisciplinary care is difficult to achieve between specialist clinical services and primary care practitioners, but should improve outcomes for patients with chronic and/or complex chronic physical diseases. This systematic review identifies outcomes of different models that integrate specialist and primary care practitioners, and characteristics of models that delivered favourable clinical outcomes. For quality appraisal, the Cochrane Risk of Bias tool was used. Data are presented as a narrative synthesis due to marked heterogeneity in study outcomes. Ten studies were included. Publication bias cannot be ruled out. Despite few improvements in clinical outcomes, significant improvements were reported in process outcomes regarding disease control and service delivery. No study reported negative effects compared with usual care. Economic outcomes showed modest increases in costs of integrated primary-secondary care. Six elements were identified that were common to these models of integrated primary-secondary care: (1) interdisciplinary teamwork; (2) communication/information exchange; (3) shared care guidelines or pathways; (4) training and education; (5) access and acceptability for patients; and (6) a viable funding model. Compared with usual care, integrated primary-secondary care can improve elements of disease control and service delivery at a modestly increased cost, although the impact on clinical outcomes is limited. Future trials of integrated care should incorporate design elements likely to maximise effectiveness. PMID:26329878

  5. Efficacy of amoxycillin versus amoxycillin/clavulanate in acute exacerbations of chronic pulmonary obstructive disease in primary care

    Directory of Open Access Journals (Sweden)

    Carl Llor

    2008-10-01

    moderate patients in primary care.Keywords: exacerbation, chronic obstructive pulmonary disease, randomised controlled trial, amoxycillin, primary care, amoxycillin/clavulanate

  6. Issues facing the future health care workforce: the importance of demand modelling.

    Science.gov (United States)

    Segal, Leonie; Bolton, Tom

    2009-01-01

    This article examines issues facing the future health care workforce in Australia in light of factors such as population ageing. It has been argued that population ageing in Australia is affecting the supply of health care professionals as the health workforce ages and at the same time increasing the demand for health care services and the health care workforce.However, the picture is not that simple. The health workforce market in Australia is influenced by a wide range of factors; on the demand side by increasing levels of income and wealth, emergence of new technologies, changing disease profiles, changing public health priorities and a focus on the prevention of chronic disease. While a strong correlation is observed between age and use of health care services (and thus health care workforce), this is mediated through illness, as typified by the consistent finding of higher health care costs in the months preceding death.On the supply side, the health workforce is highly influenced by policy drivers; both national policies (eg funded education and training places) and local policies (eg work place-based retention policies). Population ageing and ageing of the health workforce is not a dominant influence. In recent years, the Australian health care workforce has grown in excess of overall workforce growth, despite an ageing health workforce. We also note that current levels of workforce supply compare favourably with many OECD countries. The future of the health workforce will be shaped by a number of complex interacting factors.Market failure, a key feature of the market for health care services which is also observed in the health care labour market - means that imbalances between demand and supply can develop and persist, and suggests a role for health workforce planning to improve efficiency in the health services sector. Current approaches to health workforce planning, especially on the demand side, tend to be highly simplistic. These include historical

  7. Shifting chronic disease management from hospitals to primary care in Estonian health system: analysis of national panel data

    Science.gov (United States)

    Atun, Rifat; Gurol–Urganci, Ipek; Hone, Thomas; Pell, Lisa; Stokes, Jonathan; Habicht, Triin; Lukka, Kaija; Raaper, Elin; Habicht, Jarno

    2016-01-01

    Background Following independence from the Soviet Union in 1991, Estonia introduced a national insurance system, consolidated the number of health care providers, and introduced family medicine centred primary health care (PHC) to strengthen the health system. Methods Using routinely collected health billing records for 2005–2012, we examine health system utilisation for seven ambulatory care sensitive conditions (ACSCs) (asthma, chronic obstructive pulmonary disease [COPD], depression, Type 2 diabetes, heart failure, hypertension, and ischemic heart disease [IHD]), and by patient characteristics (gender, age, and number of co–morbidities). The data set contained 552 822 individuals. We use patient level data to test the significance of trends, and employ multivariate regression analysis to evaluate the probability of inpatient admission while controlling for patient characteristics, health system supply–side variables, and PHC use. Findings Over the study period, utilisation of PHC increased, whilst inpatient admissions fell. Service mix in PHC changed with increases in phone, email, nurse, and follow–up (vs initial) consultations. Healthcare utilisation for diabetes, depression, IHD and hypertension shifted to PHC, whilst for COPD, heart failure and asthma utilisation in outpatient and inpatient settings increased. Multivariate regression indicates higher probability of inpatient admission for males, older patient and especially those with multimorbidity, but protective effect for PHC, with significantly lower hospital admission for those utilising PHC services. Interpretation Our findings suggest health system reforms in Estonia have influenced the shift of ACSCs from secondary to primary care, with PHC having a protective effect in reducing hospital admissions. PMID:27175280

  8. Chiropractic as spine care: a model for the profession

    Directory of Open Access Journals (Sweden)

    Metz R Douglas

    2005-07-01

    Full Text Available Abstract Background More than 100 years after its inception the chiropractic profession has failed to define itself in a way that is understandable, credible and scientifically coherent. This failure has prevented the profession from establishing its cultural authority over any specific domain of health care. Objective To present a model for the chiropractic profession to establish cultural authority and increase market share of the public seeking chiropractic care. Discussion The continued failure by the chiropractic profession to remedy this state of affairs will pose a distinct threat to the future viability of the profession. Three specific characteristics of the profession are identified as impediments to the creation of a credible definition of chiropractic: Departures from accepted standards of professional ethics; reliance upon obsolete principles of chiropractic philosophy; and the promotion of chiropractors as primary care providers. A chiropractic professional identity should be based on spinal care as the defining clinical purpose of chiropractic, chiropractic as an integrated part of the healthcare mainstream, the rigorous implementation of accepted standards of professional ethics, chiropractors as portal-of-entry providers, the acceptance and promotion of evidence-based health care, and a conservative clinical approach. Conclusion This paper presents the spine care model as a means of developing chiropractic cultural authority and relevancy. The model is based on principles that would help integrate chiropractic care into the mainstream delivery system while still retaining self-identity for the profession.

  9. Modern wound care - practical aspects of non-interventional topical treatment of patients with chronic wounds.

    Science.gov (United States)

    Dissemond, Joachim; Augustin, Matthias; Eming, Sabine A; Goerge, Tobias; Horn, Thomas; Karrer, Sigrid; Schumann, Hauke; Stücker, Markus

    2014-07-01

    The treatment of patients with chronic wounds is becoming increasingly complex. It was therefore the aim of the members of the working group for wound healing (AGW) of the German Society of Dermatology (DDG) to report on the currently relevant aspects of non-interventional, topical wound treatment for daily practice. -Beside necessary procedures, such as wound cleansing and débridement, we describe commonly used wound dressings, their indications and practical use. Modern antiseptics, which are currently used in wound therapy, usually contain polyhexanide or octenidine. Physical methods, such as negative-pressure treatment, are also interesting options. It is always important to objectify and adequately treat pain symptoms which often affect these patients. Modern moist wound therapy may promote healing, reduce complications, and improve the quality of life in patients with chronic wounds. Together with the improvement of the underlying causes, modern wound therapy is an important aspect in the overall treatment regime for patients with chronic wounds. PMID:24813380

  10. Use of a care bundle in the emergency department for acute exacerbations of chronic obstructive pulmonary disease: a feasibility study.

    LENUS (Irish Health Repository)

    McCarthy, Cormac

    2013-01-01

    Aim: To determine the efficacy and usefulness of a chronic obstructive pulmonary disease (COPD) care bundle designed for the initial management of acute exacerbations of COPD and to assess whether it improves quality of care and provides better outcomes. Introduction: The level of care provided in the emergency department (ED) for COPD exacerbations varies greatly, and there is a need for a more systematic, consistent, evidence-based quality improvement approach to improve outcomes and costs. Methods: A prospective before and after study was carried out in a university teaching hospital. Fifty consecutive patients were identified in the ED with COPD exacerbations and their management was reviewed. Following the education of ED staff and the implementation of a COPD care bundle, the outcome for 51 consecutive patients was analyzed. This COPD care bundle consisted of ten elements considered essential to the management of COPD exacerbations and was scored 0–10 according to the number of items on the checklist implemented correctly. Results: Following implementation, the mean bundle score out of 10 improved from 4.6 to 7 (P,0.001). There was a significant decrease in the unnecessary use of intravenous corticosteroids from 60% to 32% (P=0.003) and also a marked improvement in the use of oxygen therapy, with appropriate treatment increasing from 76% to 96% (P=0.003). Prophylaxis for venous thromboembolism also improved from 54% to 73% (P=0.054). The 30-day readmission rate did not significantly improve. Conclusion: The use of a bundle improves the delivery of care for COPD exacerbations in the ED. There is more appropriate use of therapeutic interventions, especially oxygen therapy and intravenous corticosteroids.

  11. What drives quality improvement in chronic kidney disease (CKD) in primary care: process evaluation of the Quality Improvement in Chronic Kidney Disease (QICKD) trial

    Science.gov (United States)

    Nihat, Akin; de Lusignan, Simon; Thomas, Nicola; Tahir, Mohammad Aumran; Gallagher, Hugh

    2016-01-01

    Objectives This study is a process evaluation of the Quality Improvement in Chronic Kidney Disease (QICKD) study, comparing audit-based education (ABE) and sending clinical guidelines and prompts (G&P) with usual practice, in improving systolic blood pressure control in primary care. This evaluation aimed to explore how far clinical staff in participating practices were aware of the intervention, and why change in practice might have taken place. Setting 4 primary care practices in England: 2 received ABE, and 2 G&P. We purposively selected 1 northern/southern/city and rural practice from each study arm (from a larger pool of 132 practices as part of the QICKD trial). Participants The 4 study practices were purposively sampled, and focus groups conducted with staff from each. All staff members were invited to attend. Interventions Focus groups in each of 4 practices, at the mid-study point and at the end. 4 additional trial practices not originally selected for in-depth process evaluation took part in end of trial focus groups, to a total of 12 focus groups. These were recorded, transcribed and analysed using the framework approach. Results 5 themes emerged: (1) involvement in the study made participants more positive about the CKD register; (2) clinicians did not always explain to patients that they had CKD; (3) while practitioners improved their monitoring of CKD, many were sceptical that it improved care and were more motivated by pay-for-performance measures; (4) the impact of study interventions on practice was generally positive, particularly the interaction with specialists, included in ABE; (5) the study stimulated ideas for future clinical practice. Conclusions Improving quality in CKD is complex. Lack of awareness of clinical guidelines and scepticism about their validity are barriers to change. While pay-for-performance incentives are the main driver for change, quality improvement interventions can have a complementary influence. PMID:27053264

  12. Transmural care in the rehabilitation sector: implementation experiences with a transmural care model for people with spinal cord injury

    OpenAIRE

    Bloemen-Vrencken, J.H.A.; de Witte, L.P.; Engels, J.P.G.M.; Van den Heuvel, W.J.A.; Post, M.W.M.

    2005-01-01

    Abstract Purposes The purpose of this article is first to describe the development and content of a transmural care model in the rehabilitation sector, which aims to reduce the number and severity of health problems of people with spinal cord injury (SCI) and improve the continuity of care. Second, the purpose is to describe the applicability and implementation experiences of a transmural care model in the rehabilitation sector. Methods The transmural care model was developed in cooperation w...

  13. Public Health Nutrition: The Accord of Dietitian Providers in Managing Medicare Chronic Care Outpatients in Australia

    Directory of Open Access Journals (Sweden)

    Robyn P. Cant

    2010-04-01

    Full Text Available Medicare Australia: Chronic Disease Management program subsidizes allied health consultations for eligible outpatients with chronic disease or complex needs. In an evaluation study, private practice dietitians (n = 9 were interviewed to explore their patient management strategies including consultation time-allocation and fees. Time allocation was fee-based. Short first consultations were seen as meeting patients’ needs for low-cost services but were regarded by dietitians as ineffective, however longer initial consultations increased cost to patients. No strategy in use was optimal. There is a need for change in Medicare policy to meet the needs of both dietitians and patients in achieving the behaviour change goals of patients.

  14. Cancer patient-centered home care: a new model for health care in oncology

    Science.gov (United States)

    Tralongo, Paolo; Ferraù, Francesco; Borsellino, Nicolò; Verderame, Francesco; Caruso, Michele; Giuffrida, Dario; Butera, Alfredo; Gebbia, Vittorio

    2011-01-01

    Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients’ needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients’ needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective. PMID:21941445

  15. Incremental health care costs for chronic pain in Ontario, Canada: a population-based matched cohort study of adolescents and adults using administrative data.

