Journal articles on the topic 'Stanford Model Chronic Disease Self-Management Program'
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y, M. Murph, J. Saunder s, M. Campbel l, B. Jackso n, and D. Berlowit z. "The process of implementing the Stanford Model Chronic Disease Self-Management Program: The Northern Hospital experience." Australian Journal of Primary Health 9, no. 3 (2003): 127. http://dx.doi.org/10.1071/py03036.
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In March 2002, The Northern Clinical Research Centre (NCRC), Epping, implemented the Stanford model Chronic Disease Self-Management Program (CDSMP). The NCRC is the first health facility to implement the CDSMP for all cause chronic conditions in the northern suburbs of Melbourne. This paper outlines the establishment, marketing, co-ordination and personnel for a successful program as identified by the NCRC. Barriers to participation in a program were identified by the NCRC and steps to minimise these were implemented. The evaluation of this program in a scientific manner enables the effect of this adjuvant therapy to be examined in the Australian population. Fifty-two participants have graduated from the CDSMP at The Northern Hospital since the program commenced. This paper reviews the unplanned re-admission rates for people who have participated in the CDSMP as part of an ongoing study.
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Francis, Caitlin F., Anne-Marie Feyer, and Ben J. Smith. "Implementing chronic disease self-management in community settings: lessons from Australian demonstration projects." Australian Health Review 31, no. 4 (2007): 499. http://dx.doi.org/10.1071/ah070499.
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The evaluation of the Sharing Health Care Initiative addressed the translation of different models of chronic disease self-management into health and community service contexts in Australia. Across seven projects, four intervention models were adopted: (1) the Stanford Chronic Disease Self Management course; (2) generic disease management planning, training and support; (3) tailored disease management planning, training and support, and; (4) telephone coaching. Targeted recruitment through support groups and patient lists was most successful for reaching high-needs clients. Projects with well developed organisational structures and health system networks demonstrated more effective implementation. Engagement of GPs in recruitment and client support was limited. Future self-management programs will require flexible delivery methods in the primary health care setting, involving practice nurses or the equivalent. After 12 months there was little evidence of potential sustainability, although structures such as consumer resource centres and client support clubs were established in some locations. Only one project was able to use Medicare chronic disease-related items to integrate self-management support into routine general practice. Participants in all projects showed improvements in self-management practices, but those receiving Model 3, flexible and tailored support, and Model 4, telephone coaching, reported the greatest benefits
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Özkan, İlknur, and Nermin Olgun. "The relationship between self efficacy, general self disease management strategies in coping with pain and quality of life in migraine patients: Testing a theoretical methodMigrenli hastalarda öz yeterlik, ağrıyla başa çıkmada kendi genel yönetim stratejileri ve yaşam kalitesi arasındaki ilişkinin incelenmesi: Teorik bir modelin test edilmesi." Journal of Human Sciences 14, no. 4 (November 2, 2017): 3389. http://dx.doi.org/10.14687/jhs.v14i4.4787.
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This study was designed to test a causality-based model in the context of relationships based on social cognitive theory and the literature for the purpose of examining how self-efficacy directly affects the quality of life of migraine patients through self- disease management skills. The sample of the study consisted of 343 migraine patients selected from a neurology outpatient clinic. The data were collected with self-report method using Self-Disease Management Strategies Scale in Migraine Patients developed by the researcher, the interview form, Quality of Life Scale in Migraine Patients and Self-Efficacy for Managing Chronic Disease 6-Item Scale, SEMCD developed by Stanford Patient Education Research Center. In order to test construct validity of scales, explanatory factor analysis and varimax axis rotation basic component analysis were applied. Cronbach's alpha values were calculated by analyzing the internal consistency for all the items in the scales and each subscale of the scale. The model proposed in the study was tested by using Structural Equation Model (SEM)-path analysis with latent variables in lisrel program. In SEM application, direct effect of self-efficacy on quality of life and indirect effect on self-disease management strategies were found to be statistically significant. Based on these results, self-efficacy can be thought to be a determinant of self-efficacy, quality of life of the patient and the patient’s skills of using self-disease management strategies. In order to improve the quality of life of migraine patients, their self-efficacy on disease management should be assessed and nursing practices should be planned to increase their confidence in the ability of preventing and managing migraine attacks.Extended English abstract is in the end of PDF (TURKISH) file. ÖzetBu araştırma, öz yeterliğin migrenli hastaların yaşam kalitesini doğrudan ve kendi kendine hastalık yönetimi becerileri aracılığı yoluyla ne kadar etkilediğini incelemek amacıyla, sosyal bilişsel teoriden temel alarak ve literatüre dayalı ilişkiler bağlamında nedensellik temelli bir modeli test etmek amacıyla planlanmıştır. Araştırmanın örneklemini bir nöroloji polikliniğinden seçilen 343 migren hastası oluşturmuştur. Veriler, görüşme formu, araştırmacı tarafından geliştirilen Migrenli Hastalarda Kendi Kendine Hastalık Yönetim Stratejileri Ölçeği, Migrenli Hastalarda Yaşam Kalitesi Ölçeği ve Standford Hasta Eğitim Araştırma Merkezi tarafından geliştirilen[WK1] [Mh2] Kronik Hastalıkları Yönetimde Öz Yeterlik Ölçeği (Self-Efficacy for Managing Chronic Disease 6-Item Scale, SEMCD) kullanılarak öz bildirim yöntemi ile toplanmıştır. Ölçeklerin yapı geçerliliğini test etmek için açıklayıcı faktör analizi ve varimaks’ eksen döndürme temel bileşenler analizi uygulanmıştır. Ölçeklerde yer alan maddelerin tamamı ve ölçeğin her bir alt boyutu için, iç tutarlık analizi yapılarak, Cronbach Alfa değerleri hesaplanmıştır. Araştırmada ileri sürülen model, lisrel programında Yapısal Eşitlik Modeli (YEM)-örtük değişkenlerle yol analizi yapılarak test edilmiştir. YEM uygulamasında öz yeterliğin yaşam kalitesi üzerine doğrudan etkisi ve kendi kendine hastalık yönetim stratejileri üzerinden dolaylı etkisi istatiksel olarak anlamlı bulunmuştur. Bu sonuçlara dayanarak; öz yeterlik, hastanın yaşam kalitesini, kendi kendine hastalık yönetim stratejilerini kullanma becerisinin bir belirleyicisi olarak düşünülebilir. Migrenli hastaların yaşam kalitesini artırmak için migrenli hastaların hastalık yönetimi konusundaki öz yeterlikleri değerlendirilmeli, hemşirelik uygulamaları hastaların migren atağını önleme ve yönetme becerileri konusundaki kendilerine olan güvenini artıracak şekilde planlanmalıdır.// // // //
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Raymond, Kateri, Mélanie Levasseur, Maud-Christine Chouinard, Jean Mathieu, and Cynthia Gagnon. "Stanford Chronic Disease Self-Management Program in myotonic dystrophy: New opportunities for occupational therapists." Canadian Journal of Occupational Therapy 83, no. 3 (May 26, 2016): 166–76. http://dx.doi.org/10.1177/0008417416646130.
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Córdova, Maria Isabel Peñarrieta de, Rodrigo Leon, Tranquilina Gutierrez, Nelda Mier, Olga Banda, and Magdalena Delabra. "Effectiveness of a chronic disease self-management program in Mexico: A randomized controlled study." Journal of Nursing Education and Practice 7, no. 7 (February 21, 2017): 87. http://dx.doi.org/10.5430/jnep.v7n7p87.
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Objective: To assess the effectiveness of a Spanish-language version of the Stanford Chronic Disease Self-management Program among adults who received medical care in community health centers in Mexico.Methods: This was a prospective, randomized study with Mexican users of community health centers in Tampico, Mexico, conducted between September 2015 and July 2016. A total of 120 adults aged 18 years or older were randomly assigned to intervention (n = 62) and control (n = 58) groups. Data were collected at baseline and at 3 and 6 months post intervention using a structured questionnaire. A repeated measures ANOVA was used for data analysis.Results: Statistically significant differences were found in intervention participants at 3 and 6 months post intervention compared to baseline and the control group for self-management behaviors, including: social activity limitation, quality of life perception, depression, stress, physical activity, communication with physicians, adherence to physician visits, and self-management behaviors.Conclusions: Chronic disease self-management programs (CDSMP) with Mexican adults in community settings are effective in improving their health and self-management behaviors. Further research is needed to assess CDSMP in Mexico and Latin America using objective measurements and examining health outcomes and self-management maintenance over longer periods of time.
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Lorig, Kate, Philip L. Ritter, Kathryn Plant, Diana D. Laurent, Pauline Kelly, and Sally Rowe. "The South Australia Health Chronic Disease Self-Management Internet Trial." Health Education & Behavior 40, no. 1 (April 4, 2012): 67–77. http://dx.doi.org/10.1177/1090198112436969.
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Objectives. To evaluate the effectiveness of an online chronic disease self-management program for South Australia residents. Method. Data were collected online at baseline, 6 months, and 12 months. The intervention was an asynchronous 6-week chronic disease self-management program offered online. The authors measured eight health status measures, seven behaviors, and four utilization measures; self-efficacy; and health care satisfaction. Results. Two hundred fifty-four South Australian adults with one or more chronic conditions completed baseline data. One hundred forty-four completed 6 months and 194 completed 1 year. Significant improvements ( p < .05) were found at 6 months for four health status measures, six health behaviors, self-efficacy, and visits to emergency departments. At 12 months, five health status indicators, six health behaviors, self-efficacy, and visits to emergency departments remained significant. Satisfaction with health care trended toward significance. Discussion. The peer-led online program was both acceptable and useful for this population. It appeared to decrease symptoms, improve health behaviors, self-efficacy, and reduce health care utilization up to 1 year. This intervention also has large potential implications for the use of a public health education model for reaching large numbers of people. It demonstrates that an Internet self-management program, which includes social media, can reach rural and underserved people as well as be effective and reduce health care costs. If this intervention can be brought to scale, it has the potential for improving the lives of large numbers of people with chronic illness. It represents a way the medical care and public health sectors can interact.
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Lin, Amy M., Barbara G. Vickrey, Frances Barry, Martin L. Lee, Monica Ayala-Rivera, Eric Cheng, Ana V. Montoya, et al. "Factors Associated With Participation in the Chronic Disease Self-Management Program." Stroke 51, no. 10 (October 2020): 2910–17. http://dx.doi.org/10.1161/strokeaha.119.028022.
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Background and Purpose: Self-management programs may improve quality of life and self-efficacy for stroke survivors, but participation is low. In a randomized controlled trial of a complex, multidisciplinary, team-based secondary stroke prevention intervention, we offered participants Chronic Disease Self-Management Program (CDSMP) workshops in addition to clinic visits and home visits. To enhance participation, workshops were facilitated by community health workers who were culturally and linguistically concordant with most participants and scheduled CDSMP sessions at convenient venues and times. Over time, we implemented additional strategies such as free transportation and financial incentives. In this study, we aimed to determine factors associated with CDSMP participation and attendance. Methods: From 2014 to 2018, 18 CDSMP workshop series were offered to 241 English and Spanish-speaking individuals (age ≥40 years) with recent stroke or transient ischemic attack. Zero-inflated Poisson regression was used to identify factors associated with participation and attendance (ie, number of sessions attended) in CDSMP. Missing values were imputed using multiple imputation methods. Results: Nearly one-third (29%) of intervention subjects participated in CDSMP. Moderate disability and more clinic/home visits were associated with participation. Participants with higher numbers of clinic and home visits (incidence rate ratio [IRR], 1.06 [95% CI, 1.01–1.12]), severe (IRR, 2.34 [95% CI, 1.65–3.31]), and moderately severe disability (IRR, 1.55 [95% CI, 1.07–2.23]), and who enrolled later in the study (IRR, 1.12 [95% CI, 1.08–1.16]) attended more sessions. Individuals with higher chaos scores attended fewer sessions (IRR, 0.97 [95% CI, 0.95–0.99]). Conclusions: Less than one-third of subjects enrolled in the SUCCEED (Secondary Stroke Prevention by Uniting Community and Chronic Care Model Teams Early to End Disparities) intervention participated in CDSMP; however, participation improved as transportation and financial barriers were addressed. Strategies to address social determinants of health contributing to chaos and engage individuals in healthcare may facilitate attendance. Registration: URL: https://www.clinicaltrials.gov . Unique identifier: NCT01763203.
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Mingo, Chivon, and Collins Airhihenbuwa. "Chronic Disease Self-Management: Behavioral Intervention Preferences Informed by the PEN-3 Cultural Model." Innovation in Aging 4, Supplement_1 (December 1, 2020): 478. http://dx.doi.org/10.1093/geroni/igaa057.1547.