    Science.gov (United States)

    Hogan, Mary-Ellen; Taddio, Anna; Katz, Joel; Shah, Vibhuti; Krahn, Murray

    2016-08-01

    Little is known about the economic burden of chronic pain and how chronic pain affects health care utilization. We aimed to estimate the annual per-person incremental medical cost and health care utilization for chronic pain in the Ontario population from the perspective of the public payer. We performed a retrospective cohort study using Ontario health care databases and the electronically linked Canadian Community Health Survey (CCHS) from 2000 to 2011. We identified subjects aged ≥12 years from the CCHS with chronic pain and closely matched them to individuals without pain using propensity score matching methods. We used linked data to determine mean 1-year per-person health care costs and utilization for each group and mean incremental cost for chronic pain. All costs are reported in 2014 Canadian dollars. After matching, we had 19,138 pairs of CCHS respondents with and without chronic pain. The average age was 55 years (SD = 18) and 61% were female. The incremental cost to manage chronic pain was $1742 per person (95% confidence interval [CI], $1488-$2020), 51% more than the control group. The largest contributor to the incremental cost was hospitalization ($514; 95% CI, $364-$683). Incremental costs were the highest in those with severe pain ($3960; 95% CI, $3186-$4680) and in those with most activity limitation ($4365; 95% CI, $3631-$5147). The per-person cost to manage chronic pain is substantial and more than 50% higher than a comparable patient without chronic pain. Costs are higher in people with more severe pain and activity limitations. PMID:26989805

  16. Costs of moderate to severe chronic pain in primary care patients – a study of the ACCORD Program

    Directory of Open Access Journals (Sweden)

    Lalonde L

    2014-07-01

    Full Text Available Lyne Lalonde,1–4 Manon Choinière,3,5 Élisabeth Martin,2,3 Djamal Berbiche,2,3 Sylvie Perreault,1,6 David Lussier7–91Faculty of Pharmacy, Université de Montréal, Montreal, QC, Canada; 2Équipe de recherche en soins de première ligne, Centre de santé et de services sociaux de Laval, Laval, QC, Canada; 3Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM, Montreal, QC, Canada; 4Sanofi Aventis Endowment Chair in Ambulatory Pharmaceutical Care, Université de Montréal and Centre de santé et de services sociaux de Laval, QC, Canada; 5Department of Anesthesiology, Faculty of Medicine, Université de Montréal, Montreal, QC, Canada; 6Sanofi Aventis Endowment Research Chair in Optimal Drug Use, Université de Montréal, Montreal, QC, Canada; 7Institut universitaire de gériatrie de Montréal, Montreal, QC, Canada; 8Division of Geriatric Medicine and Alan-Edwards Centre for Research on Pain, McGill University, Montreal, QC, Canada; 9Department of Medicine, Faculty of Medicine, Université de Montréal, Montreal, QC, CanadaBackground: The economic burden of chronic noncancer pain (CNCP remains insufficiently documented in primary care.Purpose: To evaluate the annual direct health care costs and productivity costs associated with moderate to severe CNCP in primary care patients taking into account their pain disability.Materials and methods: Patients reporting noncancer pain for at least 6 months, at a pain intensity of 4 or more on a 0 (no pain to 10 (worst possible pain intensity scale, and at a frequency of at least 2 days a week, were recruited from community pharmacies. Patients' characteristics, health care utilization, and productivity losses (absenteeism and presenteeism were documented using administrative databases, pharmacies' renewal charts, telephone, and self-administered questionnaires. Patients were stratified by tertile of pain disability measured by the Brief Pain Inventory questionnaire

  17. Modeling Safety Outcomes on Patient Care Units

    Science.gov (United States)

    Patil, Anita; Effken, Judith; Carley, Kathleen; Lee, Ju-Sung

    In its groundbreaking report, "To Err is Human," the Institute of Medicine reported that as many as 98,000 hospitalized patients die each year due to medical errors (IOM, 2001). Although not all errors are attributable to nurses, nursing staff (registered nurses, licensed practical nurses, and technicians) comprise 54% of the caregivers. Therefore, it is not surprising, that AHRQ commissioned the Institute of Medicine to do a follow-up study on nursing, particularly focusing on the context in which care is provided. The intent was to identify characteristics of the workplace, such as staff per patient ratios, hours on duty, education, and other environmental characteristics. That report, "Keeping Patients Safe: Transforming the Work Environment of Nurses" was published this spring (IOM, 2004).

  18. Inflammatory and Remodeling Events in Asthma with Chronic Exposure to House Dust Mites: A Murine Model

    OpenAIRE

    Ahn, Joong Hyun; Kim, Chi Hong; Kim, Yong Hyun; Kim, Seung Joon; Lee, Sook-Young; Kim, Young Kyoon; Kim, Kwan Hyoung; Moon, Hwa Sik; Song, Jeong Sup; Park, Sung Hak; Kwon, Soon Seog

    2007-01-01

    Although animal models with ovalbumin have been used to study chronic asthma, there are difficulties in inducing recurrence as well as in maintaining chronic inflammation in this system. Using a murine model of house dust mite (HDM)-induced bronchial asthma, we examined the airway remodeling process in response to the chronic exposure to HDM. During the seventh and twelfth weeks of study, HDM were inhaled through the nose for three consecutive days and airway responsiveness was measured. Twen...

  19. Tryptase - PAR2 axis in Experimental Autoimmune Prostatitis, a model for Chronic Pelvic Pain Syndrome

    OpenAIRE

    Roman, Kenny; Done, Joseph D.; Schaeffer, Anthony J.; Murphy, Stephen F.; Thumbikat, Praveen

    2014-01-01

    Chronic prostatitis/Chronic pelvic pain syndrome (CP/CPPS) affects up to 15% of the male population and is characterized by pelvic pain. Mast cells are implicated in the murine experimental autoimmune prostatitis (EAP) model as key to chronic pelvic pain development. The mast cell mediator tryptase-β and its cognate receptor protease-activated receptor 2 (PAR2) are involved in mediating pain in other visceral disease models. Prostatic secretions and urines from CP/CPPS patients were examined ...

  20. A Model for Implementing Integrative Practice in Health Care Agencies

    Directory of Open Access Journals (Sweden)

    Chris Patterson

    2008-01-01

    Full Text Available Over the last few years, there has been increased awareness and use of complementary/alternative therapies (CAM in many countries without the health care infrastructure to support it. The National Centre for Complementary and Alternative Medicine referred to the combining of mainstream medical therapies and CAM as integrative medicine. The creation of integrative health care teams will definitely result in redefining roles, but more importantly in a change in how services are delivered. The purpose of this paper is to describe a model of the necessary health care agency resources to support an integrative practice model. A logic model is used to depict the findings of a review of current evidence. Logic models are designed to show relationships between the goals of a program or initiative, the resources to achieve desired outputs and the activities that lead to outcomes. The four major resource categories necessary for implementing integrative care are within the domains of a professional and research development, b health human resource planning, c regulation and legislation and d practice and management in clinical areas. It was concluded that the system outcomes from activities within these resource categories should lead to freedom of choice in health care; a culturally sensitive health care system and a broader spectrum of services for achieving public health goals.

  1. Regulation of brain-derived neurotrophic factor (BDNF) in the chronic unpredictable stress rat model and the effects of chronic antidepressant treatment

    DEFF Research Database (Denmark)

    Larsen, Marianne H; Mikkelsen, Jens D; Hay-Schmidt, Anders;

    2010-01-01

    Chronic unpredictable stress (CUS) is a widely used animal model of depression. The present study was undertaken to investigate behavioral, physiological and molecular effects of CUS and/or chronic antidepressant treatment (venlafaxine or imipramine) in the same set of animals. Anhedonia, a core ...... of the dorsal hippocampus correlated with chronic antidepressant treatment emphasizing a role for BDNF in the mechanisms underlying antidepressant activity....

  2. Management of Chronic Diseases in Sub-Saharan Africa: Cross-Fertilisation between HIV/AIDS and Diabetes Care

    Directory of Open Access Journals (Sweden)

    Josefien van Olmen

    2012-01-01

    is useful to think about management of both in tandem, comparing care delivery platforms and self-management strategies. A literature review on care delivery models for diabetes and HIV/AIDS in SSA revealed potential elements for cross-fertilisation: rapid scale-up approaches through the public health approach by simplification and decentralisation; community involvement, peer support, and self-management strategies; and strengthening health services.

  3. Hypertensive chronic kidney disease in African Americans: Strategies for improving care

    OpenAIRE

    Martins, David; Agodoa, Lawrence; Norris, Keith C.

    2012-01-01

    African Americans have a disproportionate burden of chronic kidney disease (CKD), which tends to have an earlier onset and a more rapid progression in this population. Many of the factors responsible for the rapid progression of CKD in African Americans are detectable by screening and are modifiable with prompt therapy.

  4. Depression and Chronic Diseases: It Is Time for a Synergistic Mental Health and Primary Care Approach

    OpenAIRE

    Voinov, Boris; Richie, William D.; Bailey, Rahn K.

    2013-01-01

    Objective: To identify the growing significance of depression as a global leading cause of years lost to disability and its role as a major independent risk factor in many chronic illnesses. The distinct effects of depression on morbidity and mortality in cancer, diabetes, heart disease, and stroke are investigated, including behavioral factors and plausible biological mechanisms (psychoneuroimmunology of depression).

  5. Feasibility and effectiveness of a disease and care management model in the primary health care system for patients with heart failure and diabetes (Project Leonardo

    Directory of Open Access Journals (Sweden)

    Marco Matteo Ciccone

    2010-04-01

    as well as treatment paths helped promote confidence and enhance safety of chronic patient management at home.Conclusion: Physicians, care managers, and patients showed unanimous agreement regarding the positive impact on patient health and self-management, and attributed the outcomes to the strong “partnership” between the care manager and the patient and the collaboration between the physician and the care manager. Future studies should consider the possibility of incorporating a patient empowerment model which considers the patient as the most important member of the health team and care managers as key health care collaborators able to enhance and support services to patients provided by physicians in the primary health care system.Keywords: partnerships, health team, patient empowerment, care coordination

  6. Social and economic determinants of pediatric health inequalities: the model of chronic kidney disease.

    Science.gov (United States)

    Sereni, Fabio; Edefonti, Alberto; Lepore, Marta; Agostoni, Carlo; Sandoval Diaz, Mabel; Silva Galan, Yajaira; Montini, Giovanni; Tognoni, Gianni

    2016-01-01

    Purpose of this review is to deal with priorities and strategies to significantly tackle inequalities in the management of pediatric diseases in low-middle-income countries. This issue has become a focal point of epidemiological and public health, with special reference to chronic nontransmissible diseases. We will provide our readership with an essential overview of the cultural, institutional, and political events, which have occurred over the last 20 y and which have produced the current general framework for epidemiology and public health. Then the most recent epidemiological data will be evaluated, in order to quantify the interaction between the medical components of the disease profiles and their socioeconomic determinants. Finally, a focus will be added on models of pediatric chronic kidney diseases, which are in our opinion amongst the most sensitive markers of the interplay between health and society. Collaborative, pediatrician-initiated, multicentre projects in these fields should be given priority in calls for grants supported by public agencies. The involvement of a critical mass of those working in the "fringes" of pediatric care is a final, essential mean by which significant results can be produced under the sole responsibility and research interest of centers of excellence. PMID:26466076

  7. Managing severe burn injuries: challenges and solutions in complex and chronic wound care

    OpenAIRE

    Jeschke, Marc

    2016-01-01

    Alan D Rogers, Marc G Jeschke Ross Tilley Burn Centre, Division of Plastic and Reconstructive Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada Abstract: Encountered regularly by health care providers across both medical and surgical fields and an increasing socioeconomic burden globally, wound care is severely neglected. Practice is heavily influenced by anecdote rather than evidence-based protocols and industry-biased lite...

  8. Managing severe burn injuries: challenges and solutions in complex and chronic wound care

    OpenAIRE

    AD Rogers; MG, Jeschke

    2016-01-01

    Alan D Rogers, Marc G Jeschke Ross Tilley Burn Centre, Division of Plastic and Reconstructive Surgery, Department of Surgery, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada Abstract: Encountered regularly by health care providers across both medical and surgical fields and an increasing socioeconomic burden globally, wound care is severely neglected. Practice is heavily influenced by anecdote rather than evidence-based protocols and industry-biased literatu...

  9. Quality Adjustment for Health Care Spending on Chronic Disease: Evidence from Diabetes Treatment, 1999-2009

    OpenAIRE

    Eggleston, Karen N.; Shah, Nilay D.; Smith, Steven A; Berndt, Ernst R.; Newhouse, Joseph P.

    2011-01-01

    Although US health care expenditures reached 17.6 percent of GDP in 2009, quality measurement in this important service sector remains limited. Studying quality changes associated with 11 years of health care for patients with diabetes, we find that the value of reduced mortality and avoided treatment spending, net of the increase in annual spending, was $9,094 for the average patient. These results suggest that the unit cost of diabetes treatment, adjusting for the value of health outcomes, ...

  10. Self Care

    Science.gov (United States)

    ... Care Connections Experiences Research Learning Evaluation Print Email Self Care If you are living with a chronic ... help you cope can make a real difference. Self-care techniques are things you can do for ...