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Abstract Chronic Disease Self-Management Program (CDSMP) is an evidence-based program shown to improve health status, healthcare utilization, and health behaviors among individuals diagnosed with chronic conditions. Aging African Americans, a population at a greater risk of chronic disease diagnosis and burden, are underrepresented in the utilization of self-management behavioral programs. Previous research suggested that cultural distinctions (e.g., values, beliefs, preferences, experiences) impact the participation of racial/ethnic minorities in health-related research, health behavior outcomes, and healthcare utilization. Little is known about unique cultural influences on CDSMP utilization among this target group. To our knowledge, no research has applied a culture-specific theory to understand preferences or use of CDSMP among aging African Americans. Guided by the PEN-3 cultural model, this study examines preferences, barriers, and facilitators that may influence CDSMP utilization for the management of diagnosed chronic conditions. Using a qualitative research design, African Americans (N=50) from six Atlanta Metropolitan faith-based organizations participated in the 6-week CDSMP and one of six focus groups. Participants were largely female (70%) experiencing multiple chronic conditions (M=2) with an average age of 70. Focus groups were transcribed, and a thematic analysis was applied to identify emergent themes. Participants preferred programs that included family, community liaisons, and relevant advertisement material suggesting the importance of cultural identity. Accessing CDSMP at a familiar location with an endorsement of program benefit from trusted sources suggests the importance of relationship and expectations. Findings shed light on factors that may cause aging African Americans to embrace or avoid CDSMP as a healthcare option.
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Moore, Ellie, Sharon Lawn, Candice Oster, and Andrea Morello. "Self-management programs for Aboriginal and Torres Strait Islander Peoples with chronic conditions: A rapid review." Chronic Illness 15, no. 2 (December 29, 2017): 83–123. http://dx.doi.org/10.1177/1742395317750266.
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Objectives Review the evidence for the effectiveness of chronic condition self-management programs applied to Aboriginal and Torres Strait Islander Peoples. Methods A rapid review methodology was followed to develop an evidence summary from peer-reviewed and grey literature. Results Only seven peer-reviewed studies were identified. The evidence indicated that group programs, particularly the Stanford Program, and structured individual chronic condition self-management programs were of good quality for Aboriginal and Torres Strait Islander Peoples, although these need to be integrated into practice in order to see the greatest benefits. The Flinders Program showed promise as a standardised program with content designed specifically with and for these populations. Numerous grey literature sources were identified, many using strong participatory approaches developed locally within Aboriginal and Torres Strait Islander Peoples. However, few of these programs have been subject to rigorous evaluation. Discussion Despite the significant focus on chronic condition self-management programs to help address the burden of disease for Aboriginal and Torres Strait Islander Peoples, few studies exist that have been properly evaluated. The Closing the Gap Principles developed by the Australian Institute of Health and Welfare offer important guidance for how to proceed to maximise engagement, cultural appropriateness and ownership of program initiatives.
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Harvey, Peter W., John N. Petkov, Gary Misan, Jeffrey Fuller, Malcolm W. Battersby, Teofilo N. Cayetano, Kate Warren, and Paul Holmes. "Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes." Australian Health Review 32, no. 2 (2008): 330. http://dx.doi.org/10.1071/ah080330.
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The Sharing Health Care SA chronic disease selfmanagement (CDSM) project in rural South Australia was designed to assist patients with chronic and complex conditions (diabetes, cardiovascular disease and arthritis) to learn how to participate more effectively in the management of their condition and to improve their self-management skills. Participants with chronic and complex conditions were recruited into the Sharing Health Care SA program and offered a range of education and support options (including a 6-week peer-led chronic disease self-management program) as part of the Enhanced Primary Care care planning process. Patient self-reported data were collected at baseline and subsequent 6-month intervals using the Partners in Health (PIH) scale to assess selfmanagement skill and ability for 175 patients across four data collection points. Health providers also scored patient knowledge and self-management skills using the same scale over the same intervals. Patients also completed a modified Stanford 2000 Health Survey for the same time intervals to assess service utilisation and health-related lifestyle factors. Results show that both mean patient self-reported PIH scores and mean health provider PIH scores for patients improved significantly over time, indicating that patients demonstrated improved understanding of their condition and improved their ability to manage and deal with their symptoms. These results suggest that involvement in peer-led selfmanagement education programs has a positive effect on patient self-management skill, confidence and health-related behaviour.
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Liu, Yuexing, Xiaoyu Wu, Chun Cai, Patrick Y. Tang, Muchieh Maggy Coufal, Yiqing Qian, Samantha Ling Luu, Edwin B. Fisher, and Weiping Jia. "Peer support in Shanghai’s Commitment to diabetes and chronic disease self-management: program development, program expansion, and policy." Translational Behavioral Medicine 10, no. 1 (February 2020): 13–24. http://dx.doi.org/10.1093/tbm/ibz194.
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Abstract Identifying organizational settings for sustainable, scalable implementation of peer support (PS) is a challenge. Development, initial evaluation, and community expansion of PS for populations with diabetes staged in the context of the Shanghai Integration Model integrating primary and specialty care for diabetes. Development Phase with 9 Community Health Centers (CHCs) leading to Community Expansion Phase with additional 12 communities. Development Phase peer leaders (PLs) co-led meetings on diabetes management, led neighborhood activities, and followed up with individuals and families. Among 1,284 participants, changes in HbA1c, other clinical markers, and diabetes distress were significant (ps from 0.001 to 0.041), pronounced among those with elevated levels, for example, HbA1c reduction from 9.09% to 8.50% among those ≥8% at baseline (p < 0.001). Ratings of Implementation were associated with reduced HbA1c and diabetes distress and increased neighborhood support. In particular, linking with community resources and utilization of neighborhood Residential Committees were associated with improved HbA1c, indicating the value of PS programs including community resources. Thus, the Community Expansion Phase includes district- and community-level health staff, Community Self Management Groups, and Residential Committees along with CHCs in 12 communities, all of which have implemented activities during the first 6 months. PS programs are feasible and appear to add value among populations with diabetes in community settings such as Shanghai. Recognition by the Shanghai government has included PS as a key strategy for achieving self-management of chronic disease in its 2030 health goals.
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Nielsen, Annegrete Juul, and Casper Bruun Jensen. "Travelling Frictions." Science & Technology Studies 26, no. 2 (January 1, 2013): 61–79. http://dx.doi.org/10.23987/sts.55299.
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Contemporary disease self-management programs aim to renegotiate the terms on which patients participate in their own health care. Though the notion of ‘patient 2.0’ has mainly been used to speak to patient empowerment through IT, we therefore propose to view self-management as eliciting “the patient” in a different shape. In this paper, we explore the embedded assumptions, imagined potentials and concrete practices of the Stanford Chronic Disease Self-Management Program (CDSMP), in order to understand how this program reconfigures a particular form of global patient. To analyse this process we consider the CDSMP as a traveling technology. First, we demonstrate that its successful globalization has been enabled by tying together specific forms of theorizing, evidence-basing, and scripting in a theory-methods package. Second, we show that the globalization of the program entails various forms of localization in the national health care setting of Denmark. In this context, we examine different kinds of efforts required to maintain the ‘global’ identity of the program even as it is ‘localized’. In particular, we show that the insertion of the program into Danish health care generates frictions. Such frictions are brought to light comparatively as Danish health care policy-makers, practitioners, consultants and chronic patients engage with and reflect upon the characteristics of the program. We argue that this analysis holds implications for ‘patient 2.0’, both as practical accomplishment and as a conceptual tool for social studies of medicine and health care.
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López González, Ana Laura. "Implications of diabetes self-management education in metabolic control." Mexican Journal of Medical Research ICSA 8, no. 16 (July 5, 2020): 72–80. http://dx.doi.org/10.29057/mjmr.v8i16.3911.
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Diabetes is a chronic, progressive and disabling disease that affects millions of people around the world, with a high mortality rate derived from poor control. The paradigm of the treatment of diabetes has shifted to focus on empowering the person with diabetes to manage the disease successfully and to improve their quality of life. Diabetes self-management education, or DSME, is a process where people with diabetes gain the knowledge and skills needed to make informed decisions, modify their behaviour and to self-manage, in collaboration with health personnel, successfully the disease and its related conditions. To achieve these goals a structured educational program is used, in 4 stages which include assessment, planning, implementation and evaluation; to carry on this program, the model of the seven self-care behaviours known as AADE7®, developed by the American Association of Diabetes Educators, is used as a frame of reference. The objective of this paper is to analyse the components of the education program for diabetes self-care as well as its reference framework, the AADE7® model, and its importance in the metabolic control of diabetes.
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Aini Saludin, Farhana, Nurazean Maarop, Norziha Megat Mohd Zainuddin, Roslina Mohammad, and Sya Azmeela Shariff. "A Conceptual Model on Websites Design Features for Self-Management of Chronic-Diseases Patients." International Journal of Engineering & Technology 7, no. 4.36 (December 9, 2018): 479. http://dx.doi.org/10.14419/ijet.v7i4.36.23922.
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Undeniably, there are several reasons to be connected to the Internet. In healthcare, finding health information from the Internet and websites is common among the global community. Searching health information over the Internet can assists chronic-disease patients in self-managing their health condition. Self-management program with Information Technology empowerment would improve time, distance and traffic barriers because it is easily accessible, up-to-date, and offers tailored feedback to patients` health status. There is great demand of health websites use though at the same time users are facing concerns and limitations due to medical jargons use and navigational problems. Hence, there is a strong reason why more studies need to be conducted in this particular area especially in the design and development of health websites. Based on a review of relevant papers, this paper aims to propose a model for websites design features for self-management of chronic-diseases patients. Ten relevant features of health websites are extracted and proposed in this study. The study may be beneficial to health websites users and eventually improve their health conditions.
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Arnold, Marilynn S., Patricia M. Butler, Robert M. Anderson, Martha M. Funnell, and Catherine Feste. "Guidelines for Facilitating a Patient Empowerment Program." Diabetes Educator 21, no. 4 (August 1995): 308–12. http://dx.doi.org/10.1177/014572179502100408.
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The traditional medical treatment model often ignores the emotional, spiritual, social, and cognitive aspects of living with a chronic disease such as diabetes. Empowerment programs address these psychosocial areas by helping individuals develop skills and self-awareness in goal setting, problem solving, stress management, coping, social support, and motivation. Although many diabetes educators have been taught to use an empowerment curriculum to facilitate self-management, there is minimal research concerning the actual process of providing such programs to patients. We evaluated an empowerment curriculum (Empowerment: A Personal Path to Self-Care) with a diverse group of individuals with diabetes to determine the key elements of planning and implementing a successful diabetes patient empowerment program.
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Solomon, Patricia, Nancy Margaret Salbach, Kelly Kathleen O’Brien, Stephanie Nixon, Larry Baxter, and Nicole Gervais. "Evaluation of a Community-Based Self-Management Program to Increase Access to Rehabilitation for People Living with HIV." Journal of the International Association of Providers of AIDS Care (JIAPAC) 18 (January 1, 2019): 232595821988333. http://dx.doi.org/10.1177/2325958219883334.
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We qualitatively evaluated a novel educational program to help people living with HIV understand the role of rehabilitation, facilitate access to rehabilitation, and promote self-management of chronic disease in Canada. The program incorporated components of self-efficacy, client-centered care, peer education, and problem-based learning. Delivery of the community-engaged program was viewed as feasible and acceptable; however, a flexible delivery model was deemed important. Perceived learning was related to rehabilitation, advocacy, and taking responsibility for one’s health. A co-leader model and access to online resources were strengths. Future work should assess the ability to apply advocacy knowledge and skills to access rehabilitation services.
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Lawn, Sharon, Sara Zabeen, David Smith, Ellen Wilson, Cathie Miller, Malcolm Battersby, and Kevin Masman. "Managing chronic conditions care across primary care and hospital systems: lessons from an Australian Hospital Avoidance Risk Program using the Flinders Chronic Condition Management Program." Australian Health Review 42, no. 5 (2018): 542. http://dx.doi.org/10.1071/ah17099.
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Objective The study aimed to determine the impact of the Flinders Chronic Condition Management Program for chronic condition self-management care planning and how to improve its use with Bendigo Health’s Hospital Admission Risk Program (HARP). Methods A retrospective analysis of hospital admission data collected by Bendigo Health from July 2012 to September 2013 was undertaken. Length of stay during admission and total contacts post-discharge by hospital staff for 253 patients with 644 admissions were considered as outcome variables. For statistical modelling we used the generalised linear model. Results The combination of the HARP and Flinders Program was able to achieve significant reductions in hospital admissions and non-significant reduction in emergency department presentations and length of stay. The generalised linear model predicted that vulnerable patient groups such as those with heart disease (P = 0.037) and complex needs (P < 0.001) received more post-discharge contacts by HARP staff than those suffering from diabetes, renal conditions and psychosocial needs when they lived alone. Similarly, respiratory (P < 0.001), heart disease (P = 0.015) and complex needs (P = 0.050) patients had more contacts, with an increased number of episodes than those suffering from diabetes, renal conditions and psychosocial needs. Conclusion The Flinders Program appeared to have significant positive impacts on HARP patients that could be more effective if high-risk groups, such as respiratory patients with no carers and respiratory and heart disease patients aged 0–65, had received more targeted care. What is known about the topic? Chronic conditions are common causes of premature death and disability in Australia. Besides mental and physical impacts at the individual level, chronic conditions are strongly linked to high costs and health service utilisation. Hospital avoidance programs such as HARP can better manage chronic conditions through a greater focus on coordination and integration of care across primary care and hospital systems. In support of HARP, self-management interventions such as the Flinders Program aim to help individuals better manage their medical treatment and cope with the impact of the condition on their physical and mental wellbeing and thus reduce health services utilisation. What does this paper add? This paper sheds light on which patients might be more or less likely to benefit from the combination of the HARP and Flinders Program, with regard to their impact on reductions in hospital admissions, emergency department presentations and length of stay. This study also sheds light on how the Flinders Program could be better targeted towards and implemented among high-need and high-cost patients to lessen chronic disease burden on Australia’s health system. What are the implications for practitioners? Programs targeting vulnerable populations and applying evidence-based chronic condition management and self-management support achieve significant reductions in potentially avoidable hospitalisation and emergency department presentation rates, though sex, type of chronic condition and living situation appear to matter. Benefits might also accrue from the combination of contextual factors (such as the Flinders Program, supportive service management, clinical champions in the team) that work synergistically.
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Shaw, Jessica D., Daniel J. O’Neal, Kris Siddharthan, and Britta I. Neugaard. "Pilot Program to Improve Self-Management of Patients with Heart Failure by Redesigning Care Coordination." Nursing Research and Practice 2014 (2014): 1–10. http://dx.doi.org/10.1155/2014/836921.
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Objectives. We tested both an educational and a care coordination element of health care to examine if better disease-specific knowledge leads to successful self-management of heart failure (HF).Background. The high utilization of health care resources and poor patient outcomes associated with HF justify tests of change to improve self-management of HF.Methods. This prospective study tested two components of the Chronic Care Model (clinical information systems and self-management support) to improve outcomes in the self-management of HF among patients who received intensive education and care coordination during their acute care stay. A postdischarge follow-up phone call assessed their knowledge of HF self-management compared to usual care patients.Results. There were 20 patients each in the intervention and usual care groups. Intervention patients were more likely to have a scale at home, write down their weight, and practice new or different health behaviors.Conclusion. Patients receiving more intensive education knew more about their disease and were better able to self-manage their weight compared to patients receiving standard care.
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Mersal, Fathia, and Samah El-Awady. "Evaluation of bronchial asthma educational package on asthma self-management among school age children based on Orem’s self-care model in Zagazig city." International Journal of Advanced Nursing Studies 7, no. 1 (December 21, 2017): 8. http://dx.doi.org/10.14419/ijans.v7i1.8648.
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Background: Asthma is the widespread health problem and most common chronic disease among children. Developing self-care skills related to children with asthma forms a basis for nursing care. Orem’s self-care model is one of the most comprehensive self-care theories that provide a good clinical guide for planning and implementing the principles of good self-care.The Aim of this study: was to determine the effect of asthma educational package based on Orem’s self-care model on the development of self-care activities of children with asthma.Subjects and Methods: a quasi-experimental study conducted on a purposive sample of 106 children with bronchial asthma in pediatric outpatient clinic at Zagazig University hospital. The research tools used in this study were demographic characteristics of studied children. Asthma triggers inventory, asthma knowledge questionnaire, asthma self-management questionnaire, asthma Self-Efficacy regarding self-management of asthma, medication adherence, and inhaler technique observation checklist and health instruction guidelines.Results: the results showed that after the training intervention self-efficacy, asthma management, adherence of asthmatic children to medications were significantly increased (p > 000). The study findings concluded that the asthma education program improved all aspects of self-efficacy and activities of asthma management after program implementation.Conclusion: the educational program based on Orem’s self-care model successfully improves the performance of inhaler use. The study indicates that self-care activities were efficient among children with asthma after implementation of program.Recommendations: it suggested to conduct Orem’s self-care model for children with bronchial asthma and to replicate the study in many settings to support its effectiveness.
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Berlowitz, David J., and Marnie Graco. "The development of a streamlined, coordinated and sustainable evaluation methodology for a diverse chronic disease management program." Australian Health Review 34, no. 2 (2010): 148. http://dx.doi.org/10.1071/ah08689.
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Background. The Northern Alliance Hospital Admission Risk Program–Chronic Disease Management comprises 13 services delivering care to those with chronic disease and older people with complex care needs, who are frequent hospital users. Aims. To develop and implement a system-wide approach to the evaluation of this existing program. Methods. The Northern Clinical Research Centre audited all existing, routinely collected administrative data within the program and then met with each service to develop service specific outcome measures. The evaluators then developed and implemented a system-wide evaluation approach to measure performance in terms of: client profile; access and entry; service efficiency; client outcomes; and hospital demand. Results. Data are collected electronically and more than 80% are derived from existing, administrative datasets, minimising staff and client burden. Additional data include client outcomes and a health related quality of life measure. The preliminary twelve month data suggest that clients have the equivalent of ‘fair’ or ‘poor’ self-reported health status (n = 862) and the average health utility scores are significantly (P < 0.05) worse than population control data. These analyses reveal, for the first time, that the Northern Alliance Hospital Admission Risk Program–Chronic Disease Management program is targeting appropriate clients. Discussion. This methodology will enable many prospective assessments to be performed including; client outcome evaluation, service model comparisons, and cost-utility analyses. Conclusion. This evaluation approach demonstrates the feasibility of a highly coordinated ‘whole of system’ evaluation. Such an approach may ultimately contribute to the development of evidence-based policy. What is known about the topic? Program evaluation literature recommends establishing the objectives of a program, and the corresponding evaluation methodology early in the planning phase so that a thorough evaluation can commence with the implementation of the program. What does this paper add? This paper provides an alternative evaluation methodology developed around the available administrative data, thereby maximising efficiency with data collection and analysis with minimal burden on clinicians. This pragmatic approach may be appropriate for large, ongoing programs with an existing administrative dataset and where funding for evaluation is limited. What are the implications for practitioners? This paper has implications for both administrators and clinicians. The methodology is designed to facilitate evidence-based policy and planning at a regional and state level, and to assist with quality improvement at the local service level through ongoing performance monitoring and benchmarking.
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Crosby, Lori E., Naomi Joffe, Karen Kalinyak, Alex Bruck, and Clinton H. Joiner. "Six-Month Data From a Pilot Self-Management Intervention ForAdolescents With Sickle Cell Disease." Blood 122, no. 21 (November 15, 2013): 1675. http://dx.doi.org/10.1182/blood.v122.21.1675.1675.
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Abstract Background Tanabe and colleagues (2010) highlighted the importance of engaging patients with Sickle Cell Disease (SCD) in disease self-management activities to improve health outcomes. Specifically, they recommended interventions that address disease self-efficacy, patient-provider communication, healthy lifestyle behaviors, future planning, and advocacy. The Stanford Chronic Disease Self-Management Program (CDSMP) is a six-week, structured intervention for adults with a chronic disease that helps them develop self-management skills in all of these areas. The CDSMP has been implemented with adults with a variety of chronic diseases (e.g., arthritis, Type II diabetes), and outcome data has shown improvements in health utilization, health status and self-management behaviors for participants six-months post participation in the CDSMP (Lorig et al. 2001). There is limited data available on the effectiveness of the CDSMP for adults with SCD, particularly young adults and adolescents. As a first step in examining the effectiveness of the CDSMP in adolescents with SCD, we conducted two CDSMP intervention groups with SCD patients 16-24 years of age. Objective The objective of the study was to assess: 1) the feasibility, acceptability and utility of the CDSMP with this population, and, 2) changes in disease self-efficacy, quality of life (QOL), and self-management behaviors from pre to 6-months after participation in the CDSMP. Methods Patients were eligible if they: 1) had a diagnosis of SCD; 2) were followed by the University of Cincinnati Health Complex or Cincinnati Children’s Hospital Medical Center (CCHMC) sickle cell clinics; 3) were between the ages of 16 -24; and, 4) had no significant cognitive limitations. Participants received a letter followed by a phone call inviting them to participate in the CDSMP and were compensated at the end of each weekly session. Results Eighteen adolescents completed the CDSMP (i.e., attended four of the six sessions) and have completed their 6-month follow-up. The majority of patients were female (56%) and had Hb SS (SS 67%; SC 28%; Sβ+Thal 5%); the mean age for participants was 19.06 (SD = 2.44). Acceptability data indicated that sessions 2 and 6 (physical activity and exercise, managing difficult emotions, working with your healthcare provider, and planning for the future) were the most beneficial. Overall participant satisfaction with the CDSMP was high, M=8.88 (SD=1.67) on a scale of 1-10 (10=totally satisfied). Qualitative comments suggest that the participants enjoyed interacting with other patients and learning skills to help manage their illness. Repeated measures ANOVAs were used to examine the QOL and disease self-efficacy data. There was not a significant improvement on PedsQL total scores over time. Patient-reported disease self-efficacy scores showed a positive trend (F(1.572, 9.432) = 3.442, P = .083). Participants reported continuing to use a number of the self-management skills/strategies they learned during the intervention such as better breathing (86.7%), problem solving (73.3%), and action planning (66.7%). Discussion Initial Results from this small pilot suggest that the CDSMP may have some promising benefits as an intervention for adolescents and young adults with SCD given its feasibility, acceptability, and potential impact on disease self-efficacy and utilization of skills learned. In addition to participants being satisfied with the content, structure, and opportunity to interact with other participants, they also reported that they continued to use the self-management skills that they had developed. Disease self-efficacy also trended upwards for participants over the course of the intervention. Although improvements in quality of life were not observed at six-months post-intervention, the small sample size likely had an impact. The next steps will be to examine these outcomes for the duration of the post-intervention period (i.e., nine and twelve-month follow-ups) to determine whether the improvements in disease self-efficacy are maintained and whether we see quality of life improving once analyses are completed with a more complete sample size. Disclosures: No relevant conflicts of interest to declare.
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Fraser, Robert, Dawn Ehde, Dagmar Amtmann, Aimee Verrall, Kurt L. Johnson, Erica Johnson, and George H. Kraft. "Self-Management for People with Multiple Sclerosis." International Journal of MS Care 15, no. 2 (June 1, 2013): 99–106. http://dx.doi.org/10.7224/1537-2073.2012-044.
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People with multiple sclerosis (MS) must manage the day-to-day effects of the disease on their lives. Self-management interventions may be helpful in this challenge. An international, multidisciplinary consensus conference was held on November 15, 2010, by the University of Washington's Rehabilitation Research and Training Center for Multiple Sclerosis (MS RRTC), with funding from the Consortium of Multiple Sclerosis Centers (CMSC) and the National Institute on Disability and Rehabilitation Research (NIDRR), to discuss the concept of self-management for people with MS. The specific goals of the consensus conference were as follows: 1) review the current research on self-management and related issues in chronic disability and specifically in MS; 2) review optimal research methodologies, outcome measurement tools, program planning frameworks, and dissemination strategies for self-management research; and 3) establish recommendations on the next steps necessary to develop, adapt, and test self-management interventions for people with MS. The consensus conference and this document are the initial steps toward achieving the stated goals. Participants in the consensus conference concluded that it is necessary to: 1) define an empirically based conceptual model of self-management for people with MS; 2) establish reliable and valid self-management outcome measures; 3) use best practices to validate models of self-management interventions; and 4) plan dissemination and knowledge translation of interventions once their effectiveness is established.
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Jiang, Yuyu, Fenglan Liu, Jianlan Guo, Pingping Sun, Zhongyi Chen, Jinping Li, Liming Cai, et al. "Evaluating an Intervention Program Using WeChat for Patients With Chronic Obstructive Pulmonary Disease: Randomized Controlled Trial." Journal of Medical Internet Research 22, no. 4 (April 21, 2020): e17089. http://dx.doi.org/10.2196/17089.
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Background The application of telemedicine in home pulmonary rehabilitation interventions for the management of patients with chronic obstructive pulmonary disease (COPD) has achieved promising results. Objective This study aimed to develop a WeChat official account (Pulmonary Internet Explorer Rehabilitation [PeR]) based on social media. It further evaluated the effect of PeR on the quality of life, symptoms, and exercise self-efficacy of patients with COPD. Methods The functional modules of PeR were developed by a multidisciplinary team according to the electronic health–enhanced chronic care model (eCCM) components. A total of 106 patients were randomly selected (53 in the PeR group and 53 in the outpatient face-to-face group [FtF]). Pulmonary rehabilitation intervention was conducted for 3 months, and the outcome was observed for 3 months. The primary outcome was patient quality of life measured with the COPD assessment test (CAT). The secondary outcomes were evaluated using the modified Medical Research Council scale (mMRC), exercise self-regulatory efficacy scale (Ex-SRES), and St George’s Respiratory Questionnaire (SGRQ). Results The intention-to-treat analysis was used in the study. A total of 94 participants completed the 6-month pulmonary rehabilitation program. No statistically significant differences were observed in CAT (F1,3=7.78, P=.001), Ex-SRES (F1,3=21.91, P<.001), and mMRC scores (F1,3=29.64, P<.001) between the two groups with the variation in time tendency. The Ex-SRES score had a significant effect on the CAT score (P=.03). The partial regression coefficient of Ex-SRES to CAT was 0.81, and Exp (B) was 2.24. Conclusions The telemedicine technology was effective using the eCCM combined with a behavioral intervention strategy centering on self-efficacy. Pulmonary rehabilitation at home through PeR and FtF could improve the sense of self-efficacy and quality of life and alleviate symptoms in patients with COPD. Trial Registration Chinese Clinical Trial Registry ChiCTR1900022770; https://tinyurl.com/tmmvpq3
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Sidiq, Rapitos, John Amos, Widdefrita Widdefrita, Novelasari Novelasari, Evi Maria Silaban, Yannurdin Yannurdin, Suhaimi Suhaimi, and Mahaza Mahaza. "The Needs for Information and Education Media in Supporting Self-Management of Patients with Diabetes Mellitus." Media Kesehatan Masyarakat Indonesia 16, no. 2 (June 29, 2020): 247. http://dx.doi.org/10.30597/mkmi.v16i2.9774.