  11. Cost-effectiveness of counselling, graded-exercise and usual care for chronic fatigue: evidence from a randomised trial in primary care

    Directory of Open Access Journals (Sweden)

    Sabes-Figuera Ramon

    2012-08-01

    Full Text Available Abstract Background Fatigue is common and has been shown to result in high economic costs to society. The aim of this study is to compare the cost-effectiveness of two active therapies, graded-exercise (GET and counselling (COUN with usual care plus a self-help booklet (BUC for people presenting with chronic fatigue. Methods A randomised controlled trial was conducted with participants consulting for fatigue of over three months’ duration recruited from 31 general practices in South East England and allocated to one of three arms. Outcomes and use of services were assessed at 6-month follow-up. The main outcome measure used in the economic evaluation was clinically significant improvements in fatigue, measured using the Chalder fatigue scale. Cost-effectiveness was assessed using the net-benefit approach and cost-effectiveness acceptability curves. Results Full economic and outcome data at six months were available for 163 participants; GET = 51, COUN = 58 and BUC = 54. Those receiving the active therapies (GET and COUN had more contacts with care professionals and therefore higher costs, these differences being statistically significant. COUN was more expensive and less effective than the other two therapies. The incremental cost-effectiveness ratio of GET compared to BUC was equal to £987 per unit of clinically significant improvement. However, there was much uncertainty around this result. Conclusion This study does not provide a clear recommendation about which therapeutic option to adopt, based on efficiency, for patients with chronic fatigue. It suggests that COUN is not cost-effective, but it is unclear whether GET represents value for money compared to BUC. Clinical Trial Registration number at ISRCTN register: 72136156

  12. A global framework for action to improve the primary care response to chronic non-communicable diseases: a solution to a neglected problem

    Directory of Open Access Journals (Sweden)

    Zachariah Rony

    2009-09-01

    Full Text Available Abstract Background Although in developing countries the burden of morbidity and mortality due to infectious diseases has often overshadowed that due to chronic non-communicable diseases (NCDs, there is evidence now of a shift of attention to NCDs. Discussion Decreasing the chronic NCD burden requires a two-pronged approach: implementation of the multisectoral policies aimed at decreasing population-level risks for NCDs, and effective and affordable delivery of primary care interventions for patients with chronic NCDs. The primary care response to common NCDs is often unstructured and inadequate. We therefore propose a programmatic, standardized approach to the delivery of primary care interventions for patients with NCDs, with a focus on hypertension, diabetes mellitus, chronic airflow obstruction, and obesity. The benefits of this approach will extend to patients with related conditions, e.g. those with chronic kidney disease caused by hypertension or diabetes. This framework for a "public health approach" is informed by experience of scaling up interventions for chronic infectious diseases (tuberculosis and HIV. The lessons learned from progress in rolling out these interventions include the importance of gaining political commitment, developing a robust strategy, delivering standardised interventions, and ensuring rigorous monitoring and evaluation of progress towards defined targets. The goal of the framework is to reduce the burden of morbidity, disability and premature mortality related to NCDs through a primary care strategy which has three elements: 1 identify and address modifiable risk factors, 2 screen for common NCDs and 3 and diagnose, treat and follow-up patients with common NCDs using standard protocols. The proposed framework for NCDs borrows the same elements as those developed for tuberculosis control, comprising a goal, strategy and targets for NCD control, a package of interventions for quality care, key operations for

  13. ASSESSMENT OF LIFESTYLE-RELATED RISK FACTORS CONTRIBUTING FOR CHRONIC NON COMMUNICABLE DISEASE IN PATIENTS VISITING RURAL TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Dahal Prasanna

    2013-06-01

    Full Text Available Chronic Non-communicable diseases remain an area of high public health concern especially in developing countries where growing middle class and ever changing lifestyle have led to the rapid increase in the burden of non-communicable disease. The study aimed to assess various lifestyle and behavioral risk factors contributing for non-communicable chronic disease in patients visiting rural tertiary care hospital. A total of 152 patients were selected and analyzed in the study out of which 49 (32.22% were female and 102 (67.78% were male. The average age of the male patients were found to be 61.79years (SD±9.28 and females were 57.1years (SD±10.3. Majority of patients were from lower socioeconomic and educational status. Various risk factors contributing for chronic non-communicable disease that are identified in the study were advance age i.e. > 40years 142 (93.42%, genetically risk factor 46 (30.26%, poor income status 120 (78.95%, occupational exposure to dust, smoke and irritants 111 (73.03%, high body mass index (BMI75 (49.34%, stress 110 (72.37%, inadequate sleep 5 (3.29%, smoking habit 69 (45.4%, Alcohol consuming habit 63 (41.48%, lack of physical activity 59 (38.81%, rare fruit consuming habit 72 (47.37% and less vegetable consumption i.e. ≤ 1/day were 32 (21.05%. Study concluded that substantially high levels of the various lifestyle and behavioral related risk factors such as poor socioeconomic status, smoking, alcohol consumption, high BMI or obesity, stress etc, were significantly associated in patients with chronic disease.

  14. Global access to surgical care: a modelling study

    OpenAIRE

    Blake C Alkire, MD; Dr. Nakul P Raykar, MD; Mark G Shrime, MD; Thomas G Weiser, MD; Prof. Stephen W Bickler, MD; John A Rose, MD; Cameron T Nutt, BA; Sarah L M Greenberg, MD; Meera Kotagal, MD; Johanna N Riesel, MD; Micaela Esquivel, MD; Tarsicio Uribe-Leitz, MD; George Molina, MD; Prof. Nobhojit Roy, MD; John G Meara, MD

    2015-01-01

    Background: More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission's vision. Methods: We modelled access to surgical services in 196 countries with respect to four dimensions: timelines...

  15. A Model of Induction for Specialised Residential Care

    OpenAIRE

    Ann McWilliams; Siobhan Quinlan Cooke; Niall Hanlon

    2006-01-01

    The Social Care Education and Training Project at the Dublin Institute of Technology is a four year project funded by the Department of Health and Children. The project has increased the number of students enrolled in social care courses at the Institute and delivers Continued Professional Development courses for workers in the specialised residential units. The article describes an induction model developed and delivered by the project team to new workers in the specialised residential unit...

  16. The Philadelphia PRIME Program: A Model For Primary Care Education

    OpenAIRE

    Bellini, Lisa M; Asch, David A.

    1997-01-01

    Expanding primary care and ambulatory experiences in internal medicine training programs is limited by insufficient resources devoted to their development and implementation, heavy inpatient service demands and loyalty to the traditional inpatient based training model. Overcoming these barriers is a challenge likely to create new approaches to ambulatory education. The Pilot Education and Ambulatory Care (PACE) program at the Sepulveda VA is one such initiative that represents a multidiscipli...

  17. Models of advance directives in mental health care: stakeholder views

    OpenAIRE

    Atkinson, J.M.; Garner, H.C.; Gilmour, W H

    2004-01-01

    Objective: The aim of this study was to examine perceptions of the place of advance directives in mental health care. Methods: Postal survey of stakeholders was carried out to assess their views on different models of advance directives in mental health care. A total of 473 responded. Results: In all, 28% of psychiatrists thought advance directives were needed compared to 89% of voluntary organisations and above two–thirds of the other stakeholder groups. There were clear tensions be...

  18. [Hygienic aspects with regard to nursing of home care patients with AIDS, chronic diseases and mental handicaps].

    Science.gov (United States)

    Sonntag, H G; Flassak, H; Throm, W

    1995-04-01

    A human handicap is defined as a broad, hard and long lasting restriction of the mental development and the social integration. Groups of handicapped persons can be divided into mentally, psychologically, physically, sensory (blind, deaf) handicapped as well as into multiple disabled and chronically sick persons and those in need of care (old). New groups with demands for aid are among others people suffering from AIDS, psychologically sick (old) and people getting old as well as mentally, physically und multiple handicapped persons, people suffering from cancer, severely ill and dying people. For all handicapped people should be demanded the possibility of living almost normal lives. For all persons directly concerned as well as their families such a normal life should include: the right of self-determination and autonomy, the demand for complex styles of living and nearby care/support, the providing of respective infrastructures such as barrier free living and access to public institutions, access to public transport and homes fitting for handicapped persons, the demand for out-patient treatment by a complex range of various possibilities of support and finally, the providing of alternative forms of living in contrast to the traditional way of life of handicapped people like families or homes. Three important living areas can be derived from these ideas, namely: living conditions, education/professional and working field, social life/social environment. These important living areas require preventive measures, mainly advice and information centres, places to go early recognition and early promotion of handicapped people and those in risk of a handicap (especially children) as well as medical, professional and social rehabilitation or integration. Concerning the spectrum of support, aid and care in the homely area up to now already exists a variety of offers by out-patient services (information services, social units, mobile support services

  19. Primary care physicians’ perspectives on computer-based health risk assessment tools for chronic diseases: a mixed methods study

    Directory of Open Access Journals (Sweden)

    Teja Voruganti

    2015-09-01

    Full Text Available Background Health risk assessment tools compute an individual’s risk of developing a disease. Routine use of such tools by primary care physicians (PCPs is potentially useful in chronic disease prevention. We sought physicians’ awareness and perceptions of the usefulness, usability and feasibility of performing assessments with computer-based risk assessment tools in primary care settings.Methods Focus groups and usability testing with a computer-based risk assessment tool were conducted with PCPs from both university-affiliated and community-based practices. Analysis was derived from grounded theory methodology.Results PCPs (n = 30 were aware of several risk assessment tools although only select tools were used routinely. The decision to use a tool depended on how use impacted practice workflow and whether the tool had credibility. Participants felt that embedding tools in the electronic medical records (EMRs system might allow for health information from the medical record to auto-populate into the tool. User comprehension of risk could also be improved with computer-based interfaces that present risk in different formats.Conclusions In this study, PCPs chose to use certain tools more regularly because of usability and credibility. Despite there being differences in the particular tools a clinical practice used, there was general appreciation for the usefulness of tools for different clinical situations. Participants characterised particular features of an ideal tool, feeling strongly that embedding risk assessment tools in the EMR would maximise accessibility and use of the tool for chronic disease management. However, appropriate practice workflow integration and features that facilitate patient understanding at point-of-care are also essential. 

  20. External Validation of a Referral Rule for Axial Spondyloarthritis in Primary Care Patients with Chronic Low Back Pain.

    Directory of Open Access Journals (Sweden)

    Lonneke van Hoeven

    Full Text Available To validate and optimize a referral rule to identify primary care patients with chronic low back pain (CLBP suspected for axial spondyloarthritis (axSpA.Cross-sectional study with data from 19 Dutch primary care practices for development and 38 for validation.Primary care patients aged 18-45 years with CLBP existing more than three months and onset of back pain started before the age of 45 years.The number of axSpA patients according to the ASAS criteria.The referral rule (CaFaSpA referral rule was developed using 364 CLBP patients from 19 primary care practices and contains four easy to use variables; inflammatory back pain, good response to nonsteriodal anti-inflammatory drugs, family history of spondyloarthritis and a back pain duration longer than five years. This referral rule is positive when at least two variables are present. Validation of the CaFaSpA rule was accomplished in 579 primary care CLBP patients from 38 practices from other areas. Performance of the referral rule was assessed by c-statistic and calibration plot. To fit the final referral rule the development and validation datasets were pooled leading to a total study population of 943 primary care participants.The referral rule was validated in 579 patients (41% male, mean age 36 (sd7.0. The percentage of identified axSpA patients was 16% (n=95. External validation resulted in satisfactory calibration and reasonable discriminative ability (c-statistics 0.70 [95% CI, 0.64-0.75]. In the pooled dataset sensitivity and specificity of the referral rule were 75% and 58%.The CaFaSpA referral rule for axSpA consists of four easy to use predictors for primary care physicians and has a good predictive value in this validation study. The referral rule has the potential to be a screening tool for primary care by identifying CLBP patients suspected for axSpA.

  1. The gap between policy and practice: a systematic review of patient-centred care interventions in chronic heart failure.

    Science.gov (United States)

    Kane, P M; Murtagh, F E M; Ryan, K; Mahon, N G; McAdam, B; McQuillan, R; Ellis-Smith, C; Tracey, C; Howley, C; Raleigh, C; O'Gara, G; Higginson, I J; Daveson, B A

    2015-11-01

    Patient-centred care (PCC) is recommended in policy documents for chronic heart failure (CHF) service provision, yet it lacks an agreed definition. A systematic review was conducted to identify PCC interventions in CHF and to describe the PCC domains and outcomes. Medline, Embase, CINAHL, PsycINFO, ASSIA, the Cochrane database, clinicaltrials.gov, key journals and citations were searched for original studies on patients with CHF staged II-IV using the New York Heart Association (NYHA) classification. Included interventions actively supported patients to play informed, active roles in decision-making about their goals of care. Search terms included 'patient-centred care', 'quality of life' and 'shared decision making'. Of 13,944 screened citations, 15 articles regarding 10 studies were included involving 2540 CHF patients. Three studies were randomised controlled trials, and seven were non-randomised studies. PCC interventions focused on collaborative goal setting between patients and healthcare professionals regarding immediate clinical choices and future care. Core domains included healthcare professional-patient collaboration, identification of patient preferences, patient-identified goals and patient motivation. While the strength of evidence is poor, PCC has been shown to reduce symptom burden, improve health-related quality of life, reduce readmission rates and enhance patient engagement for patients with CHF. There is a small but growing body of evidence, which demonstrates the benefits of a PCC approach to care for CHF patients. Research is needed to identify the key components of effective PCC interventions before being able to deliver on policy recommendations. PMID:26435042

  2. ATTEND: Toward a Mindfulness-Based Bereavement Care Model

    Science.gov (United States)

    Cacciatore, Joanne; Flint, Melissa

    2012-01-01

    Few, if any, mindfulness-based bereavement care models exist. The ATTEND (attunement, trust, touch, egalitarianism, nuance, and death education) model is an interdisciplinary paradigm for providers, including physicians, social workers, therapists, nursing staff, and others. Using a case example to enhance the breadth and depth of understanding,…

  3. Chronic Myeloid Leukemia (CML) Mouse Model in Translational Research.

    Science.gov (United States)