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Diabetes mellitus is a chronic disease that has very high morbidity and mortality rate. This disease cannot be cured but can be controlled with good self-management. This research supports the need for appropriate information and educational media in supporting self-management of patien with diabetes mellitus. This research is qualitative and quantitative. The sample of this study was 105 people with diabetes. Data collection was conducted from July to November 2019 at 7 Puskesmas in Padang City, namely: Nanggalo, Lapai, Alai, Andalas, Ambacang, Kuranji, and Pauh, with interview questions and interviews. Qualitative data processing techniques with coding and data validity by triangulation and analyzed using data reduction, data presentation, and analysis. Quantitative data analysis uses SEM (Structural Equation Model) analysis with the Lisrel 8.7 program. The results showed that the informants were elderly (56-65 years), 60% had good self-management quality, 65% actively participated in chronic disease management programs, 49.5 did not have cellphones. All aspects of self-management, namely blood sugar testing, physical exercise, taking medicine, diet and health education, can be used as educational material. Research information shows the fact most still need information about self-management of diabetics and in the form of conventional media. Informants who use phones that are approved for Android-based self-management applications.
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Bourbeau, Jean, Raquel Farias, Pei Zhi Li, Guylaine Gauthier, Livia Battisti, Valérie Chabot, Marie-France Beauchesne, Denis Villeneuve, Patricia Côté, and Louis-Philippe Boulet. "The Quebec Respiratory Health Education Network: Integrating a model of self-management education in COPD primary care." Chronic Respiratory Disease 15, no. 2 (July 27, 2017): 103–13. http://dx.doi.org/10.1177/1479972317723237.
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The objective of this study is to evaluate whether a chronic obstructive pulmonary disease (COPD) self-management education program with coaching of a case manager improves patient-related outcomes and leads to practice changes in primary care. COPD patients from six family medicine clinics (FMCs) participated in a 1-year educational program offered by trained case managers who focused on treatment adherence, inhaler techniques, smoking cessation, and the use of an action plan for exacerbations. Health-care utilization, health-related quality of life (HRQL), treatment adherence, inhaler technique, and COPD knowledge were assessed at each visit with validated questionnaires. We also evaluated whether the use of spirometry and the assessment of individual patient needs led to a more COPD-targeted treatment by primary care physicians, based on changes in prescriptions for COPD (medication, immunization, and written action plan). Fifty-four patients completed the follow-up visits and were included in the analysis. The number of unscheduled physician visits went from 40 the year before intervention to 17 after 1 year of educational intervention ( p = 0.033). Emergency room visits went from five to two and hospitalizations from two to three (NS). Significant improvements were observed in HRQL ( p = 0.0001), treatment adherence ( p = 0.025), adequate inhaler technique ( p < 0.0001), and COPD knowledge ( p < 0.001). Primary care physicians increased their prescriptions for long-acting bronchodilators with/without inhaled corticosteroid, flu immunizations, and COPD action plans in the event patient had an exacerbation. The COPD self-management educational intervention in FMCs reduced unscheduled visits to the clinic and improved patients’ quality of life, self-management skills, and knowledge. The program had a positive impact on COPD-related practices by primary care physicians in the FMCs.
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Rose, Louise, Laura Istanboulian, Lise Carriere, Anna Thomas, Han-Byul Lee, Shaghayegh Rezaie, Roshan Shafai, and Ian Fraser. "Program of Integrated Care for Patients with Chronic Obstructive Pulmonary Disease and Multiple Comorbidities (PIC COPD+): a randomised controlled trial." European Respiratory Journal 51, no. 1 (January 2018): 1701567. http://dx.doi.org/10.1183/13993003.01567-2017.
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We sought to evaluate the effectiveness of a multi-component, case manager-led exacerbation prevention/management model for reducing emergency department visits. Secondary outcomes included hospitalisation, mortality, health-related quality of life, chronic obstructive pulmonary disease (COPD) severity, COPD self-efficacy, anxiety and depression.Two-centre randomised controlled trial recruiting patients with ≥2 prognostically important COPD-associated comorbidities. We compared our multi-component intervention including individualised care/action plans and telephone consults (12-weekly then 9-monthly) with usual care (both groups). We used zero-inflated Poisson models to examine emergency department visits and hospitalisation; Cox proportional hazard model for mortality.We randomised 470 participants (236 intervention, 234 control). There were no differences in number of emergency department visits or hospital admissions between groups. We detected difference in emergency department visit risk, for those that visited the emergency department, favouring the intervention (RR 0.74, 95% CI 0.63–0.86). Similarly, risk of hospital admission was lower in the intervention group for those requiring hospital admission (RR 0.69, 95% CI 0.54–0.88). Fewer intervention patients died (21 versus 36) (HR 0.56, 95% CI 0.32–0.95). No differences were detected in other secondary outcomes.Our multi-component, case manager-led exacerbation prevention/management model resulted in no difference in emergency department visits, hospital admissions and other secondary outcomes. Estimated risk of death (intervention) was nearly half that of the control.
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Marshall, Lia W., Carmen A. Carrillo, Carmen E. Reyes, Carol Lee Thorpe, Laura Trejo, and Catherine Sarkisian. "Evaluation of Recruitment of Older Adults of Color into a Community-Based Chronic Disease Self-Management Wellness Pathway Program in Los Angeles County." Ethnicity & Disease 30, Suppl (November 19, 2020): 735–44. http://dx.doi.org/10.18865/ed.30.s2.735.
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Background: Established relationships between researchers, stakeholders and potential participants are integral for recruitment of potential older adult participants and Evidence-Based Programs (EBPs) for chronic disease management have empirically been shown to help improve health and maintain healthy and active lives. To accelerate recruitment in EBPs and potential future research, we propose a Wellness Pathway allowing for delivery within multipurpose senior centers (MPCs) linked with medical facilities among lower-income urban older adults. The study aims were to: 1) assess the effectiveness of three MPC-delivered EBPs on disease management skills, health outcomes, and self-efficacy; and 2) assess the feasibility of the proposed Wellness Pathway for lower-income urban-dwelling older adults of color.Methods: We administered surveys and conducted a pre-post analysis among participants enrolled in any 1 of 3 MPC-based EBPs (n=53). To assess feasibility of the pathway, we analyzed survey data and interviews (EBP participants, MPC staff, physicians, n=10).Results: EBP participation was associated with greater disease management skills (increased time spent stretching and aerobic activity) but not improvements in self-efficacy or other health outcomes. Interviews revealed: 1) older adults valued EBPs and felt the Wellness Pathway feasible; 2) staff felt it feasible given adequate growth management; 3) physicians felt it feasible provided adequate medical facility integration.Conclusion: MPC-based EBPs were associated with improvements in disease management skills among older adults; a proposed Wellness Pathway shows early evidence of feasibility and warrants further investigation. Future efforts to implement this model of recruiting older adults of color into EBPs should address barriers for implementation and sustainability. Ethn Dis. 2020;30(Suppl 2):735-744; doi:10.18865/ed.30.S2.735
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Bird, Stephen, Michelle Noronha, and Helen Sinnott. "An integrated care facilitation model improves quality of life and reduces use of hospital resources by patients with chronic obstructive pulmonary disease and chronic heart failure." Australian Journal of Primary Health 16, no. 4 (2010): 326. http://dx.doi.org/10.1071/py10007.
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As part of the Department of Human Services Hospital Admissions Risk Program (HARP), a group of acute and community based health care providers located in the western suburbs of Melbourne formed a consortium to reduce the demand on hospital emergency services and improve health outcomes for patients with chronic obstructive pulmonary disease (COPD) and chronic heart failure (CHF). The model of care was designed by a team of multidisciplinary specialists and medical consultants. In addition to receiving normal care, patients recruited to the project were assessed by ‘Care Facilitators’, who identified unmet health care needs and provided information, advice and education for the patient concerning their condition and self-management. Patients declining recruitment received all normal care services. The patients’ rates of emergency department (ED) presentations, inpatient admissions and hospital inpatient bed-days before and after their recruitment were calculated from the Western Health patient activity records, and pre- versus post-recruitment rates were compared using ANOVA. Changes relative to the ongoing use by those who declined recruitment were compared using the group-by-time interaction. Patient health outcomes were assessed using established disease-specific tools, and pre- versus post-recruitment values were compared using paired t-tests. Patients recruited to the COPD project reduced (P < 0.05) their emergency presentations, admissions and hospital inpatient bed-days by 10, 25 and 18%, respectively, whereas those declining recruitment increased their usage by 45, 41 and 51% respectively. Recruited CHF patients also displayed reductions in emergency presentations (39%), admissions (36%) and hospital inpatient bed-days (33%), whereas those who declined recruitment displayed lesser reductions for ED presentations (26%) and admissions (20%), and increased their use of hospital inpatient bed-days (15%). The recruited COPD patients reported a significant reduction in their symptoms (P < 0.005) and the CHF patients reported an improvement in their overall health and quality of life scores (P < 0.001). The outcome measures used in this evaluation suggest that an integrated care facilitation model that is patient focussed, provides an education component to promote greater self-management compliance and delivers a continuum of care through the acute and community health sectors, may reduce the utilisation of acute health care facilities and benefit the patient.
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Hart, Dennis L., Ruth I. Memoli, Brian Mason, and Mark W. Werneke. "Developing a Wellness Program for People with Multiple Sclerosis." International Journal of MS Care 13, no. 4 (December 1, 2011): 154–62. http://dx.doi.org/10.7224/1537-2073-13.4.154.
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Because multiple sclerosis (MS) is a multidimensional chronic disease, effective management of the illness requires a multidimensional approach. We describe a wellness program that was designed to facilitate positive health choices throughout the course of MS and present initial data analyses. We hypothesized that over the course of the program, participants would demonstrate improvement in the domains assessed. The wellness program included educational sessions in physical, mental, social, intellectual, and spiritual domains specifically targeting improved self-efficacy, physical functioning, coping skills, symptom management, and nutrition. An outcomes data collection software program was adapted to facilitate real-time patient self-report and clinician entry data collection for many domains throughout the wellness program. Initial assessment of serial measures (intake to discharge) from 65 people with MS showed improvement in several domains, including functional status (P < .05), fatigue (P < .05), fear-avoidance beliefs regarding physical activities (P < .05), depression (P < .05), somatization (P < .05), and pain (P < .05). In addition, using a model of risk for interpersonal distress, patients whose risk of elevated depression and anxiety decreased over the course of the program reported greater gains in functional status (P < .05). The results suggest possible future treatment strategies and indicate strengths and weaknesses of the wellness program, which are being used to improve the program.
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Joe, Jennie. "Promoting Cultural Capital in a Medical Camp for American Indian Youth with Diabetes." American Indian Culture and Research Journal 38, no. 1 (January 1, 2014): 123–44. http://dx.doi.org/10.17953/aicr.38.1.qj47130n435njl34.
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Type 2 diabetes mellitus, a disease that previously was characterized with an onset in the fourth decade of life or later, is now being diagnosed in children, particularly children from minority groups, including American Indians. Because children with the disease are frequently asymptomatic, they tend to ignore recommendations from their health care providers about appropriate self-management behaviors, thus increasing their risk for early onset of secondary complications, including retinopathy and end-stage renal disease. This problem with self-management can in part be attributed to a lack of knowledge as well as to denial about their disease. This article describes an intervention that encourages and motivates American Indian youth with type 2 diabetes to improve their diabetes self-management. The Medical Wellness Camp is a partnership program hosted by several Arizona tribes and the University of Arizona. The camp provided these youth with the education and the skills needed to prevent or delay diabetes-related complications that will negatively impact their quality of life. This camp is unique because it builds on and integrates an intertribal "cultural capital" model to help them learn how to adopt the lifestyle changes necessary to live with this chronic disease. The program emphasis is on education, not research. This position honors the wishes of tribal partners whose communities have been reluctant to involve their children in research, a reluctance fueled by reports about unethical research practices that have harmed other tribal communities.