    Peng, Cong; Li, Shaoguang

    2016-01-01

    Chronic myeloid leukemia (CML) is a myeloproliferative disorder characterized by increased proliferation of granulocytic cells without the loss of their capability to differentiate. CML is a clonal disease, originated at the level of Hematopoietic Stem Cells with the Philadelphia chromosome resulting from a reciprocal translocation between the chromosomes 9 and 22t(9;22)-(q34;q11). This translocation produces a fusion gene known as BCR-ABL which acquires uncontrolled tyrosine kinase activity, constantly turning on its downstream signaling molecules/pathways, and promoting proliferation of leukemia cell through anti-apoptosis and acquisition of additional mutations. To evaluate the role of each critical downstream signaling molecule of BCR-ABL and test therapeutic drugs in vivo, it is important to use physiological mouse disease models. Here, we describe a mouse model of CML induced by BCR-ABL retrovirus (MSCV-BCR-ABL-GFP; MIG-BCR-ABL) and how to use this model in translational research.Moreover, to expand the application of this retrovirus induced CML model in a lot of conditional knockout mouse strain, we modified this vector to a triple gene coexpression vector in which we can co-express BCR-ABL, GFP, and a third gene which will be tested in different systems. To apply this triple gene system in conditional gene knockout strains, we can validate the CML development in the knockout mice and trace the leukemia cell following the GFP marker. In this protocol, we also describe how we utilize this triple gene system to prove the function of Pten as a tumor suppressor in leukemogenesis. Overall, this triple gene system expands our research spectrum in current conditional gene knockout strains and benefits our CML translational research. PMID:27150093

  4. Cancer patient-centered home care: a new model for health care in oncology

    Directory of Open Access Journals (Sweden)

    Tralongo P

    2011-09-01

    Full Text Available Paolo Tralongo1, Francesco Ferraù2, Nicolò Borsellino3, Francesco Verderame4, Michele Caruso5, Dario Giuffrida6, Alfredo Butera7, Vittorio Gebbia81Medical Oncology Unit, Azienda Sanitaria Provinciale, Siracusa; 2Medical Oncology Unit, Ospedale San Vincenzo, Taormina; 3Medical Oncology Unit, Ospedale Buccheri La Ferla, Palermo; 4Medical Oncology Unit, Ospedale Giovanni Paolo II, Sciacca; 5Medical Oncology Unit, Istituto Humanitas, Catania; 6Medical Oncology Unit, Istituto Oncologico del Mediterraneo, Catania; 7Medical Oncology Unit, Ospedale San Giovanni di Dio, Agrigento; 8Medical Oncology Unit, Dipartimento Oncologico, La Maddalena, Università degli Studi, Palermo, ItalyAbstract: Patient-centered home care is a new model of assistance, which may be integrated with more traditional hospital-centered care especially in selected groups of informed and trained patients. Patient-centered care is based on patients' needs rather than on prognosis, and takes into account the emotional and psychosocial aspects of the disease. This model may be applied to elderly patients, who present comorbid diseases, but it also fits with the needs of younger fit patients. A specialized multidisciplinary team coordinated by experienced medical oncologists and including pharmacists, psychologists, nurses, and social assistance providers should carry out home care. Other professional figures may be required depending on patients' needs. Every effort should be made to achieve optimal coordination between the health professionals and the reference hospital and to employ shared evidence-based guidelines, which in turn guarantee safety and efficacy. Comprehensive care has to be easily accessible and requires a high level of education and knowledge of the disease for both the patients and their caregivers. Patient-centered home care represents an important tool to improve quality of life and help cancer patients while also being cost effective.Keywords: cancer, home care

  5. Using data from patient interactions in primary care for population level chronic disease surveillance: The Sentinel Practices Data Sourcing (SPDS) project

    OpenAIRE

    Ghosh, Abhijeet; Charlton, Karen E.; Girdo, Lisa; Batterham, Marijka

    2014-01-01

    Background Population health planning within a health district requires current information on health profiles of the target population. Information obtained during primary care interactions may provide a valuable surveillance system for chronic disease burden. The Sentinel Practices Data Sourcing project aimed to establish a sentinel site surveillance system to obtain a region-specific estimate of the prevalence of chronic diseases and mental health disorders within the Illawarra-Shoalhaven ...

  6. Extending the team component of the Latimer ethical decision-making model for palliative care

    Directory of Open Access Journals (Sweden)

    Purkis ME

    2011-04-01

    Full Text Available Mary Ellen Purkis1, Elizabeth Borycki1,2, Craig Kuziemsky3, Fraser Black4, Denise Cloutier-Fisher5, Lee Ann Fox6, Patricia MacKenzie7, Ann Syme1,8, Coby Tschanz1,41School of Nursing, 2School of Health Information Science, University of Victoria, Victoria, British Columbia; 3Telfer School of Management, University of Ottawa, Ottawa, Ontario; 4Victoria Hospice Society, Victoria, British Columbia; 5Department of Geography, University of Victoria, Victoria, British Columbia; 6Kingston General Hospital, Kingston, Ontario; 7School of Social Work, University of Victoria, Victoria, British Columbia; 8British Columbia Cancer Agency, Vancouver Island Centre, Victoria, British Columbia, CanadaBackground: Each year more than 240,000 Canadians die from terminal and chronic illnesses. It is estimated that 62% of those deaths require palliative care. Palliative care is a specialized domain of health professional team practice that requires discipline-specific knowledge, skills, judgment, and expertise in order to address patient hopes, wishes, symptoms, and suffering. With the emergence of palliative care as a specialized area of interdisciplinary practice, new practice models have also emerged, eg, the Latimer ethical decision-making model for palliative care. The purpose of this research was to undertake a descriptive ethnographic field study of palliative care team practices to understand better the interdisciplinary team communication and the issues that arise when members of different health professions work together as a team.Methods: Study data were collected by observing and videotaping palliative care team meetings. Data were then analyzed using direct content analysis.Results: The study findings substantiated many of the team practice concepts outlined in Latimer's model. Palliative care teams engage in a number of processes that address patient symptoms, suffering, hopes, and plans. However, several new findings also emerged from the data that were

  7. When should managed care firms terminate private benefits for chronically mentally ill patients?

    Science.gov (United States)

    Gerson, S N

    1994-01-01

    Corporate America's healthcare cost crisis and the country's budget deficit are forcing limits on the resources used to finance healthcare, including mental healthcare. At the same time, the 1990 Americans with Disabilities Act bars discrimination against patients with chronic illnesses, including chronic mental illness. Therefore, corporate benefits managers need guidance on how to ethically and rationally allocate scarce clinical resources to those high-morbidity insureds who utilize disproportionate amounts of these resources. In particular, how should we define the public/private interface: When do patients who repeatedly fail to respond to treatment fall out of the private sector's responsibility? The author, medical director for a leading behavioral healthcare utilization management company, offers the following guidelines recommending reasonable and practical limitations on trials of treatment for seven common categories of difficult psychiatric patients. PMID:10141406

  8. Social workers' roles in addressing the complex end-of-life care needs of elders with advanced chronic disease.

    Science.gov (United States)

    Kramer, Betty J

    2013-01-01

    This study examined social workers' roles in caring for low-income elders with advanced chronic disease in an innovative, community-based managed care program, from the perspective of elders, family, team members, and social workers. The results are drawn from a larger longitudinal, multimethod case study. Sources of data include survey reports of needs addressed by social workers for 120 deceased elders, five focus groups with interdisciplinary team members, and in-depth interviews with 14 elders and 10 of their family caregivers. A thematic conceptual matrix was developed to detail 32 distinctive social work roles that address divergent needs of elders, family, and team members. Distinctive perceptions of social workers' roles were identified for the different stakeholder groups (i.e., elders, family caregivers, team members, and social workers). Findings from this study may inform supervisors and educators regarding training needs of those preparing to enter the rapidly growing workforce of gerontological social workers who may be called upon to care for elders at the end of life. Training is particularly warranted to help social workers gain the skills needed to more successfully treat symptom management, depression, anxiety, agitation, grief, funeral planning, and spiritual needs that are common to the end of life. PMID:24295099

  9. Towards a model for integrative medicine in Swedish primary care

    Directory of Open Access Journals (Sweden)

    Falkenberg Torkel

    2007-07-01

    Full Text Available Abstract Background Collaboration between providers of conventional care and complementary therapies (CTs has gained in popularity but there is a lack of conceptualised models for delivering such care, i.e. integrative medicine (IM. The aim of this paper is to describe some key findings relevant to the development and implementation of a proposed model for IM adapted to Swedish primary care. Methods Investigative procedures involved research group and key informant meetings with multiple stakeholders including general practitioners, CT providers, medical specialists, primary care administrators and county council representatives. Data collection included meeting notes which were fed back within the research group and used as ongoing working documents. Data analysis was made by immersion/crystallisation and research group consensus. Results were categorised within a public health systems framework of structures, processes and outcomes. Results The outcome was an IM model that aimed for a patient-centered, interdisciplinary, non-hierarchical mix of conventional and complementary medical solutions to individual case management of patients with pain in the lower back and/or neck. The IM model case management adhered to standard clinical practice including active partnership between a gate-keeping general practitioner, collaborating with a team of CT providers in a consensus case conference model of care. CTs with an emerging evidence base included Swedish massage therapy, manual therapy/naprapathy, shiatsu, acupuncture and qigong. Conclusion Despite identified barriers such as no formal recognition of CT professions in Sweden, it was possible to develop a model for IM adapted to Swedish primary care. The IM model calls for testing and refinement in a pragmatic randomised controlled trial to explore its clinical effectiveness.

  10. Identifying determinants of care for tailoring implementation in chronic diseases: an evaluation of different methods

    OpenAIRE

    Krause, Jane; van Lieshout, Jan; Klomp, Rien; Huntink, Elke; Aakhus, Eivind; Flottorp, Signe; Jaeger, Cornelia; Steinhaeuser, Jost; Godycki-Cwirko, Maciek; Kowalczyk, Anna; Agarwal, Shona; Wensing, Michel; Baker, Richard

    2014-01-01

    Background The tailoring of implementation interventions includes the identification of the determinants of, or barriers to, healthcare practice. Different methods for identifying determinants have been used in implementation projects, but which methods are most appropriate to use is unknown. Methods The study was undertaken in five European countries, recommendations for a different chronic condition being addressed in each country: Germany (polypharmacy in multimorbid patients); the Netherl...

  11. Frequency and Interrelations of Risk Factors for Chronic Low Back Pain in a Primary Care Setting

    OpenAIRE

    Lefevre-Colau, Marie-Martine; Fayad, Fouad; Rannou, François; Fermanian, Jacques; Coriat, Fernand; Mace, Yann; Revel, Michel; Poiraudeau, Serge

    2009-01-01

    Introduction Many risk factors have been identified for chronic low back pain (cLBP), but only one study evaluated their interrelations. We aimed to investigate the frequency of cLBP risk factors and their interrelations in patients consulting their general practitioners (GPs) for cLBP. Methods A cross-sectional, descriptive, national survey was performed. 3000 GPs randomly selected were asked to include at least one patient consulting for cLBP. Demographic, clinical characteristics and the p...

  12. Identifying chronic widespread pain in primary care: a medical record database study

    OpenAIRE

    Mansfield, Kathryn

    2014-01-01

    Chronic widespread pain (CWP) is common and associated with poor health. In general practice no morbidity code for CWP exists. By identifying patients in medical records consulting regularly over five years with multiple individual regional (axial, upper limb, lower limb) problems, a previous study identified patients in one practice with features consistent with CWP. This suggests patients regularly consult for regional pains without being recognised, or managed, as having a generalised cond...

  13. CURRENT STATE OF CHRONIC WOUND CARE IN KAZAKHSTAN: FOCUS ON TOPICAL TREATMENTS

    OpenAIRE

    Alma Akhmetova; Timur Saliev; Gulsim Kulsharova; Talgat Nurgozhin; Sergey Mikhalovsky

    2015-01-01

    Background — The presence of chronic hard-to-heal wounds significantly affects patients’ quality of life causing pain, discomfort, decrease of mobility and consequently leads to social isolation and depression. This type of wound is more prevalent among older population. It has been estimated that up to 1-2% of the world population have this condition. The treatment of hard-to-heal wounds is expensive and long-term process, and, stresses healthcare systems of every country. Unfortunately, lim...

  14. Chronic Obstructive PulmonaryDisease : Early detection and prevention in primary care

    OpenAIRE

    Stratelis, Georgios

    2009-01-01

    Background and aims. Early detection of Chronic Obstructive Pulmonary Disease (COPD) and secondary prevention by means of smoking cessation are the only available methods of stopping the progression of the disease. The overall aim was to examine the possibilities of early detection and prevention of COPD in General Practice. The specific aims were to evaluate a method of detecting COPD at its early stages, to investigate the rate of emphysema in smokers with normal lung function and smokers d...

  15. Self-perceived symptoms and care needs of patients with severe to very severe chronic obstructive pulmonary disease, congestive heart failure or chronic renal failure and its consequences for their closest relatives: the research protocol

    Directory of Open Access Journals (Sweden)

    Schols Jos MGA

    2008-05-01

    Full Text Available Abstract Background Recent research shows that the prevalence of patients with very severe chronic obstructive pulmonary disease (COPD, congestive heart failure (CHF and chronic renal failure (CRF continues to rise over the next years. Scientific studies concerning self-perceived symptoms and care needs in patients with severe to very severe COPD, CHF and CRF are scarce. Consequently, it will be difficult to develop an optimal patient-centred palliative care program for patients with end-stage COPD, CHF or CRF. The present study has been designed to assess the symptoms, care needs, end-of-life care treatment preferences and communication needs of patients with severe to very severe COPD, CHF or CRF. Additionally, family distress and care giving burden of relatives of these patients will be assessed. Methods/design A cross-sectional comparative and prospective longitudinal study in patients with end-stage COPD, CHF or CRF has been designed. Patients will be recruited by their treating physician specialist. Patients and their closest relatives will be visited at baseline and every 4 months after baseline for a period of 12 months. The following outcomes will be assessed during home visits: self-perceived symptoms and care needs; daily physical functioning; general health status; end-of-life care treatment preferences; end-of-life care communication and care-giver burden of family caregivers. Additionally, end-of-life care communication and prognosis of survival will be assessed with the physician primarily responsible for the management of the chronic organ failure. Finally, if patients decease during the study period, the baseline preferences with regard to life-sustaining treatments will be compared with the real end-of-life care. Discussion To date, the symptoms, care needs, caregiver burden, end-of-life care treatment preferences and communication needs of patients with very severe COPD, CHF or CRF remain unknown. The present study will

  16. How can the practice nurse be more involved in the care of the chronically ill? The perspectives of GPs, patients and practice nurses

    Directory of Open Access Journals (Sweden)

    Heiderhoff Marc

    2006-03-01

    Full Text Available Background A well established "midlevel" of patient care, such as nurse practitioners and/or physician assistants, exits in many countries like the US, Canada, and Australia. In Germany, however there is only one kind of profession assisting the physician in practices, the practice nurse. Little is known about the present involvement of practice nurses in patients' care in Germany and about the attitudes of GPs, assistants and patients concerning an increased involvement. The aim of our study was to get qualitative information on the extent to which practice nurses are currently involved in the treatment of patients and about possibilities of increased involvement as well as on barriers of increased involvement. Methods We performed qualitative, semi-structured interviews with 20 GPs, 20 practice nurses and 20 patients in the Heidelberg area. The interviews were digitally recorded, transcribed and content-analysed with ATLAS.ti. Results Practice nurses are only marginally involved in the treatment of patients. GPs as well as patients were very sceptical about increased involvement in care. Patients were sceptical about nurses' professional background and feared a worsening of the patient doctor relationship. GPs also complained about the nurses' deficient education concerning medical knowledge. They feared a lack of time as well as a missing reimbursement for the efforts of an increased involvement. Practice nurses were mostly willing to be more involved, regarding it as an appreciation of their role. Important barriers were lack of time, overload with administrative work, and a lack of professional knowledge. Conclusion Practice nurses were only little involved in patient care. GPs were more sceptical than patients regarding an increased involvement. One possible area, accepted by all interviewed groups, was patient education as for instance dietary counselling. New treatment approaches as the chronic care model will require a team approach

  17. Early nephrology care provided by the nephrologist alone is not sufficient to mitigate the social and psychological aspects of chronic kidney disease

    Directory of Open Access Journals (Sweden)

    Ana Amélia Fayer

    2011-01-01

    Full Text Available OBJECTIVE: Patients with chronic kidney disease who receive early nephrology care have a better prognosis with maintenance dialysis. We aimed to determine whether early referral to a nephrologist can also improve the psychological burden of having chronic kidney disease. SUBJECTS AND METHODS: Thirty-nine patients with chronic kidney disease that required hemodialysis were studied: 19 had a $ 6-month history of nephrology care (Group1, and 20 had never received any prior nephrology care (Group2. All patients participated in a semi-structured interview that addressed their perceived knowledge and psychological aspects related to CKD and hemodialysis. Demographic and laboratory data as well as socioeconomic status were evaluated. RESULTS: In both groups, most of the patients were of low socioeconomic status. Group 1 had significantly better laboratory parameters (p<0.05. The patients' answers to the questions showed no differences between the groups: 63% of Group 1 and 55% of Group 2 reported that they had no prior knowledge about dialysis; 58% and 40%, respectively, reported that they ''don't completely understand what the doctor says''; and 74% and 85%, respectively, believed that their ''kidneys would work again''. CONCLUSION: Pre-dialysis nephrology care improves the clinical conditions of the patients with chronic kidney disease but is insufficient for minimizing other aspects of having chronic kidney disease.

  18. Challenges of nurse delivery of psychological interventions for long-term conditions in primary care: a qualitative exploration of the case of chronic fatigue syndrome/myalgic encephalitis

    Directory of Open Access Journals (Sweden)

    Peters Sarah

    2011-12-01

    Full Text Available Abstract Background The evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs is now well-established. With increasing numbers of such patients being managed in primary care, and a shortage of specialists in psychology and behavioural management to deliver interventions, therapeutic interventions are increasingly being delivered by general nurses with limited training in psychological interventions. It is unknown what issues this raises for the nurses or their patients. The purpose of the study was to examine the challenges faced by non-specialist nurses when delivering psychological interventions for an LTC (chronic fatigue syndrome/myalgic encephalomyelitis [CFS/ME] within a primary care setting. Methods A qualitative study nested within a randomised controlled trial [ISRCTN 74156610] explored the experiences and acceptability of two different psychological interventions (pragmatic rehabilitation and supportive listening from the perspectives of nurses, their supervisors, and patients. Semi structured in-depth interviews were conducted with three nurse therapists, three supervisors, and 46 patients. An iterative approach was used to develop conceptual categories from the dataset. Results Analyses identified four sets of challenges that were common to both interventions: (i being a novice therapist, (ii engaging patients in the therapeutic model, (iii dealing with emotions, and (iv the complexity of primary care. Each challenge had the potential to cause tension between therapist and patient. A number of strategies were developed by participants to manage the tensions. Conclusions Tensions existed for nurses when attempting to deliver psychological interventions for patients with CFS/ME in this primary care trial. Such tensions should be addressed before implementing psychological interventions within routine clinical practice. Similar tensions may be found

  19. [Community-based rehabilitation and outpatient care for patients with acquired brain injury and chronic neurological disability in Germany: continuing support for social participation and re-integration in the neurological care system?].

    Science.gov (United States)

    Reuther, P; Hendrich, A; Kringler, W; Vespo, E

    2012-12-01

    In Germany a number of patients who are suffering from acquired brain injury and chronic neurological disability are either undersupplied or exposed to inappropriate care in their social environment. The number of these patients is increasing due to the changes in the procedures of care and due to demographic factors. While acute medical care and early rehabilitative treatment is accessible throughout the German health care system the necessary multimodal and competent care is rare or absent in the social participative sites such as life and occupational environments of the patients. The complex impairment of the brain, the central organ for sensorial, executive and other cognitive functions of human beings, renders the affected patient an exception in the system of medical and social care - this has only inadequately been considered in the past. The authors explain the necessity to disclose the status of a "human-with acquired-brain damage (Mensch-mit-erworbener-Hirnschädigung, MeH)" explicitly as severely disabled. The paper recommends a number of structural and procedural elements that have proven to overcome the insufficient or inappropriate support in integrating the patients suffering from acquired brain injury and chronic neurological disability in their social environment as well as for a demand-focused support with sustainable rehabilitative and ambulant follow-up procedures. Comparisons with other developed health care systems and international guidelines show that with organizing of early-supported-discharge, community-ambulation, shared-care and community-based-rehabilitation these problems have long since been identified elsewhere. Community-based and resident-oriented concepts have already been systematically implemented. In order to achieve the necessary support for the individual patient, a nation-wide development is necessary in Germany to perform the principles of the German social code and the principles of the Convention on the Rights of

  20. The Current Landscape of Transitions of Care Practice Models: A Scoping Review.

    Science.gov (United States)

    Rochester-Eyeguokan, Charmaine D; Pincus, Kathleen J; Patel, Roshni S; Reitz, Shirley J

    2016-01-01

    Transitions of care (TOC) are a set of actions to ensure patient coordination and continuity of care as patients transfer between different locations or levels. During transitions associated with chronic or acute illness, vulnerable patients may be placed at risk with fragmented systems compromising their health and safety. In addition, poor care transitions also have an enormous impact on health care spending. The primary objective of this scoping review is to summarize the current landscape of practice models that deliver TOC services in the United States. The secondary objective is to use the information to characterize the current state of best practice models. A search of the PubMed, Embase, Cumulative Index to Nursing and Allied Health Literature, Web of Science, International Pharmaceutical Abstracts, National Center for Biotechnology Information at the U.S. National Library of Medicine, and Cochrane Library databases (January 1, 2000-April 13, 2015) for articles pertaining to TOC models, limited to U.S. studies published in the English language with human subjects, gleaned 1362 articles. An additional 26 articles were added from the gray literature. Articles meeting inclusion criteria underwent a second review and were categorized into four groups: background information, original TOC research articles not evaluating practice model interventions, original TOC research articles describing practice models, and systematic or Cochrane reviews. The reviewers met weekly to discuss the challenges and resolve disagreements regarding literature reviews with consensus before progressing. A total of 188 articles describing TOC practice models met the inclusion criteria. Despite the strengths of several quality TOC models, none satisfied all the components recommended by leading experts. Multimodal interventions by multidisciplinary teams appear to represent a best practice model for TOC to improve patient outcomes and reduce readmissions, but one size does not fit all

  1. Enhanced itch elicited by capsaicin in a chronic itch model.

    Science.gov (United States)

    Yu, Guang; Yang, Niuniu; Li, Fengxian; Chen, Meijuan; Guo, Changxiong J; Wang, Changming; Hu, Danyou; Yang, Yan; Zhu, Chan; Wang, Zhongli; Shi, Hao; Gegen, Tana; Tang, Ming; He, Qian; Liu, Qin; Tang, Zongxiang

    2016-01-01

    Chronic itch (pruritus) is an important clinical problem. However, the underlying molecular basis has yet to be understood. The Transient Receptor Potential Vanilloid 1 channel is a heat-sensitive cation channel expressed in primary sensory neurons and involved in both thermosensation and pain, but its role in chronic itch remains elusive. Here, we for the first time revealed an increased innervation density of Transient Receptor Potential Vanilloid 1-expressing sensory fibers in the skin afflicted with chronic itch. Further analysis indicated that this phenomenon is due to an expansion of Transient Receptor Potential Vanilloid 1-expressing sensory neurons under chronic itch conditions. As a functional correlates of this neuronal expansion, we observed an enhanced neuronal responsiveness to capsaicin under the dry skin conditions. Importantly, the neuronal hypersensitivity to capsaicin results in itch, rather than pain sensation, suggesting that the up-regulated Transient Receptor Potential Vanilloid 1 underlies the pain-to-itch switch under chronic itchy conditions. The study shows that there are different mechanisms of chronic pain and itching, and Transient Receptor Potential Vanilloid 1 plays an important role in chronic itch. PMID:27118771

  2. 淮阴区慢性丝虫病患者关怀照料效果%Effect of caring for chronic filariasis patients in Huaiyin District

    Institute of Scientific and Technical Information of China (English)

    唐勇; 金小林; 杨文洲; 朱丹丹

    2012-01-01

    目的 观察淮阴区淋巴水肿/慢性丝虫象皮肿病患者照料工作的成效.方法 开设慢性丝虫病照料点和定期上门指导患者进行自我照料.结果 通过对慢性丝虫病患者的关怀照料,绝大多数患者症状明显减轻,症状出现频次呈明显下降趋势.结论 对慢性丝虫病患者给予关怀和照料,能减轻患者症状,提高生活质量.%Objective To evaluate the effect of the caring for patients with lymphedema/chronic filariasis elephantiasis in Huaiyin District. Methods The chronic filariasis care sites were established and the medical workers provided the guidance regularly to patients for their self-cares. Results Through the caring for patients with chronic filariasis, their symptoms alleviated obviously, and the symptom frequency showed a significant downward trend. Conclusion The caring for the chronic filariasis patients can alleviate the symptoms and improve the quality of life.

  3. Parents' perspective of their journey caring for a child with chronic neuropathic pain.

    Science.gov (United States)

    Gaughan, Veronica; Logan, Deirdre; Sethna, Navil; Mott, Sandra

    2014-03-01

    When a child has chronic pain, it affects the parents. Their response and how it is factored into their lives and family function was the phenomenon of interest that drove this study. The available literature was sparse, especially when the pain etiology was neuropathic. The purpose of this study was to describe the parents' perception of the pain journey from the initial occurrence of their child's pain through the labyrinth of treatment options to successful outcome, to gain a better understanding of parental beliefs about pain, and to learn how parental attitudes and behaviors relate to children's response to treatment for chronic pain. Qualitative descriptive design was used to better understand the phenomenon from those who were the experts because they had experienced it. Parents whose child was enrolled in a pain rehabilitation program participated in open-ended interviews. The children/adolescents were 8-18 years old and diagnosed with complex regional pain syndrome or a related chronic pain condition. During data immersion, the investigators uncovered the pervasive underlying themes of suffering and disempowerment. In addition, the multiple meaning elements were grouped into three categories and supportive subcategories labeled as follows: parent distress, with subcategories schism in parenting, searching, and disabled parenting; and lack of control, with the subcategories family/community, fear, and empowerment. The voices of parents were heard in their description of the exhausting and difficult journey in search of pain relief for their child. Their comments provided insight into how they defined the child's pain and their related parental role. PMID:23219393

  4. Primary Health Care: a strategic framework for the prevention and control of chronic non-communicable disease

    Directory of Open Access Journals (Sweden)

    Alessandro R. Demaio

    2014-08-01

    Full Text Available In 2014, chronic, non-communicable diseases (NCDs represent the leading causes of global mortality and disability. Government-level concern, and resulting policy changes, are manifesting. However, there continues to be a paucity of guiding frameworks for legislative measures. The surge of NCDs will require strong and effective governance responses, particularly in low and middle-income countries. Simultaneously following the 2008 World Health Report, there has recently been renewed interest in Primary Health Care (PHC and its core principles. With this, has come strengthened support for revitalizing this approach, which aims for equitable and cost-effective population-health attainment. In this light and reflecting recent major global reports, declarations and events, we propose and critique a PHC approach to NCDs, highlighting PHC, with its core themes, as a valuable guiding framework for health promotion and policy addressing this group of diseases.