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Iles, Richard A., Diann S. Eley, Desley G. Hegney, Elizabeth Patterson, Jacqui Young, Christopher Del Mar, Robyn Synnott, and Paul A. Scuffham. "Revenue effects of practice nurse-led care for chronic diseases." Australian Health Review 38, no. 4 (2014): 363. http://dx.doi.org/10.1071/ah13171.
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Objective To determine the economic feasibility in Australian general practices of using a practice nurse (PN)-led care model of chronic disease management. Methods A cost-analysis of item numbers from the Medicare Benefit Schedule (MBS) was performed in three Australian general practices, one urban, one regional and one rural. Patients (n =254; >18 years of age) with chronic conditions (type 2 diabetes, hypertension, ischaemic heart disease) but without unstable or major health problems were randomised into usual general practitioner (GP) or PN-led care for management of their condition over a period of 12 months. After the 12-month intervention, total MBS item charges were evaluated for patients managed for their stable chronic condition by usual GP or PN-led care. Zero-skewness log transformation was applied to cost data and log-linear regression analysis was undertaken. Results There was an estimated A$129 mean increase in total MBS item charges over a 1-year period (controlled for age, self-reported quality of life and geographic location of practice) associated with PN-led care. The frequency of GP and PN visits varied markedly according to the chronic disease. Conclusions Medicare reimbursements provided sufficient funding for general practices to employ PNs within limits of workloads before the new Practice Nurse Incentive Program was introduced in July 2012. What is known about the topic? The integration of practice nurses (PN) into the Australian health system is limited compared with the UK and other parts of Europe. There are known patient benefits of PNs collaborating with general practitioners, especially in chronic disease management, but the benefits from a financial perspective are less clear. What does this paper add? The cost-analysis of a PN-led model of chronic disease management in Australian general practice is reported, providing an indication of the financial impact of using PNs in primary healthcare. What are the implications for practitioners? Taking into account general practice and individual PN workloads, sufficient funding for employment of PNs is provided by Medicare reimbursements.
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Patel, Anish, and Laurie Keefer. "P027 TRANSITION OF CARE OF ACTIVE DUTY PATIENTS WITH IBD TO THE VETERANS ADMINISTRATION HEALTHCARE SYSTEM: TOOLKIT FOR SUCCESS." Inflammatory Bowel Diseases 26, Supplement_1 (January 2020): S57. http://dx.doi.org/10.1093/ibd/zaa010.146.
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Abstract The shift from being an active duty military patient with inflammatory bowel disease (IBD) seen in a military treatment facility (MTF) to being a veteran receiving chronic illness care within the Veterans Administration (VA) is a time of increased vulnerability and risk for loss of continuity of care, and poor disease outcomes. A transitional care program must prioritize the psychosocial growth, self-efficacy and disease-specific knowledge of active military patients who are transitioning to VA care as well as enhance collaborative management between military and VA providers. The Department of Defense (DoD) has established the Transition Assistance Program (TAP) to assist military members to civilian life, but limit preparedness in skills to navigate/understand medical care. There is currently no available data on transition readiness from active duty military medical care to VA medical care and our objective is to determine the feasibility and acceptability of a self-management intervention. Methods: We prospectively measured readiness with the use of the IBD Self-Efficacy Scale (IBD-SES) and Transition Readiness Assessment Questionnaire (TRAQ). All enrolled patients (50 active duty servicemembers) were in disease remission and underwent TAP and 50% were further randomized to undergo TRAQ-based educational and behavioral interventions via mobile applications and clinical consults. Results: Servicemembers who underwent further TRAQ-based interventions compared to those only undergoing TAP demonstrated significant improvement in medication/appointment management, tracking/managing health issues, and talking with providers (p<0.001). Furthermore, these servicemembers also demonstrated significant improvement in self-efficacy and self-management which was maintained up to 3 months post military discharge (p<0.001). Servicemembers had an average VA primary care wait time of 3.5 months and for Gastroenterology specialist of 5.4 months, resulting in >60% of servicemembers having to discontinue therapy due to lapse in care (50% rate of flares) and unnecessary therapy switch. Conclusion: This is the first and only study to assess transitioning from active duty service to VA medical care for a chronic illness. We demonstrated improved and sustained self-efficacy outcomes with a transition program for IBD along with potential limitations in the VA transition. We have an opportunity to influence the conversation of appropriate DoD transition of medical care and to develop a model of care with wider applicability.
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Kooij, Laura, Petra J. E. Vos, Antoon Dijkstra, and Wim H. van Harten. "Effectiveness of a Mobile Health and Self-Management App for High-Risk Patients With Chronic Obstructive Pulmonary Disease in Daily Clinical Practice: Mixed Methods Evaluation Study." JMIR mHealth and uHealth 9, no. 2 (February 4, 2021): e21977. http://dx.doi.org/10.2196/21977.
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Background Mobile health and self-management interventions may positively affect behavioral change and reduce hospital admissions for patients with chronic obstructive pulmonary disease (COPD). However, not all patients qualify for these interventions, and systematic, comprehensive information on implementation- and compliance-related aspects of mobile self-management apps is lacking. Due to the tendency to target digital services to patients in stable phases of disease, it is especially relevant to focus on the use of these services in broad clinical practice for patients recently discharged from hospital. Objective This study aims to evaluate the effects of a mobile health and self-management app in clinical practice for recently discharged patients with COPD on use of the app, self-management, expectations, and experiences (technology acceptance); patients’ and nurses’ satisfaction; and hospital readmissions. Methods A prototype of the app was pilot tested with 6 patients with COPD. The COPD app consisted of an 8-week program including the Lung Attack Action Plan, education, medication overview, video consultation, and questionnaires (monitored by nurses). In the feasibility study, adult patients with physician-diagnosed COPD, access to a mobile device, and proficiency of the Dutch language were included from a large teaching hospital during hospital admission. Self-management (Partners in Health Scale), technology acceptance (Unified Theory Acceptance and Use of Technology model), and satisfaction were assessed using questionnaires at baseline, after 8 weeks, and 20 weeks. Use was assessed with log data, and readmission rates were extracted from the electronic medical record. Results A total of 39 patients were included; 76.4% (133/174) of patients had to be excluded from participation, and 48.9% of those patients (65/133) were excluded because of lack of digital skills, access to a mobile device, or access to the internet. The COPD app was opened most often in the first week (median 6.0; IQR 3.5-10.0), but its use decreased over time. The self-management element knowledge and coping increased significantly over time (P=.04). The COPD app was rated on a scale of 1-10, with an average score by patients of 7.7 (SD 1.7) and by nurses of 6.3 (SD 1.2). Preliminary evidence about the readmission rate showed that 13% (5/39) of patients were readmitted within 30 days; 31% (12/39) of patients were readmitted within 20 weeks, compared with 14.1% (48/340) and 21.8% (74/340) in a preresearch cohort, respectively. Conclusions The use of a mobile self-management app after hospital discharge seems to be feasible only for a small number of patients with COPD. Patients were satisfied with the service; however, use decreased over time, and only knowledge and coping changed significantly over time. Therefore, future research on digital self-management interventions in clinical practice should focus on including more difficult subgroups of target populations, a multidisciplinary approach, technology-related aspects (such as acceptability), and fine-tuning its adoption in clinical pathways. Trial Registration Clinicaltrials.gov NCT04540562; https://clinicaltrials.gov/ct2/show/NCT04540562.
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Schneider, Ellen C., Lesley Steinman, and Casey Dicocco. "IS YOUR COMMUNITY-BASED HEALTH PROMOTION PROGRAM EVIDENCE BASED AND READY FOR DISSEMINATION? HERE’S HOW TO FIND OUT." Innovation in Aging 3, Supplement_1 (November 2019): S79. http://dx.doi.org/10.1093/geroni/igz038.306.
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Abstract Evidence-based programs (EBPs) offer proven ways to promote health and prevent disease among older adults in their communities. EBPs are based on rigorous study of the effects of specific interventions or model programs, demonstrate consistently positive changes in important health-related and functional measures, and have tools in place to maintain program access, quality, and efficiency across diverse settings. The University of North Carolina at Chapel Hill’s Center for Health Promotion and Disease Prevention (UNC HPDP), in partnership with the Evidence-Based Leadership Collaborative (EBLC), has established a review process and Review Council to identify new community programs that meet the evidence-based program criteria established by the Administration for Community Living (ACL), one of the chief U.S. federal agencies responsible for aging programs. Approved programs are then eligible for Older Americans Act Title III-D and other discretionary funding to support organizations that deliver EBPs to improve older adult health. The review process assesses the effectiveness, outcomes, and evaluation of the program, information about program implementation, training, and other key elements for successful program dissemination. The Review Council consists of national leaders with expertise in program research, evaluation, and implementation. The review process is supported by the ACL-funded National Chronic Disease Self-Management Education and Falls Prevention Resource Centers. This session will describe the ACL evidence-based health promotion program criteria that must be met for approval; an overview of the review process; and how researchers can submit their programs for review. Time will be allowed for questions, discussion, and research to practice implications.
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Pramita, Rianti, Siti Saidah Nasution, and Jenny Marlindawani. "Effect of Family Empowerment on Self Care of Patients with Type-2 Diabetes Mellitus: A Systematic Review." Open Access Macedonian Journal of Medical Sciences 9, F (June 23, 2021): 224–33. http://dx.doi.org/10.3889/oamjms.2021.6155.
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Introduction: Diabetes Mellitus Type 2 (T2DM) is a chronic disease that will be suffered for life, so it is necessary to provide education to patients and families so that it is easy to understand the course of the disease, prevention and obstacles in the management of T2DM. Family empowerment can be started by optimizing family functions to help patients with T2DM to adapt and comply with self-care actions through four dimensions, empathic (emotional), encouragement (reward), facilitative (instrumental), and participatory (participation). This systematic review aims to identify and evaluate the effect of family empowerment interventions on self-care for T2DM patients.
Methods: The database used for article searches consisted of EBSCO, PubMed and ProQuest using relevant keywords based on the topic and title of the study. The selection of articles used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) diagram method, the overall results were 2,635 articles and 8 articles that fit the inclusion criteria and were analyzed descriptively narrative and had met the methodological quality study according to JBI guidelines (Joanna Briggs Critical Appraising Methodology).
Results: 8 articles with the Family Empowerment Process Model intervention program and the Diabetes Mellitus Education Program which is a family-oriented program that includes education classes, group discussions, home visits, and telephone follow-up. Education is provided to families through direct discussion and through telephone calls with a duration of each call of approximately 15 to 20 minutes scheduled for 9 am to 12 noon. Follow-up was done by telephone in the intervention group for approximately 3 months to 12 months.
Conclusion: The findings of this systematic review indicate that family empowerment interventions based on health education can have a good effect on improving self-care for patients with type 2 diabetes mellitus
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Conte, Kathleen P., Fabian Held, Olivia Pipitone, and Sally Bowman. "The Feasibility of Recruiting and Training Lay Leaders During Real-World Program Delivery and Scale-up: The Case of Walk With Ease." Health Promotion Practice 22, no. 1 (April 11, 2019): 91–101. http://dx.doi.org/10.1177/1524839919840004.
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Introduction. To maximize limited resources, many health promotion programs are designed to be delivered by volunteer lay leaders. But this model poses challenges to implementation in real-world settings and barriers to successfully scaling-up programs. This study examines the current lay leader training model for Walk With Ease, a Centers for Disease Control and Prevention–funded evidence-based arthritis program delivered at-scale. Method. Recruited volunteers ( n = 106) opted into free online or in-person training and agreed to deliver one Walk With Ease program within the following year—only 49%, however, did. Using logistic regression models and qualitative interviews, we explored predictors of volunteer delivery. Results. Volunteers had higher odds of delivering programs if they trained online (odds ratio [OR] = 9.04, 95% confidence interval [CI: 2.30, 48.36]), previously taught health programs (OR = 15.52, 95% CI [3.51, 103.55]) or trained in the second year of implementation (OR = 27.08, 95% CI [2.63, 415.78]). Qualitative findings underscored that successful volunteers were readied by their previous health education experience. Conclusions. While online training modes appear effective to prepare experienced volunteers, lay leaders required additional support. This calls into question whether lay-led delivery models are suitable for scaling-up programs with limited resources. Given the many lay-led health interventions for chronic disease self-management, investing in common training and infrastructures for lay leader development could advance the quality and sustainability of real-world program delivery.
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Rule, John, Roger Dunston, and Nicky Solomon. "Remaking Practices in the Redesign of a Primary Healthcare Program." Asia Pacific Journal of Health Management 12, no. 1 (April 26, 2017): 36–41. http://dx.doi.org/10.24083/apjhm.v12i1.95.
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Objective: To develop a detailed account of changed practices in everyday work in the redesign of a primary healthcare program.
Design: The research aimed to produce layered and rich descriptions of the complex and multidimensional remaking of health practices. Empirical data was gathered through ethnographic methods including; interviewing, self-reporting, observation and shadowing. The subjects of the research were involved as active participants in the research design, data gathering and analysis.