  5. Job mobility among parents of children with chronic health conditions: Early effects of the 2010 Affordable Care Act.

    Science.gov (United States)

    Chatterji, Pinka; Brandon, Peter; Markowitz, Sara

    2016-07-01

    We examine the effects of the 2010 Patient Protection and Affordable Care Act's (ACA) prohibition of preexisting conditions exclusions for children on job mobility among parents. We use a difference-in-difference approach, comparing pre-post policy changes in job mobility among privately-insured parents of children with chronic health conditions vs. privately-insured parents of healthy children. Data come from the 2004 and 2008 Survey of Income and Program Participation (SIPP). Among married fathers, the policy change is associated with about a 0.7 percentage point, or 35 percent increase, in the likelihood of leaving an employer voluntarily. We find no evidence that the policy change affected job mobility among married and unmarried mothers. PMID:27060524

  6. Severity Scales for Use in Primary Health Care to Assess Chronic Fatigue Syndrome/Myalgic Encephalomyelitis.

    Science.gov (United States)

    Hardcastle, Sharni Lee; Brenu, Ekua Weba; Johnston, Samantha; Staines, Donald; Marshall-Gradisnik, Sonya

    2016-06-01

    Chronic fatigue syndrome/myalgic encephalomyelitis (CFS/ME) is a physical and cognitive disabling illness, characterized by severe fatigue and a range of physiological symptoms, that primarily affects women. The immense variation in clinical presentation suggests differences in severity based on symptomology and physical and cognitive functional capacities. In this article, we examine a number of severity scales used in assessing severity of patients with CFS/ME and the clinical aspects of CFS/ME severity subgroups. The use of severity scales may be important in CFS/ME because it permits the establishment of subgroups that may improve accuracy in both clinical and research settings. PMID:25315708

  7. Nursing care gestion of chronically ill elderly people. Policlinico 2, year 2007

    OpenAIRE

    Liudmila Carbonell Sanamé

    2009-01-01

    A descriptive prospective study was made to those patients aged more than 60 years who are attended in the Policlinico 2 “Leonilda Tamayo Matos” in Isla de la Juventud during the year 2007. The study population was 1254 and 700 chronically ill elderly people were taken as representative sample, using a simple random sampling. The Mini Mental State Examination and a satisfaction survey was made to old people, all these with their informed consent. The main variables to study were: sex, age, ra...

  8. Asthma in ear, nose, and throat primary care patients with chronic rhinosinusitis with nasal polyps

    DEFF Research Database (Denmark)

    Frendø, Martin; Håkansson, Kåre; Schwer, Susanne;

    2016-01-01

    were prospectively recruited from nine PC ear, nose, and throat clinics in the Copenhagen area. CRSwNP was diagnosed according to the European Position Paper on Chronic Rhinosinusitis and Nasal Polyps; severity was assessed by using a visual analog scale. Allergy, lung function, and asthma tests....... Frequently, asthma was undiagnosed. However, asthma was significantly less prevalent in PC patients compared with patients referred for ESS. The frequent concomitance of asthma, i.e., united airways disease, in PC patients calls for closer collaboration between ear, nose, and throat specialists, and asthma...

  9. Pediatric Fear-Avoidance Model of Chronic Pain: Foundation, Application and Future Directions

    Directory of Open Access Journals (Sweden)

    Gordon JG Asmundson

    2012-01-01

    Full Text Available The fear-avoidance model of chronic musculoskeletal pain has become an increasingly popular conceptualization of the processes and mechanisms through which acute pain can become chronic. Despite rapidly growing interest and research regarding the influence of fear-avoidance constructs on pain-related disability in children and adolescents, there have been no amendments to the model to account for unique aspects of pediatric chronic pain. A comprehensive understanding of the role of fear-avoidance in pediatric chronic pain necessitates understanding of both child/adolescent and parent factors implicated in its development and maintenance. The primary purpose of the present article is to propose an empirically-based pediatric fear-avoidance model of chronic pain that accounts for both child/adolescent and parent factors as well as their potential interactive effects. To accomplish this goal, the present article will define important fear-avoidance constructs, provide a summary of the general fear-avoidance model and review the growing empirical literature regarding the role of fear-avoidance constructs in pediatric chronic pain. Assessment and treatment options for children with chronic pain will also be described in the context of the proposed pediatric fear-avoidance model of chronic pain. Finally, avenues for future investigation will be proposed.

  10. Looking after yourself: Clinical understandings of chronic-care self management strategies in rural and urban contexts of the United Kingdom and Australia

    OpenAIRE

    Carr, Susan; Paliadelis, Penny; Lhussier, Monique; Forster, Natalie; Eaton, Simon; Parmenter, Glenda; Death, Catharine

    2014-01-01

    Objectives: This article reports on the outcomes of two similar projects undertaken during 2011–2012 in Australia (Rural Northern New South Wales) and the United Kingdom (Urban Northern United Kingdom) that sought to identify the strategies that health professionals employ to actively involve patients with chronic conditions in the planning and delivery of their care. In particular, this study explored understandings and contexts of care that impacted on the participants’ practices. This stud...

  11. Developing resources to support the diagnosis and management of Chronic Fatigue Syndrome/Myalgic Encephalitis (CFS/ME) in primary care: a qualitative study

    OpenAIRE

    Hannon Kerin; Peters Sarah; Fisher Louise; Riste Lisa; Wearden Alison; Lovell Karina; Turner Pam; Leech Yvonne; Chew-Graham Carolyn

    2012-01-01

    Abstract Background NICE guidelines emphasise the need for a confident, early diagnosis of Chronic Fatigue Syndrome/ Myalgic Encephalitis (CFS/ME) in Primary Care with management tailored to the needs of the patient. Research suggests that GPs are reluctant to make the diagnosis and resources for management are currently inadequate. This study aimed to develop resources for practitioners and patients to support the diagnosis and management of CFS/ME in primary care. Methods Semi structured in...

  12. Police officer, deal-maker, or health care provider? Moving to a patient-centered framework for chronic opioid management.

    Science.gov (United States)

    Nicolaidis, Christina

    2011-06-01

    How we frame our thoughts about chronic opioid therapy greatly influences our ability to practice patient-centered care. Even providers who strive to be nonjudgmental may approach clinical decision-making about opioids by considering if the pain is real or they can trust the patient. Not only does this framework potentially lead to poor or unshared decision-making, it likely adds to provider and patient discomfort by placing the provider in the position of a police officer or a judge. Similarly, providers often find themselves making deals with patients using a positional bargaining approach. Even if a compromise is reached, this framework can potentially inadvertently weaken the therapeutic relationship by encouraging the idea that the patient and provider have opposing goals. Reframing the issue can allow the provider to be in a more therapeutic role. As recommended in the American Pain Society/American Academy of Pain Medicine guidelines, providers should decide whether the benefits of opioid therapy are likely to outweigh the harms for a specific patient (or sometimes, for society) at a specific time. This article discusses how providers can use a benefit-to-harm framework to make and communicate decisions about the initiation, continuation, and discontinuation of opioids for managing chronic nonmalignant pain. Such an approach focuses decisions and discussions on judging the treatment, not the patient. It allows the provider and the patient to ally together and make shared decisions regarding a common goal. Moving to a risk-benefit framework may allow providers to provide more patient-centered care, while also increasing provider and patient comfort with adequately monitoring for harm. PMID:21539703

  13. Asthma, chronic obstructive pulmonary disease, or both? Diagnostic labeling and spirometry in primary care patients aged 40 years or more

    Directory of Open Access Journals (Sweden)

    Melbye H

    2011-11-01

    Full Text Available Hasse Melbye1, Elin Drivenes1, Lene G Dalbak2, Tone Leinan1, Svein Høegh-Henrichsen2, Anders Østrem21General Practice Research Unit, Department of Community Medicine, University of Tromsø, 2General Practice Research Unit, Department of Health and Society, University of Oslo, NorwayAims: To describe symptoms and lung function in patients registered with asthma or chronic obstructive pulmonary disease (COPD in primary care and to examine how spirometry findings fit with general practitioners’ (GPs diagnoses.Methods: Patients aged ≥40 years with a diagnosis of asthma or COPD registered in the electronic medical record during the previous 5 years were recruited at seven GP offices in Norway in 2009–2010. Registered diagnosis, spirometry results, comorbidity, and reported symptoms were compared.Results: Among 376 patients, 62% were women. Based on Global Initiative for Chronic Obstructive Lung Diseases criteria, a spirometry diagnosis of COPD could be made in 68.1% of the patients with a previous COPD diagnosis and in 17.1% of those diagnosed with asthma only (P < 0.001. The κ agreement between last clinical diagnosis of COPD and COPD based on spirometry was 0.50. A restrictive spirometry pattern was found in 19.4% and more frequently in patients diagnosed with both asthma and COPD (23.9% than in patients diagnosed with COPD only (6.8%, P = 0.003.Conclusion: The ability of GPs to differentiate between asthma and COPD seems to have considerably improved during the last decade, probably due to the dissemination of spirometry and guidelines for COPD diagnosis. A diagnosis of COPD that cannot be confirmed by spirometry represents a challenge in clinical practice, in particular when a restrictive pattern on spirometry is found.Keywords: asthma, COPD, diagnosis, primary care

  14. Nursing leaders can deliver a new model of care.

    Science.gov (United States)

    Shalala, Donna E

    2014-01-01

    Millions more insured Americans. Increasing numbers of older patients. Higher rates of chronic illness. Fewer providers. How can our healthcare system not only manage these challenges but also improve performance and access to care while containing costs? The answer lies with our nurses. In some parts of the United States, nurses provide the full spectrum of primary and preventive care. They have successfully improved access and quality in rural areas. In other parts, nurses' hands are tied by antiquated laws and regulations that limit their ability to expand access to care. Our system cannot increase access when we have providers who are not allowed to perform to the top of their education, training, and capability. It is time to rethink how we deliver primary and preventive care and redefine the roles of doctors and nurses. This article examines the history of the Institute of Medicine's (IOM) Future of Nursing report (chaired by the author) and the resulting Future of Nursing Campaign for Action, which is working to institute the report's recommendations in all 50 states. The IOM report's recommendations are simple: 1. Remove outdated restrictions on nursing practice. 2. Promote nurse leadership on hospital boards and in all healthcare sectors. 3. Strengthen nurse education and training, and increase the number of nurses with advanced degrees. 4. Increase diversity in the nursing workforce to better reflect the patient population. 5. Improve data reporting and compilation to predict workforce needs. New York, Kentucky, and Minnesota are three recent states to remove barriers pre venting advanced practice registered nurses from practicing at the top of their license. Similar efforts in California, Florida, and Indiana failed initially but are expected to make progress in the near future. The article makes clear how and why the Center to Champion Nursing in America (an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation) is working to

  15. Chronic cough and a normal chest X-ray - a simple systematic approach to exclude common causes before referral to secondary care: a retrospective cohort study.

    Science.gov (United States)

    Turner, Richard D; Bothamley, Graham H

    2016-01-01

    Chronic cough is common in the community and can cause significant morbidity. It is not clear how closely treatment guidelines are used in general practice, or how often specialist referral is indicated. We aimed to assess the management of chronic cough in primary care before referral to a cough clinic, and to assess the outcome of managing chronic cough with an approach of simple investigation and empirical treatment trials. Data were extracted from the records of all patients attending a district general hospital respiratory clinic over a two-year period with isolated chronic cough lasting ⩾8 weeks. The clinic assessed symptoms with a cough-severity visual analogue scale and the Leicester Cough Questionnaire. Among 266 patients, the most frequent diagnoses were asthma (29%), gastro-oesophageal reflux (22%) and angiotensin-converting enzyme inhibitor use (14%). In all, 12% had unexplained chronic cough. Common diagnoses had often not been excluded in primary care: only 21% had undergone spirometry, 86% had undergone chest radiography and attempts to exclude asthma with corticosteroids had been made only in 39%. In the clinic few investigations were conducted that were not available in primary care. Substantial improvements in symptoms occurred with a median (interquartile range) total of 2 (2-3) clinic visits. We estimated that 87% of patients could have been managed solely in primary care; we did not identify distinguishing characteristics among this group. Most cases of chronic cough referred to secondary care could be managed with a simple and systematic approach, which is potentially transferrable to a community setting. PMID:26937758

  16. Model-based decision support in diabetes care.

    Science.gov (United States)

    Salzsieder, E; Vogt, L; Kohnert, K-D; Heinke, P; Augstein, P

    2011-05-01

    The model-based Karlsburg Diabetes Management System (KADIS®) has been developed as a patient-focused decision-support tool to provide evidence-based advice for physicians in their daily efforts to optimize metabolic control in diabetes care of their patients on an individualized basis. For this purpose, KADIS® was established in terms of a personalized, interactive in silico simulation procedure, implemented into a problem-related diabetes health care network and evaluated under different conditions by conducting open-label mono- and polycentric trials, and a case-control study, and last but not least, by application in routine diabetes outpatient care. The trial outcomes clearly show that the recommendations provided to the physicians by KADIS® lead to significant improvement of metabolic control. This model-based decision-support system provides an excellent tool to effectively guide physicians in personalized decision-making to achieve optimal metabolic control for their patients. PMID:20621384

  17. Traumatization and chronic pain: a further model of interaction

    OpenAIRE

    Egloff, Niklaus

    2013-01-01

    Niklaus Egloff,1 Anna Hirschi,2 Roland von Känel1 1Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, University Hospital, Bern, Switzerland; 2Outpatient Clinic for Victims of Torture and War, Swiss Red Cross, Bern-Wabern, Switzerland Abstract: Up to 80% of patients with severe posttraumatic stress disorder are suffering from “unexplained” chronic pain. Theories about the links between traumatization and chronic pain have be...

  18. Traumatization and chronic pain: a further model of interaction.

    OpenAIRE

    Egloff N; Hirschi A; von Känel R

    2013-01-01

    Niklaus Egloff,1 Anna Hirschi,2 Roland von Känel1 1Department of General Internal Medicine, Division of Psychosomatic Medicine, Inselspital, University Hospital, Bern, Switzerland; 2Outpatient Clinic for Victims of Torture and War, Swiss Red Cross, Bern-Wabern, Switzerland Abstract: Up to 80% of patients with severe posttraumatic stress disorder are suffering from “unexplained” chronic pain. Theories about the links between traumatization and chronic pain have become the subj...

  19. BACTERIOLOGICAL PROFILE OF CHRONIC SUPPURATIVE OTITIS MEDIA CASES AT A TERTIARY CARE CENTRE IN KARNATAKA

    Directory of Open Access Journals (Sweden)

    Anjana

    2016-02-01

    Full Text Available Chronic Suppurative Otitis Media (CSOM is one of the most common chronic diseases of childhood. It is one of the common causes of deafness and can also cause permanent perforation. AIM This study was carried out to know the bacterial aetiology of CSOM and their antibiotic susceptibility pattern. MATERIALS AND METHODS Hundred patients with symptoms of CSOM who were not on antibiotics were included in the present study. Gram stain, culture and sensitivity and biochemical reactions were carried out to identify the organism and to assess their antibiotic susceptibility pattern. RESULTS The most common organism isolated in this study was Staphylococcus aureus (45.6% followed by Pseudomonas aeruginosa (34.7%, Klebsiella pneumoniae (6.5%, Proteus mirabilis (4.3%, Enterococcus fecalis (2.1%, Citrobacter koseri (2.1%, Acinetobacter baumannii (2.1% and Bacteroides (2.1%. Staphylococcal isolates showed highest susceptibility to commonly used antibiotics, gentamycin, ciprofloxacin. Most of the gram negative isolates showed susceptibility to amikacin, ciprofloxacin, third generation cephalosporins. CONCLUSION The study of microbial pattern and their antibiotic susceptibility determines the prevalent bacterial organisms causing CSOM in local area and helps to decide empirical treatment of otitis media and its complications for successful outcome, thus to prevent the emergence of resistant strains.

  20. Model Point-of-Care Ultrasound Curriculum in an Intensive Care Unit Fellowship Program and Its Impact on Patient Management

    OpenAIRE

    Keith Killu; Victor Coba; Michael Mendez; Subhash Reddy; Tanja Adrzejewski; Yung Huang; Jessica Ede; Mathilda Horst

    2014-01-01

    Objectives. This study was designed to assess the clinical applicability of a Point-of-Care (POC) ultrasound curriculum into an intensive care unit (ICU) fellowship program and its impact on patient care. Methods. A POC ultrasound curriculum for the surgical ICU (SICU) fellowship was designed and implemented in an urban, academic tertiary care center. It included 30 hours of didactics and hands-on training on models. Minimum requirement for each ICU fellow was to perform 25–50 exams on respec...

  1. Technologies of birth and models of midwifery care

    Directory of Open Access Journals (Sweden)

    Christine McCourt

    2014-08-01

    Full Text Available This article is based on a study of a reform in the organisation of maternity services in the United Kingdom, which aimed towards developing a more woman-centred model of care. After decades of fragmentation and depersonalisation of care, associated with the shift of birth to a hospital setting, pressure by midwives and mothers prompted government review and a relatively radical turnaround in policy. However, the emergent model of care has been profoundly influenced by concepts and technologies of monitoring. The use of such technologies as ultrasound scans, electronic foetal monitoring and oxytocic augmentation of labour, generally supported by epidural anaesthesia for pain relief, have accompanied the development of a particular ecological model of birth – often called active management –, which is oriented towards the idea of an obstetric norm. Drawing on analysis of women’s narrative accounts of labour and birth, this article discusses the impact on women’s embodiment in birth, and the sources of information they use about the status of their own bodies, their labour and that of the child. It also illustrates how the impact on women’s experiences of birth may be mediated by a relational model of support, through the provision of caseload midwifery care.

  2. Did changing primary care delivery models change performance? A population based study using health administrative data

    Directory of Open Access Journals (Sweden)

    Klein-Geltink Julie

    2011-06-01

    Full Text Available Abstract Background Primary care reform in Ontario, Canada started with the introduction of new enrollment models, the two largest of which are Family Health Networks (FHNs, a capitation-based model, and Family Health Groups (FHGs, a blended fee-for-service model. The purpose of this study was to evaluate differences in performance between FHNs and FHGs and to compare performance before and after physicians joined these new primary care groups. Methods This study used Ontario administrative claims data to compare performance measures in FHGs and FHNs. The study population included physicians who belonged to a FHN or FHG for at least two years. Patients were included in the analyses if they enrolled with a physician in the two years after the physician joined a FHN or FHG, and also if they saw the physician in a two year period prior to the physician joining a FHN or FHG. Performance was derived from the administrative data, and included measures of preventive screening for cancer (breast, cervical, colorectal and chronic disease management (diabetes, heart failure, asthma. Results Performance measures did not vary consistently between models. In some cases, performance approached current benchmarks (Pap smears, mammograms. In other cases it was improving in relation to previous measures (colorectal cancer screening. There were no changes in screening for cervical cancer or breast cancer after joining either a FHN or FHG. Colorectal cancer screening increased in both FHNs and FHGs. After enrolling in either a FHG or a FHN, prescribing performance measures for diabetes care improved. However, annual eye examinations decreased for younger people with diabetes after joining a FHG or FHN. There were no changes in performance measures for heart failure management or asthma care after enrolling in either a FHG or FHN. Conclusions Some improvements in preventive screening and diabetes management which were seen amongst people after they enrolled may be

  3. Needs of psychopedagogical training for the care of children with chronic disease: perceptions of hospital nursing

    Directory of Open Access Journals (Sweden)

    Maria Rosa Rosselló

    2015-02-01

    Full Text Available OBJECTIVE To identify the psychopedagogical training needs of the pediatric nurses in the largest public hospital of the Balearic Islands, Spain. METHOD This study was developed with a quantitative and qualitative design, where 78 nurses (97.5% of the service answered a questionnaire, and 15 participated in interviews that were analyzed via content analysis. RESULTS The quantitative results show gaps in the knowledge and psychopedagogical skills of the staff. These aspects could facilitate the development of tasks tailored to the personality and the psychoevolutional time of children with chronic diseases, as well as to the emotional state of families. The qualitative data was organized into four categories: family support; hospital and education; psychopedagogical training and difficulties in practice. The little communication between nurses and teachers is evident. CONCLUSION The data reinforces the need to implement training strategies and interdisciplinary work among health professionals, educators and families.

  4. STUDY OF CHRONIC SUPPURATIVE OTTIS MEDIA PATIENTS ATTENDING TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Nagajyothi

    2015-01-01

    Full Text Available The present study was conducted to find out the common bacterial flora of both aerobic and aerobic which are prevalent in chronic suppurative otitis media and to know the antibiotic susceptibility of organisms in CSOM. The study period was from J anuary to December – 2006 in Dept of Microbiology , Kurnool Medical college , Kurnool. A total of 200 ear swabs were bacteriologically investigated both in aerobic and anaerobic cultures. Out of 200 swabs , 180 comprised study group , 20 comprised of control g roup. Highest incidence of CSOM is observed in age group below 10 years . Prevalence is more in males than females. Incidence of various species of aerobic organisms in the order of preference - Staphylococcus (45% , Pseudomonas (25% , Proteus ( 15% , Klebsie lla (7% , E.coli (4% , miscellaneous(4%.Incidence of anaerobic organisms are in the order of preference as Bacteriodes and Peptococci.

  5. An analysis of Liberia's 2007 national health policy: lessons for health systems strengthening and chronic disease care in poor, post-conflict countries

    Directory of Open Access Journals (Sweden)

    Chan Brian T

    2011-10-01

    Full Text Available Abstract Background Globally, chronic diseases are responsible for an enormous burden of deaths, disability, and economic loss, yet little is known about the optimal health sector response to chronic diseases in poor, post-conflict countries. Liberia's experience in strengthening health systems and health financing overall, and addressing HIV/AIDS and mental health in particular, provides a relevant case study for international stakeholders and policymakers in other poor, post-conflict countries seeking to understand and prioritize the global response to chronic diseases. Methods We conducted a historical review of Liberia's post-conflict policies and their impact on general economic and health indicators, as well as on health systems strengthening and chronic disease care and treatment. Key sources included primary documents from Liberia's Ministry of Health and Social Welfare, published and gray literature, and personal communications from key stakeholders engaged in Liberia's Health Sector Reform. In this case study, we examine the early reconstruction of Liberia's health care system from the end of conflict in 2003 to the present time, highlight challenges and lessons learned from this initial experience, and describe future directions for health systems strengthening and chronic disease care and treatment in Liberia. Results Six key lessons emerge from this analysis: (i the 2007 National Health Policy's 'one size fits all' approach met aggregate planning targets but resulted in significant gaps and inefficiencies throughout the system; (ii the innovative Health Sector Pool Fund proved to be an effective financing mechanism to recruit and align health actors with the 2007 National Health Policy; (iii a substantial rural health delivery gap remains, but it could be bridged with a robust cadre of community health workers integrated into the primary health care system; (iv effective strategies for HIV/AIDS care in other settings should be

  6. Comparison of yoga versus stretching for chronic low back pain: protocol for the Yoga Exercise Self-care (YES trial

    Directory of Open Access Journals (Sweden)

    Hawkes Rene J

    2010-03-01

    Full Text Available Abstract Background Back pain, one of the most prevalent conditions afflicting American adults, is the leading reason for using complementary and alternative medicine (CAM therapies. Yoga is an increasingly popular "mind-body" CAM therapy often used for relieving back pain and several small studies have found yoga effective for this condition. This study will assess whether yoga is effective for treating chronic low back pain compared with self care and exercise and will explore the mechanisms responsible for any observed benefits. Methods/Design A total of 210 participants with low back pain lasting at least 3 months will be recruited from primary care clinics of a large healthcare system based in Seattle. They will be randomized in a 2:2:1 ratio to receive 12 weekly yoga classes, 12 weekly conventional therapeutic exercise classes of comparable physical exertion, or a self-care book. Interviewers masked to participants' treatment group will assess outcomes at baseline and 6, 12 and 26 weeks after randomization. Primary outcomes will be back-related dysfunction and symptom bothersomeness. In addition, data will be collected on physical measurements (e.g., flexion at baseline and 12 weeks and saliva samples will be obtained at baseline, 6 and 12 weeks. Information will be collected on specific physical, psychological, and physiological factors to allow exploration of possible mechanisms of action through which yoga could relieve back pain and dysfunction. The effectiveness of yoga will be assessed using analysis of covariance (using general estimating equations - GEE within an intention-to-treat context. If yoga is found effective, further analyses will explore whether yoga's benefits are attributable to physical, psychological and/or physiological factors. Conclusions This study will provide the clearest evidence to date about the value of yoga as a therapeutic option for treating chronic back pain, and if the results are positive, will help

  7. Recruitment bias in chronic pain research: whiplash as a model.

    Science.gov (United States)

    Nijs, Jo; Inghelbrecht, Els; Daenen, Liesbeth; Hachimi-Idrissi, Said; Hens, Luc; Willems, Bert; Roussel, Nathalie; Cras, Patrick; Wouters, Kristien; Bernheim, Jan

    2011-11-01

    In science findings which cannot be extrapolated to other settings are of little value. Recruitment methods vary widely across chronic whiplash studies, but it remains unclear whether this generates recruitment bias. The present study aimed to examine whether the recruitment method accounts for differences in health status, social support, and personality traits in patients with chronic whiplash-associated disorders (WAD). Two different recruitment methods were compared: recruiting patients through a local whiplash patient support group (group 1) and local hospital emergency department (group 2). The participants (n=118) filled in a set of questionnaires: the Neck Disability Index, Medical Outcome Study Short-Form General Health Survey, Anamnestic Comparative Self-Assessment measure of overall well-being, Symptom Checklist-90, Dutch Personality Questionnaire, and the Social Support List. The recruitment method (either through the local emergency department or patient support group) accounted for the differences in insufficiency, somatization, disability, quality of life, self-satisfaction, and dominance (all p values recruitment methods generated chronic WAD patients comparable for psychoneurotism, social support, self-sufficiency, (social) inadequacy, rigidity, and resentment (p>.01). The recruitment of chronic WAD patients solely through patient support groups generates bias with respect to the various aspects of health status and personality, but not social support. In order to enhance the external validity of study findings, chronic WAD studies should combine a variety of recruitment procedures. PMID:21853277

  8. Multidisciplinary outpatient care program for patients with chronic low back pain: design of a randomized controlled trial and cost-effectiveness study [ISRCTN28478651

    Directory of Open Access Journals (Sweden)

    Anema Johannes R

    2007-09-01

    Full Text Available Abstract Background Chronic low back pain (LBP is a major public and occupational health problem, which is associated with very high costs. Although medical costs for chronic LBP are high, most costs are related to productivity losses due to sick leave. In general, the prognosis for return to work (RTW is good but a minority of patients will be absent long-term from work. Research shows that work related problems are associated with an increase in seeking medical care and sick leave. Usual medical care of patients is however, not specifically aimed at RTW. The objective is to present the design of a randomized controlled trial, i.e. the BRIDGE-study, evaluating the effectiveness in improving RTW and cost-effectiveness of a multidisciplinary outpatient care program situated in both primary and outpatient care setting compared with usual clinical medical care for patients with chronic LBP. Methods/Design The design is a randomized controlled trial with an economic evaluation alongside. The study population consists of patients with chronic LBP who are completely or partially sick listed and visit an outpatient clinic of one of the participating hospitals in Amsterdam (the Netherlands. Two interventions will be compared. 1. a multidisciplinary outpatient care program consisting of a workplace intervention based on participatory ergonomics, and a graded activity program using cognitive behavioural principles. 2. usual care provided by the medical specialist, the occupational physician, the patient's general practitioner and allied health professionals. The primary outcome measure is sick leave duration until full RTW. Sick leave duration is measured monthly by self-report during one year. Data on sick leave during one-year follow-up are also requested form the employers. Secondary outcome measures are pain intensity, functional status, pain coping, patient satisfaction and quality of life. Outcome measures are assessed before randomization and 3, 6

  9. A Model of Induction for Specialised Residential Care

    Directory of Open Access Journals (Sweden)

    Ann McWilliams

    2006-01-01

    Full Text Available The Social Care Education and Training Project at the Dublin Institute of Technology is a four year project funded by the Department of Health and Children. The project has increased the number of students enrolled in social care courses at the Institute and delivers Continued Professional Development courses for workers in the specialised residential units. The article describes an induction model developed and delivered by the project team to new workers in the specialised residential units in the Dublin region although the course is suitable for all residential care settings. The evaluation suggests that the majority of participants found the induction module worthwhile because it had a positive effect on their professional practice and increased their self confidence. This supports the need for formal induction training for all new workers to ensure they perform their professional duties effectively as possible in their new working environment.