Setting: HealthOne was a New South Wales government attempt to provide a local and responsive model to improve chronic disease management in primary and community healthcare settings. We report specifically on the HealthOne program implemented in a suburb of Western Sydney.
Main outcome measures: The research did not aim to evaluate the program but to uncover instances of professional learning though identifying changes in professional practice. These were noted and observed by the researchers and research participants or through reflexive conversations with the program planners, healthcare workers and the research team.
Results: Drawing on the work of a number of learning and practice-based theory writers, particularly those using a socio-material approach, we describe how practice change has occurred and how work practiceshave been remade at this site - especially in the role of the General Practice Liaison Nurse (GPLN).
Conclusions: The research demonstrated the potential for new categories and practices of health work to emerge; this was especially seen in the work of the GPLN but also extended to new ways of working through General Practitioners and community health networks.
Abbreviations: GP – General Practitioner; GPLN – General Practice Liaison Nurse.
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de Batlle, Jordi, Mireia Massip, Eloisa Vargiu, Nuria Nadal, Araceli Fuentes, Marta Ortega Bravo, Felip Miralles, Ferran Barbé, and Gerard Torres. "Implementing Mobile Health–Enabled Integrated Care for Complex Chronic Patients: Intervention Effectiveness and Cost-Effectiveness Study." JMIR mHealth and uHealth 9, no. 1 (January 14, 2021): e22135. http://dx.doi.org/10.2196/22135.
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Background Integrated care can generate health and social care efficiencies through the defragmentation of care and adoption of patient-centered preventive models. eHealth can be a key enabling technology for integrated care. Objective The aim of this study was to assess the effectiveness and cost-effectiveness of the implementation of a mobile health (mHealth)-enabled integrated care model for complex chronic patients. Methods As part of the CONNECARE Horizon 2020 project, a prospective, pragmatic, two-arm, parallel implementation trial was held in a rural region of Catalonia, Spain. During 3 months, elderly patients with chronic obstructive pulmonary disease or heart failure and their carers experienced the combined benefits of the CONNECARE organizational integrated care model and the eHealth platform supporting it, consisting of a patient self-management app, a set of integrated sensors, and a web-based platform connecting professionals from different settings, or usual care. We assessed changes in health status with the 12-Item Short-Form Survey (SF-12), unplanned visits and admissions during a 6-month follow up, and the incremental cost-effectiveness ratio (ICER). Results A total of 48 patients were included in the integrated care arm and 28 patients receiving usual care were included in the control arm (mean age 82 years, SD 7 years; mean Charlson index 7, SD 2). Integrated care patients showed a significant increase in the SF-12 physical domain with a mean change of +3.7 (SD 8.4) (P=.004) and total SF-12 score with a mean change of +5.8 (SD 12.8) (P=.003); however, the differences in differences between groups were not statistically significant. Integrated care patients had 57% less unplanned visits (P=.004) and 50% less hospital admissions related to their main chronic diseases (P=.32). The integrated care program generated savings in different cost scenarios and the ICER demonstrated the cost-effectiveness of the program. Conclusions The implementation of a patient-centered mHealth-enabled integrated care model empowering the patient, and connecting primary, hospital, and social care professionals reduced unplanned contacts with the health system and health costs, and was cost-effective. These findings support the notion of system-wide cross-organizational care pathways supported by mHealth as a successful way to implement integrated care.
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Pandya, D. B. "AB0973 THE IMPACT OF YOGA, ANTI-INFLAMMATORY DIET & SELF MONITORING IN CHILDREN WITH RHEUMATIC DISEASES." Annals of the Rheumatic Diseases 79, Suppl 1 (June 2020): 1781.1–1782. http://dx.doi.org/10.1136/annrheumdis-2020-eular.2650.
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Background:There is growing evidence of positive effects of yoga, special diet and an internet-based model of self-monitoring in adults with rheumatic diseases in various small scale independent studies. These studies have shown improvement in disease activity, symptom relief, quality of life, mental health issues and social life and thereby optimizing the disease management in a holistic way.Objectives:The present study was designed to investigate the combined effects of yoga, anti-inflammatory diet and self monitoring in children with chronic rheumatic diseases.Methods:In the clinical study, a total of 22 children aged more than 8 years with newly diagnosed rheumatic disease were enrolled. Depending on their consent, they were divided into two groups; 1) experimental group and 2) control group.Experimental and Control Group (n=22)All 22 participants were advised every month follow up for the next 4 months. Baseline disease activity and damage scores were calculated for all.Experimental Group (n=14)Three different printed materials were given.1. Pictures of “Yoga Ashnas” with explanation in their understandable language2. Pictures of foods under two headings: 1) beneficial and 2)harmful3. Self monitoring kit: Disease and medicines information leaflets and simplified pictorialversion of disease specific monitoring and damage scores✓All 14 participants were enrolled to a single time yoga training session under a guidance of an experienced yoga teacher.✓All are advised 45 minutes yoga every day at home.✓All are put on strict diet chart.✓All should read the material and calculate their disease score/s every time before their next visit.Table:Table A: CharacteristicsExperimental group(n=14)Control group(n=8)Median age12.8 years11.2 yearsMales5 (35.71%)3 (37.5%)Females9 (64.28%)5 (62.5)Juvenile Systemic Lupus Erythematosus (JSLE)2 (14.28%)2 (25%)Juvenile Dermatomyositis (JDM)2 (14.28%)1 (12.5%)Juvenile systemic sclerosis (JSSc)1 (7.14%)2 (25%)Mixed connective tissue disease (MCTD)2 (14.28%)0Enthesitis related arthritis (ERA)3 (21.42%)1 (12.5%)Polyarticular Juvenile Idiopathic Arthritis (PJIA)4 (28.57%)2 (25%)Conclusion:Yoga, anti-inflammatory diet and self-monitoring have shown extremely beneficial effects in children with rheumatic diseases in multiple ways.Table B: Monitoring ParameterExperimental group(n=14)Control Group(n=8)Improvement in disease activity13 (92.8%)6 (75%)Relief in pain and fatigue12 (85.71%)3 (37.5%)Optimum weight maintenance10 (71.42%)1 (12.5%)Improvement in routine activity and school performance12 (85.71%)4 (50%)Improvement in mood and behavioural problems12 (85.71%)2 (25%)Knowledge, awareness and involvement of patient and family members in disease management12 (85.71%)2 (25%)Adherence to management14 (100%)6 (75%)Use of alternative medicines1 (7.14%)3 (37.5)Early identification of risk factor/s5 (35.71%)0 (0 %)References:[1]Impact of yoga based mind-body intervention on systemic inflammatory markers and co-morbid depression in active Rheumatoid arthritis patients: A randomized controlled trial. Gautam S, et al. Restor Neurol Neurosci 2019 - Clinical Trial. PMID 30714983[2]Effects of Mediterranean diet on the treatment of rheumatoid arthritis. Porras M, et al. Medwave 2019. PMID 31226103 Spanish, English.[3]Effectiveness of an online self-management tool, OPERAS (an On-demand Program to EmpoweR Active Self-management), for people with rheumatoid arthritis: a research protocol. Tam J, et al. Trials 2019. PMID 31829286 Free PMC article.Disclosure of Interests:None declared
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Munawar, Maha, Richard Ward, Kate Uchendu, Rouhi Fazelzad, Janet Papadakos, and Kevin H. M. Kuo. "Patient Education Interventions for Improving Self-Management in Adults with Hemoglobinopathies: A Systematic Review and Meta-Analysis." Blood 134, Supplement_1 (November 13, 2019): 5783. http://dx.doi.org/10.1182/blood-2019-131718.
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INTRODUCTION Hemoglobinopathies, such as sickle cell disease (SCD) and thalassemia, are chronic blood disorders with a profound impact on a patient's life expectancy and quality. Patients often come from marginalized populations with variable health literacy. Prior studies have demonstrated improved outcomes in chronic illness as a result of empowering patients through various education strategies. This systematic review investigates the current state of patient education for SCD and thalassemia with the goal of elucidating which strategies have been effective in improving patient knowledge and/or ability to cope with illness. METHODS Literature was searched up to August 2018 in Medline, PsycINFO, Scopus, CINAHL, Cochrane Central, Cochrane Database of Systematic Reviews, EMBASE, Emcare, and the International Clinical Trials Registry Platform (ICTRP). Randomized controlled trials (RCTs) examining the effects of patient education on patients aged 18 years and older or transitioning into adulthood were included. Psychological interventions were excluded. Preliminary analysis focused on three outcomes: disease knowledge, self-efficacy, and coping ability. Meta-analysis was performed using RevMan 5.3. A random effects model with the inverse variance method was chosen. Standardized mean difference (SMD) was calculated for continuous outcomes due to the different scales used by each study. Changes from baseline with missing standard deviations were imputed from known standard deviations from other studies (Higgins 2011). Heterogeneity was evaluated using the I2 statistic. Domain-based approach was used to assess risk of bias (Higgins 2011). RESULTS The search yielded 12173 citations, 3575 were duplicates. Two reviewers screened the title and abstracts for full text retrieval. Of the 28 full-text citations reviewed, 8 met the inclusion criteria, representing 6 unique RCTs. Of the 6 RCTs, 2 were at high risk of attrition bias. The other domains generally exhibited an unclear risk of bias. Improvement in patient knowledge was a measured outcome in 3 RCTs totalling 351 participants with SCD, mostly of African-American descent. Standard deviations (SD) were lacking in the baseline and 6 month knowledge questionnaire results from Krishnamurti 2018. Attempts to impute the SDs were unsuccessful. Meta-analysis was conducted in the remaining 2 RCTs (n=274). Statistically significant SMD of 0.39 (95% CI 0.05 to 0.72, p=0.02, Figure 1A) in favour of the intervention group with low heterogeneity (I2=24%). These interventions were delivered as either a web-based multimedia education program or in a classroom setting. An increase in self-efficacy was reported in 2 RCTs (n=67) with a statistically significant SMD of 0.72 (95% CI 0.22 to 1.22, p=0.005, Figure 1B) in favour of patient education with no observed statistical heterogeneity (I2=0). Coping ability was reported in 2 RCTs (n=107) but one study was excluded from analysis due to lack of sufficient randomization data. For the remaining study (n=40), the SMD at 0.16 was not statistically significant (95% CI -0.46 to 0.78, p=0.60, Figure 1C). CONCLUSIONS This review summarizes the current state of patient education for adult hemoglobinopathy patients in which some efforts have been made for SCD but no comparable interventions exist for thalassemia. Interventions demonstrated a significant effect on improvement in knowledge and self-efficacy. However, this effect is of uncertain clinical significance due to lack of reporting on clinically relevant illness and healthcare utilization-related outcomes. Only one RCT adequately reported on improvement in coping ability with no statistical significance. Given these results, there is currently insufficient evidence to determine what intervention strategies might benefit adult patients with hemoglobinopathies. This review is limited by the paucity of high-quality RCTs addressing the impact of patient education on self-management. Notably, a considerable volume of studies that employ a non-RCT design were identified and also warrant appropriate analysis. Rigorously designed trials are needed to draw clinically-relevant conclusions regarding type and effectiveness of patient education for adult hemoglobinopathy patients. REFERENCE: Higgins JPT, Green S (eds.). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011. Disclosures Kuo: Agios: Consultancy; Alexion: Consultancy, Honoraria; Apellis: Consultancy; Bioverativ: Other: Data Safety Monitoring Board; Bluebird Bio: Consultancy; Celgene: Consultancy; Novartis: Consultancy, Honoraria; Pfizer: Consultancy.
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Brown, Lauren, and Amy Sobota. "Measuring Transition Readiness of Young Adults with Sickle Cell Disease Using the Transition Readiness Assessment Questionnaire." Blood 128, no. 22 (December 2, 2016): 3534. http://dx.doi.org/10.1182/blood.v128.22.3534.3534.