  10. Phenotypic Variation in Patients with Chronic Obstructive Pulmonary Disease in Primary Care.

    Science.gov (United States)

    Beekman, Emmylou; Mesters, Ilse; Spigt, Mark G; van Eerd, Eva A M; Gosselink, Rik; de Bie, Rob A; van Schayck, Onno C P

    2016-01-01

    Introduction. Despite the high number of inactive patients with COPD, not all inactive patients are referred to physical therapy, unlike recommendations of general practitioner (GP) guidelines. It is likely that GPs take other factors into account, determining a subpopulation that is treated by a physical therapist (PT). The aim of this study is to explore the phenotypic differences between inactive patients treated in GP practice and inactive patients treated in GP practice combined with PT. Additionally this study provides an overview of the phenotype of patients with COPD in PT practice. Methods. In a cross-sectional study, COPD patient characteristics were extracted from questionnaires. Differences regarding perceived health status, degree of airway obstruction, exacerbation frequency, and comorbidity were studied in a subgroup of 290 inactive patients and in all 438 patients. Results. Patients treated in GP practice combined with PT reported higher degree of airway obstruction, more exacerbations, more vascular comorbidity, and lower health status compared to patients who were not referred to and treated by a PT. Conclusion. Unequal patient phenotypes in different primary care settings have important clinical implications. It can be carefully concluded that other factors, besides the level of inactivity, play a role in referral to PT. PMID:27148553

  11. Phenotypic Variation in Patients with Chronic Obstructive Pulmonary Disease in Primary Care

    Directory of Open Access Journals (Sweden)

    Emmylou Beekman

    2016-01-01

    Full Text Available Introduction. Despite the high number of inactive patients with COPD, not all inactive patients are referred to physical therapy, unlike recommendations of general practitioner (GP guidelines. It is likely that GPs take other factors into account, determining a subpopulation that is treated by a physical therapist (PT. The aim of this study is to explore the phenotypic differences between inactive patients treated in GP practice and inactive patients treated in GP practice combined with PT. Additionally this study provides an overview of the phenotype of patients with COPD in PT practice. Methods. In a cross-sectional study, COPD patient characteristics were extracted from questionnaires. Differences regarding perceived health status, degree of airway obstruction, exacerbation frequency, and comorbidity were studied in a subgroup of 290 inactive patients and in all 438 patients. Results. Patients treated in GP practice combined with PT reported higher degree of airway obstruction, more exacerbations, more vascular comorbidity, and lower health status compared to patients who were not referred to and treated by a PT. Conclusion. Unequal patient phenotypes in different primary care settings have important clinical implications. It can be carefully concluded that other factors, besides the level of inactivity, play a role in referral to PT.

  12. Ethical considerations in chronic musculoskeletal disease.

    Science.gov (United States)

    MacKenzie, C Ronald; de Melo-Martin, Inmaculada

    2015-06-01

    Chronic diseases compromise the life of the sufferer, encumber their families, and exert intractable burdens on the health-care system. With the aging of the population, such conditions have become the primary determinants of morbidity and mortality and the leading cause of disability in our society. Despite the serious challenges they impose, the ethical discourse engendered by them has lagged behind that of acute care medicine. Of particular relevance are the challenges to individual autonomy, as the dilemmas arising in the chronic care setting have not only medical but personal and societal dimensions, may require the input of multiple participants, and resolve over longer periods of time. As such, the conventional model of autonomy is often inadequate to address problems in the chronic care setting. This paper deals with this dilemma through an examination of a clinical scenario. A framework for the exploration of ethical problems in the chronic care setting is thus presented. PMID:25864103

  13. Evaluation of the integrated community based home care model

    Directory of Open Access Journals (Sweden)

    LR Uys

    2001-09-01

    Full Text Available In 1999-2000 the Integrated Community-Based Home Care model for the care of people with AIDS in communities were implemented in seven sites across the country. The post-implementation evaluation showed that most respondents felt that the model could be replicated if a functioning and informed network including all partners, and a strong management team were in place. The effects of the project were mainly positive for all stakeholders (hospice, clinic, hospital, PWA and their carers, professionals and other community members. Hospitals and community- based services became more aware of and involved in the needs of PWA and felt that the model enabled them to address these needs. PWA and their carers felt supported and respected.

  14. Primary care patient and provider preferences for diabetes care managers

    Directory of Open Access Journals (Sweden)

    Ramona S DeJesus

    2010-06-01

    Full Text Available Ramona S DeJesus1, Kristin S Vickers2, Robert J Stroebel1, Stephen S Cha31Division of Primary Care Internal Medicine, Mayo Clinic, Rochester, MN, USA; 2Department of Psychiatry and Psychology, Mayo Clinic, MN, USA; 3Department of Biostatistics, Mayo Clinic, Rochester, MN, USAPurpose: The collaborative care model, using care managers, has been shown to be effective in achieving sustained treatment outcomes in chronic disease management. Little effort has been made to find out patient preferences for chronic disease care, hence, we conducted a study aimed at identifying these.Methods: A 20-item questionnaire, asking for patients’ and providers’ preferences and perceptions, was mailed out to 1000 randomly selected patients in Olmsted County, Minnesota, identified through a diabetes registry to have type 2 diabetes mellitus, a prototypical prevalent chronic disease. Surveys were also sent to 42 primary care providers.Results: There were 254 (25.4% patient responders and 28 (66% provider responders. The majority of patients (>70% and providers (89% expressed willingness to have various aspects of diabetes care managed by a care manager. Although 75% of providers would be comfortable expanding the care manager role to other chronic diseases, only 39.5% of patient responders would be willing to see a care manager for other chronic problems. Longer length of time from initial diagnosis of diabetes was associated with decreased patient likelihood to work with a care manager.Conclusion: Despite study limitations, such as the lack of validated measures to assess perceptions related to care management, our results suggest that patients and providers are willing to collaborate with a care manager and that both groups have similar role expectations of a care manager.Keywords: care manager, collaborative care, patient preference, diabetes care

  15. Predictors of outcome in neck pain patients undergoing chiropractic care: comparison of acute and chronic patients

    Directory of Open Access Journals (Sweden)

    Peterson Cynthia

    2012-08-01

    Full Text Available Abstract Background Neck pain is a common complaint in patients presenting for chiropractic treatment. The few studies on predictors for improvement in patients while undergoing treatment identify duration of symptoms, neck stiffness and number of previous episodes as the strong predictor variables. The purpose of this study is to continue the research for predictors of a positive outcome in neck pain patients undergoing chiropractic treatment. Methods Acute ( 3 months (n = 255 neck pain patients with no chiropractic or manual therapy in the prior 3 months were included. Patients completed the numerical pain rating scale (NRS and Bournemouth questionnaire (BQ at baseline prior to treatment. At 1 week, 1 month and 3 months after start of treatment the NRS and BQ were completed along with the Patient Global Impression of Change (PGIC scale. Demographic information was provided by the clinician. Improvement at each of the follow up points was categorized using the PGIC. Multivariate regression analyses were done to determine significant independent predictors of improvement. Results Baseline mean neck pain and total disability scores were significantly (p  Conclusions The most consistent predictor of clinically relevant improvement at both 1 and 3 months after the start of chiropractic treatment for both acute and chronic patients is if they report improvement early in the course of treatment. The co-existence of either radiculopathy or dizziness however do not imply poorer prognosis in these patients.

  16. Chronic Low Back Pain: Toward an Integrated Psychosocial Assessment Model.

    Science.gov (United States)

    Strong, Jenny; And Others

    1994-01-01

    Integrated six dimensions of chronic low back pain (pain intensity, functional disability, attitudes toward pain, pain coping strategies, depression, illness behavior) to provide multidimensional patient profile. Data from 100 patients revealed presence of three distinct patient groups: patients who were in control, patients who were depressed and…

  17. A New Long-Term Care Facilities Model in Nova Scotia, Canada: Protocol for a Mixed Methods Study of Care by Design

    OpenAIRE

    Marshall, Emily Gard; Boudreau, Michelle Anne; Jensen, Jan L; Edgecombe, Nancy; Clarke, Barry; Burge, Frederick; Archibald, Greg; Taylor, Anthony; Andrew, Melissa K.

    2013-01-01

    Background Prior to the implementation of a new model of care in long-term care facilities in the Capital District Health Authority, Halifax, Nova Scotia, residents entering long-term care were responsible for finding their own family physician. As a result, care was provided by many family physicians responsible for a few residents leading to care coordination and continuity challenges. In 2009, Capital District Health Authority (CDHA) implemented a new model of long-term care called “Care b...

  18. Profiling quality of care for patients with chronic headache in three different German hospitals – a case study

    Directory of Open Access Journals (Sweden)

    Hager Stefan

    2008-01-01

    Full Text Available Abstract Background Legal requirements for quality assurance in German rehabilitation hospitals include comparisons of providers. Objective is to describe and to compare outcome quality of care offered by three hospitals providing in-patient rehabilitative treatment exemplified for patients with chronic headache. Methods We performed a prospective three center observational study on patients suffering from chronic headache. Patients underwent interventions commonly used according to internal guidelines of the hospitals. Measurements were taken at three points in time (at admission, at discharge and 6 months after discharge. Indicators of outcome quality included pain intensity and frequency of pain, functional ability, depression, quality of life and health related behavior. Analyses of differences amongst the hospitals were adjusted by covariates due to case-mix situation. Results 306 patients from 3 hospitals were included in statistical analysis. Amongst the hospitals, patients differed significantly in age, education, diagnostic subgroups, beliefs, and with respect to some pain-related baseline values (covariates. Patients in all three hospitals benefited from intervention to a clinically relevant degree. At discharge from hospital, outcome quality differed significantly after adjustment according to case-mix only in terms of patients' global assessment of treatment results. Six months after discharge, the only detectable significant differences were for secondary outcomes like improved coping with stress or increased use of self-help. The profiles for satisfaction with the hospital stay showed clear differences amongst patients. Conclusion The results of this case study do not suggest a definite overall ranking of the three hospitals that were compared, but outcome profiles offer a multilayer platform of reliable information which might facilitate decision making.

  19. The ADHD Clinic: a collaborative model of care.

    Science.gov (United States)

    Campbell, Lisa; Allan, Carla

    2014-01-01

    Hyperactivity Disorder (ADHD) is a common chronic and often life-persistent neurobehavioral disorder. At Children's Mercy Hospital, collaboration between a developmental-behavioral pediatrician and a behavioral psychologist, both of whom specialize in ADHD, allows the use of both medication and behavior modification which are recommended by the American Academy of Pediatrics and which are equally effective as stand-alone therapies. Children who receive both of these treatment modalities also fare better than those who receive only medication in a number of areas. This article will describe our collaborative clinic model and will address considerations of parent preference about these therapeutic approaches. PMID:25011340

  20. Caring for people with dementia in residential aged care: successes with a composite person-centered care model featuring Montessori-based activities.

    Science.gov (United States)

    Roberts, Gail; Morley, Catherine; Walters, Wendy; Malta, Sue; Doyle, Colleen

    2015-01-01

    Person-centered models of dementia care commonly merge aspects of existing models with additional influences from published and unpublished evidence and existing government policy. This study reports on the development and evaluation of one such composite model of person-centered dementia care, the ABLE model. The model was based on building the capacity and ability of residents living with dementia, using environmental changes, staff education and organizational and community engagement. Montessori principles were also used. The evaluation of the model employed mixed methods. Significant behavior changes were evident among residents of the dementia care Unit after the model was introduced, as were reductions in anti-psychotic and sedative medication. Staff reported increased knowledge about meeting the needs of people with dementia, and experienced organizational culture change that supported the ABLE model of care. Families were very satisfied with the changes. PMID:25499658