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Abstract Background The transition from pediatric to adult care can be a difficult time for young adults with sickle cell disease (SCD) who experience increased rates of acute care utilization and worse health outcomes. An important aspect of transition preparation includes an assessment of transition readiness. Data show that adolescents with SCD have suboptimal transition readiness, however most studies use disease specific measures which do not allow for comparisons between patient populations. The Transition Readiness Assessment Questionnaire (TRAQ) is a validated tool for youth with a variety of medical diagnoses. We have been collecting TRAQ data on our patients for the past 6 months as part of an ongoing quality improvement initiative. The purpose of this study is to analyze transition readiness scores among patients with SCD in our program, and to compare their scores with other populations of youth with special health care needs. Methods We administered the TRAQ to patients with SCD ages 13 to 22 seen in general pediatric hematology clinic or our specialized transition clinic from December 2015 to June 2016. The TRAQ contains 20 questions which measure transition readiness in five domains: managing medication, appointment keeping, tracking health issues, talking with providers, and managing daily activities. Each question is answered on a 5-point scale based on the transtheoretical model from 1 = "No, I do not know how to do this" to 5 = " Yes, I always do this when I need to". Mean TRAQ scores were analyzed by age and compared to reported TRAQ scores among other diagnostic groups in the literature. Results Fifty patients completed the TRAQ during the study period. One patient was ineligible due to cognitive delay. This represents 58% of eligible patients in our practice. Respondents were 50% female with a mean age of 17 years 9 months. The majority (70%) have HbSS. The mean overall TRAQ score was 3.5 (SD 0.72) with the highest scores in the domains of communication with providers and managing daily activities. As has previously been reported mean TRAQ scores were higher among young adults compared with older and younger adolescents. (Table 1) Our patients reported high readiness in certain aspects of medication management, with 69% of respondents stating that they always take medications correctly. However, respondents were less likely to favorably report filling needed prescriptions or reordering medications when they run out (only 22% and 27% of respondents respectively reported always completing these tasks). Questions related to insurance coverage had low scores overall; 65% of patients responded that they do not know how to apply for insurance if they lose their coverage, and 47% do not know what their insurance covers. Compared to reported TRAQ scores among patients with chronic health conditions other than SCD, our patients had lower scores in the domains of managing medications (3.63 vs 3.93), appointment keeping (2.98 vs 3.41) and tracking health issues (3.03 vs 3.33) Conclusions: By using a non-disease specific transition readiness tool we were able to analyze transition readiness in our clinic population of adolescents and young adults with SCD and compare our findings with the literature on youth with special health care needs. While it is encouraging that TRAQ scores were higher among older patients, mean scores still show room for improvement even among 18-22 year olds. Lower scores in medication management and appointment keeping in our population are particularly concerning as these aspects of chronic disease self-management are key to a successful transition to adult care. Additional work is needed to determine how transition readiness changes with time, and how we can help improve self-management and self-advocacy skills among our patients with SCD. Disclosures No relevant conflicts of interest to declare.
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Butler, Sonia, Dean Sculley, Derek Santos Santos, Antoni Fellas, Xavier Gironès, Davinder Singh-Grewal, and Andrea Coda. "Usability of eHealth and Mobile Health Interventions by Young People Living With Juvenile Idiopathic Arthritis: Systematic Review." JMIR Pediatrics and Parenting 3, no. 2 (December 1, 2020): e15833. http://dx.doi.org/10.2196/15833.
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Background Considering the changing landscape of internet use and rising ownership of digital technology by young people, new methods could be considered to improve the current model of juvenile idiopathic arthritis (JIA) management. Objective This systematic review aims to evaluate the usability of eHealth and mobile health (mHealth) interventions currently available for young people living with JIA. Methods The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to oversee this review. We systematically searched 15 databases for 252 potential studies; 2 authors independently screened all quantitative studies reporting the use of eHealth and mHealth interventions for young people (aged 1-18 years) diagnosed with JIA. Studies were excluded if they did not report outcome measures or were reviews, commentaries, or qualitative studies. Study methodological quality was scored using the Down and Black (modified) checklist. A narrative descriptive methodology was used to quantify the data because of heterogeneity across the studies. Results A total of 11 studies were included in this review, reporting 7 eHealth and mHealth interventions for young people (aged 4-18 years) living with JIA, targeting health issues such as pain, health-related quality of life, physical activity, and chronic disease self-management. The usability of the interventions was facilitated through training and ongoing support. The engagement was promoted by a combination of persuasive influences, and barriers preventing adherence were removed through personal reminders and flexible program schedules to cater to JIA and non-JIA illnesses or other commonly seen activities in childhood. The feedback obtained was that most young people and their parents liked the interventions. Conclusions The results of this review need to be considered cautiously because of the lack of rigorous testing and heterogeneity, which limits the detailed descriptions of data synthesis. Further research is needed to consider gender differences, associated costs, and the effectiveness of the interventions on health outcomes to better support young people living with JIA.
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Bootsri, Siripun, Kasam Nakornkate, and Suchitra Sukonthasab. "A Contribution of PAR for the Prevention and Control of Hypertension and Diabetes among the Elderly in Thailand." Global Journal of Health Science 9, no. 6 (November 10, 2016): 76. http://dx.doi.org/10.5539/gjhs.v9n6p76.
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BACKGROUND: A rise in the number of elderly people in society increases the need for disease prevention and health promotion services as the growing figure entails more patients suffering from chronic illnesses, such as hypertension and diabetes. In order to prevent and control these non-communicable diseases, Participation Action Research (PAR) can be a powerful mechanism for engaging the elderly in PAR, and has the potential to provide a way to enhance the health of the elderly, consequently; it is necessary to design an appropriate health promotion model involving community participation.OBJECTIVE: This participation action research aims to develop a health promotion model integrating community participation for the prevention and control of hypertension and diabetes in the elderly and to implement a local intervention.METHODS: Mixed methodologies of mainly a qualitative approach and a supported quantitative approach with a questionnaire were employed. This was community-based participatory action research in which the researchers and community partners were the main participants. The PAR model was developed interactively in collaboration with the setting of local administration, the public sector, and the private sector. The process involved assessing the situation, taking action to promote community participation based on the analysis, implementing the solution, and testing the model and evaluating the model applying the After Action Review (AAR) approach.RESULTS: A health promotion model was developed and then piloted by the community team. The model is designed to improve the health behavior of the elderly; preventing and controlling hypertension and diabetes; providing continuous health education, especially regarding the importance of nutrition; physical activity; stress management; and facilitating the access of the vulnerable elderly to health services. The results showed that all the sectors, namely, families, schools, and temples, were involved in every stage of the research. The research results indicate that the model can build community health-promotion capacity, partnership development, community health plans, and community innovation and build a supportive environment.CONCLUSION: The paper illustrates that PAR has the potential to provide a way to make the significant role of community participation in a project for the prevention and control of hypertension and diabetes and for the promotion of healthy aging in a rural setting. Moreover, PAR can enhance program design and implementation based on the sharing of best practices and the active engagement of community members. In this way, the elderly can perceive benefits of group participation in enhancing their self-care ability, their sense of empowerment, and their ability to learn to prevent, control and sustain changes in their health behavior.
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Green, Nancy S., Deepa Manwani, Luisa Soto, Yina Castillo, Karen Ireland, Zhezhen Jin, and Arlene Smaldone. "A Pilot Intervention to Improve Hydroxyurea Adherence in Youth with Sickle Cell Disease through Community Health Workers: The "Habit" Study." Blood 128, no. 22 (December 2, 2016): 1310. http://dx.doi.org/10.1182/blood.v128.22.1310.1310.
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Abstract Background: Chronic disease regimens for youth require self-management skills for a daily medication habit. Incomplete adherence to hydroxyurea (HU) is a treatment barrier for sickle cell disease (SCD) (Walsh KE, Pediatrics 2014). HU induction of fetal hemoglobin (HbF) is dose-dependent but not a standardized target (Ware RE, Hematology Am Soc Hematol Educ Program, 2015). In a previous 2-site retrospective analysis of youth with SCD, large deviation from historical personal best (PBest) HbF, a clinic-based form of maximum dose (Green NS, PBC, 2016), was common and correlated with increased acute hospital use. Here we hypothesized that: 1) A HU habit can develop through education and support of youth-parent dyads from a structured intervention of community health workers (CHW), augmented by text messaging; 2) Improved used will increase HbF; 3) The intervention is feasible and acceptable. Methods: We conducted a 2-site R21-funded randomized controlled feasibility trial (RCT), "Hydroxyurea Adherence for Personal Best in Sickle Cell Treatment: HABIT" (Smaldone A, Contemp Clin Trials, 2016)." Youth- parent dyads (youth ages 10-18) were recruited for the 6-month intervention. Eligibility required a ≥15% drop from PBest HbF on stable HU dose over the preceding year. Intervention dyads received a 6-month structured intervention of education and support by CHWs with home visits and text messaging, versus educational materials. Primary outcomes were HbF, % deviation from PBest HbF and HU pharmacy refills. Results: Using 2:1 randomization, 28 parent-youth dyads participated (18 intervention, 10 control): mean age 14.3±2.6 years, 42.9% female. At baseline, no differences were seen in HbF (10.5% vs. 13.4%, p=0.25), but deviation from PBest HbF was higher in the control group (-42.6%) than the intervention (18.1%, p=0.009). Using a growth model for % deviation from PBest HbF, the intervention group demonstrated a modest absolute improvement in deviation from PBest (2.2% per month higher in the intervention group), peaking at month 4 (p=0.31), and modest gain in mean HbF (3 versus 1.8). Four subjects exceeded their PBest. Compared to the year before intervention, pharmacy refills improved for the intervention group: 64.6% year prior, 80.7% (months 0 to 3), 85.9% (months >3 to 6), while the control group was unchanged (79.2% year prior, 83.6% months 0 to 3, 79.4% months >3 to 6). Intervention feasibility and acceptability by dyads were excellent. Conclusions: The 6-month pilot RCT "HABIT" may improve HU adherence measured by improved HbF, deviation from PBest and pharmacy refill, was feasible and acceptable, and suggests utility as an intervention. Based on these findings, a multi-center HABIT RCT of 1-year duration powered to test efficacy is planned. Funded by 5R21NR013745 (PIs Green, Smaldone) Figure Figure. Disclosures No relevant conflicts of interest to declare.
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Ahmad, Iftikhar. "LIFE STYLE AND HEALTH EDUCATION." Gomal Journal of Medical Sciences 17, no. 3 (June 25, 2020): 63–64. http://dx.doi.org/10.46903/gjms/17.03.2079.
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Lifestyle is the interest, behavior, opinion, style of living or world outlook of an individual, group, or culture; a combination of tangible factors like demographics and intangible factors like personal values and preferences.1 Recently researchers have more interest in the relationship between life style and health. Millions of people, following unhealthy lifestyle (or risk-factors), are plagued with morbidity, disability and mortality due to non-communicable, communicable diseases & nutritional disorders. Persons having unhealthy behaviors may be called as ‘at risk groups’.2 Although a healthy lifestyle has consistently been shown to decrease mortality, the population prevalence of healthy living remains low.3 The mental health of an individual can be assessed by his behavior and attitude. Common lifestyle variables influencing health include diet, exercise, sleep, smoking, alcohol consumption, substance abuse, stress management, sexual behavior, internet, recreation, etc.4 Besides, weight management, exposure to the sun, social contact, work life balance, leisure activities, screening for cancer etc. make a healthy life style. Healthy ways of living are developed through processes of socialization with parents, friends, relatives and community. However, not all life style factors are harmful. There are many life styles that promote health. For example, adequate nutrition, exercise, meditation, enough sleep etc.5 Modern or slow epidemics of non-communicable diseases (NCDs) e.g. hypertension (HTN), coronary heart disease (CHD), diabetes mellitus (DM), obesity, cancer etc. have been increasing in incidence compared to the previous century. With the increase in life expectancy, the prevalence of NCDs is on the rise. About 2 billion people are overweight in developed as well as low to middle income countries.6 Comorbidities of obesity include HTN, CHD, DM, stroke, cancers, gallbladder disease, dyslipidaemia, osteoarthritis, gout and sleep apnoea.7 Obesity is not only preventable but treatable with lifestyle modifications to forestall DM.8 Furthermore, several pathways linking obesity and CHD have been described; in particular coronary atherosclerosis, heart failure, and atrial fibrillation.9 In a study by CDC conducted in late 1970s in US, approximately 48% of all premature deaths prior to age 75 years could be traced to one’s lifestyle or health behavior choices, hence focusing on a personal responsibility model whereas another study accounts for about 63% of all deaths.10 Human behavior is a major obstacle to disease control. Changes in human behavior may prevent most of the world's major health problems & premature deaths at low cost. Public health is defined as ‘the health status of a defined group of people and the governmental actions and conditions at the local, state, and national levels to promote healthy behaviors, prevent spread of disease and injuries, protect against environmental hazards & disasters and assure the curative and rehabilitative health services. Many public health recommendations and clinical guidelines emphasize that healthy lifestyles have substantial health benefits.11 Changes in the life-style of the population by health education encompass three approaches of primary prevention as recommended by the WHO for prevention of chronic diseases. In first approach or primordial prevention, children are discouraged from adopting harmful lifestyles through individual/ mass education in countries in which many adult health problems (e.g., obesity, hypertension) have not yet appeared. Lifestyles are formed during childhood and aim is to prevent the emergence of risk factors. Second approach or population (mass) strategy is directed at the whole population, irrespective of individual risk level. A small reduction in the average blood pressure/ serum cholesterol in the community, helps in reducing the CHD prevalence. Third approach or high-risk strategy, on the other hand, aims to detect individuals at high risk by the optimum use of clinical methods and provide preventive care to them. To have an impact on the population, all the above three approaches should be implemented as they are usually complementary but the results are perceived after several decades and not immediately. Besides health education the population must have access to preventive measures.5 Lifestyle medicine program serves as a systematized approach to manage NCDS by addressing multiple risk factors through self-management skills.12 Physical activity leading to cardiorespiratory fitness is needed in all age groups, both sexes, race & ethnicities to prevent NCDs including CVDs.13 Better control of behavioral risk factors alone could prevent one-third of all acute and two-thirds of chronic disabilities. Physical activity, consumption of fresh rather than processed foods, limited use of cooking/ table salt to
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Boddicker, Nicholas J., Matthew J. Maurer, Melissa C. Larson, Cristine Allmer, Susan L. Slager, Thomas M. Habermann, Sunnia T. Chen, et al. "Treatment and Lifestyle Risk Factors for Cardiovascular Disease Post Lymphoma Diagnosis: A Prospective Study in the Modern Treatment Era." Blood 134, Supplement_1 (November 13, 2019): 422. http://dx.doi.org/10.1182/blood-2019-127203.
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Background With lymphoma survival rates increasing and a growing population of long-term survivors, the development of cardiovascular disease (CVD) in this patient population is of increasing importance. Anthracyclines are critical in the management of many lymphoma subtypes. However, there is a risk of developing anthracycline-induced CVD. Here, we estimate the cumulative incidence of CVD in adult lymphoma survivors and investigate risk factors associated with post diagnosis CVD. Methods Participants were from the Mayo component of the Molecular Epidemiology Resource (MER) of the University of Iowa/Mayo Clinic Lymphoma Specialized Program of Research Excellence (SPORE). From 2002-2015, the MER offered enrollment to all patients with newly diagnosed lymphoma who are US residents and age >18 years. Participants completed a risk factor questionnaire, and clinical and treatment data were abstracted from medical records. Patients were contacted every 6 months for the first 3 years after diagnosis and annually thereafter to assess disease status, re-treatment and new onset morbidity including CVD. CVD events, including congestive heart failure (CHF), coronary artery disease (CAD), valvular heart disease (VHD), and arrhythmia were identified and validated against medical records. CHF was validated with the Cardiovascular Health Study Criteria and/or the Framingham Criteria. CAD, arrhythmia, and VHD were validated using clinical definitions. We calculated the cumulative incidence of CVD, with death modeled as a competing risk. The association of risk factors and treatments with risk of CVD was estimated using hazard ratios (HR) and 95% confidence intervals (CI) from Cox regression with a competing risk of death. Risk factors included age, sex, diabetes, smoking, body mass index (BMI), and treatment with anthracyclines or radiation therapy. Results The study consisted of 3,063 lymphoma patients after excluding those with chronic lymphocytic leukemia and CVD prior to lymphoma diagnosis. The median age at diagnosis was 59 years (range 18-95), and 56% were males. At a median follow-up was 6.9 years (range 0.8-17.1), 640 patients (21%) had died without CVD and 485 patients self-reported CVD post lymphoma diagnosis, of which 280 (57.7%) were validated. Cardiovascular events included 86 CHF, 78 CAD, 40 VHD, and 164 arrhythmias. The cumulative incidence of CVD (Figure 1) at 5 and 10 years was 6.0% (95% 5.2%-7.0%) and 10.7% (95% CI 9.5%-12.1%), respectively. In multivariable analysis, increasing age (HR=3.93 per 5 years, p<0.001), male sex (HR=1.33, p=0.03), former smoker (HR=1.04, p=0.77), current smoker (HR=1.96, p<0.001), BMI>30 kg/m2 (HR=1.50, p=0.01), and anthracycline treatment (HR=1.49. p<0.001) were all significantly associated with risk of overall CVD, while there was no association with diabetes (HR=0.92, p=0.70) or radiation therapy (HR=1.05, p=0.78) in the multivariable model. Anthracycline use was significantly associated with increased risk of CHF (HR=2.64, p<0.001) and arrhythmia (HR=1.51, p<0.01), but not VHD (HR=0.83, p=0.56) or CAD (HR=1.23, p=0.31) after adjustment for the cardiac risk factors. The number of anthracycline cycles ranged from 0 to 12. 63.2% of individuals that received anthracyclines received 6 cycles. The 5-year cumulative incidence of CVD for 0, 1-5, 6, and >6 anthracycline cycles was 5%, 6.9%, 7.4%, and 7.7%, respectively. Adjusting for cardiac risk factors, the number of anthracycline cycles was significantly associated with increased risk of CVD (1-5 cycles HR=1.34, p=0.11; 6 cycles HR=1.51, p<0.01; >6 cycles HR=2.04, p=0.03). Furthermore, the number of anthracycline cycles was associated with CHF (1-5 cycles HR=2.82, p<0.001; 6 cycles HR=2.46, p<0.001; >6 cycles HR=5.33, p<0.001) and arrhythmia (1-5 cycles HR=1.31, p=0.27; 6 cycles HR=1.60, p<0.01; >6 cycles HR=1.65, p=0.27). Conclusions In the modern treatment era, the risk of new onset CVD in patients with lymphoma without a history of CVD is approximately 1% per year after diagnosis. Arrhythmia and CHF were the most commonly occurring CVD events in this cohort. Both traditional CVD risk factors and treatment with anthracyclines was associated with an increased risk of developing CVD, and anthracyclines were a risk factor for arrhythmia and CHF in particular. Prevention of CVD in lymphoma patients will need to address both treatment and traditional lifestyle factors. Figure 1 Disclosures Maurer: Morphosys: Membership on an entity's Board of Directors or advisory committees; Nanostring: Research Funding; Celgene: Research Funding. Nowakowski:Selvita: Membership on an entity's Board of Directors or advisory committees; Genentech, Inc.: Research Funding; F. Hoffmann-La Roche Ltd: Research Funding; Curis: Research Funding; Bayer: Consultancy, Research Funding; Celgene: Consultancy, Research Funding; NanoString: Research Funding; MorphoSys: Consultancy, Research Funding. Cerhan:NanoString: Research Funding; Celgene: Research Funding; Janssen: Membership on an entity's Board of Directors or advisory committees.
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Anjali, Anjali, and Manisha Sabharwal. "Perceived Barriers of Young Adults for Participation in Physical Activity." Current Research in Nutrition and Food Science Journal 6, no. 2 (August 25, 2018): 437–49. http://dx.doi.org/10.12944/crnfsj.6.2.18.
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This study aimed to explore the perceived barriers to physical activity among college students Study Design: Qualitative research design Eight focus group discussions on 67 college students aged 18-24 years (48 females, 19 males) was conducted on College premises. Data were analysed using inductive approach. Participants identified a number of obstacles to physical activity. Perceived barriers emerged from the analysis of the data addressed the different dimensions of the socio-ecological framework. The result indicated that the young adults perceived substantial amount of personal, social and environmental factors as barriers such as time constraint, tiredness, stress, family control, safety issues and much more. Understanding the barriers and overcoming the barriers at this stage will be valuable. Health professionals and researchers can use this information to design and implement interventions, strategies and policies to promote the participation in physical activity. This further can help the students to deal with those barriers and can help to instil the habit of regular physical activity in the later adult years.
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Thanikachalam, Mohan, G. Shanmugasundar, Muthuswamy Ravikiran, Vijaykumar Harivanzan, and Sripriya Ravi. "Abstract 226: Integration of Traditional and Alternate Chronic Care Models within a Primary Care Setting for Diabetes Management and Cardiovascular Disease Prevention." Circulation: Cardiovascular Quality and Outcomes 7, suppl_1 (July 2014). http://dx.doi.org/10.1161/circoutcomes.7.suppl_1.226.
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Background: Several chronic care models (CCMs) for diabetes management and cardiovascular disease prevention have been implemented, but outcomes have been marginal. Traditionally, CCMs have been offered within the trusted primary care practice environment, but self-management support is episodic, cost ineffective and difficult to scale. Alternate CCMs that offer self-management support mostly through telephone coaching or virtual (web/mobile platforms) interventions, enable easy access, scalability and cost effectiveness, yet are impaired by the limits of isolated self-management support when provided outside the context of the trusted, therapeutic relationship of a primary care practice. We hypothesize that an integrated model taking advantage of positive aspects of traditional and alternate CCMs will lead to positive behavioral change (empowerment), sustained patient participation and better outcomes. Methods: To test this hypothesis, we implemented the Empowerment and Participatory Care Model (EPCM) in a study center in Chennai, India by integrating face-to-face support with customized telephone, Internet and mobile phone enabled interventions within a primary care setting. Patients who participated in the traditional CCM formed the control group. Results: In the participents in traditional CCM (n=422), there was an average reduction of 0.57% in HbA1c, 16 mg/dl in fasting blood sugar, 30 mg/dl in post prandial blood sugar and 16 mg/dl of LDL at the end of year-one. In comparison, among the patients (66% men; mean age 52 yrs) who participated in the EPCM and had completed one-year in the program (n=112) there was average reduction of 1.6% in HbA1c, 57 mg/dl in fasting blood sugar, 80 mg/dl in post prandial blood sugar and 18 mg/dl of LDL (p<0.01). Figure 1 shows the difference in percent reduction of the various biochemical parameters between the EPCM and the control group. The total cost of care (other than medication) per patient per year in the EPCM, after taking into consideration purchasing power parity between USA and India, was 900 USD. Conclusion: The persons with diabetes who participated in the EPCM had better quality of metabolic control, but long-term follow up is required to assess overall reduction in the risk of cardiovascular complications and cost effectiveness.
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Carvalho, Sérgio A., Inês A. Trindade, Joana Duarte, Paulo Menezes, Bruno Patrão, Maria Rita Nogueira, Raquel Guiomar, Teresa Lapa, José Pinto-Gouveia, and Paula Castilho. "Efficacy of an ACT and Compassion-Based eHealth Program for Self-Management of Chronic Pain (iACTwithPain): Study Protocol for a Randomized Controlled Trial." Frontiers in Psychology 12 (March 9, 2021). http://dx.doi.org/10.3389/fpsyg.2021.630766.
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BackgroundChronic pain (CP) has serious medical and social consequences and leads to economic burden that threatens the sustainability of healthcare services. Thus, optimized management of pain tools to support CP patients in adjusting to their condition and improving their quality of life is timely. Although acceptance and commitment therapy (ACT) is considered an evidence-based psychological approach for CP, evidence for the efficacy of online-delivered ACT for CP is still scarce. At the same time, studies suggest that self-compassion mediates the change in disability and psychopathological symptoms in ACT interventions for CP, although self-compassion is not a specific target in ACT. Thus, an explicit focus on self-compassion might increase the efficacy of ACT interventions for CP, although this hypothesis has not been tested. This study aims to develop an eHealth ACT and compassion-based self-management intervention for CP, the iACTwithPain, and to compare its efficacy in improving health outcomes to a similar ACT-only intervention and a medical TAU group.MethodsThe eHealth platform that will host the interventions will be developed using a flat design identity and will be interactive. The iACTwithPain intervention will comprise eight weekly self-management sessions and will be developed taking into consideration the psychological flexibility model applied to CP, with the addition of explicit compassion-based components. To analyze whether the iACTwithPain intervention will present superiority in improving CP’s impact and related health markers over the two other conditions, this study will follow an RCT design with three arms. CP patients will be recruited through direct contact with patient associations and healthcare services and a national press release in Portugal. Outcome measurement will be conducted at baseline, post-intervention and at 3- and 6-month follow-ups. The interventions’ acceptability will also be assessed.DiscussionThe iACTwithPain intervention is expected to improve CP patients’ psychosocial functioning, quality of life, and empowerment, by promoting adaptive disease management and regulation of pain-related internal experiences. Results will contribute to a better understanding on the pertinence of adding compassion elements to ACT for CP and to reach an optimized intervention for CP.Clinical Trial RegistrationThis trial has been registered at ClinicalTrials.Gov (NCT04200183; 16 December 2019; https://clinicaltrials.gov/ct2/show/NCT04200183). The current manuscript comprises the first version of this clinical trial’s protocol.
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Dahl-Popolizio, Sue, Gretchen Anne Roman, Felicia Trembath, Bradley Doebbeling, and Alyssa Concha-Chavez. "Occupational Therapy in Primary Care -- Barriers, Pivots, and Outcomes: A pilot study." Internet Journal of Allied Health Sciences and Practice, 2021. http://dx.doi.org/10.46743/1540-580x/2021.1982.
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Purpose: Habits, roles, and routines are important behaviors that affect lifestyle and can lead to the development of chronic disease such as diabetes mellitus. Primary care physicians (PCPs) have limited time, suggesting an interprofessional team approach would be beneficial in helping patients modify behaviors for the prevention and treatment of chronic disease. Occupational therapists (OTs) specialize in addressing health behaviors, and literature supports including OTs on the primary care team to improve the self-management techniques of patients with chronic disease. This study was guided by Lifestyle Redesign®, an evidence-based program that addresses the health behaviors of patients with diabetes in primary care. We aimed to improve health outcomes by combining an OT-led lifestyle modification program with patient-centered treatment recommendations from an external interprofessional team. We hypothesized that the health outcomes of patients with diabetes in primary care would improve after participating in an OT-led interprofessional lifestyle modification program, and that reimbursement for services would be obtainable. Method: Two PCPs in community practice initially agreed to involve an OT on their primary care team. Due to reimbursement concerns, the PCPs later preferred to refer patients to receive the OT-led intervention at an offsite clinic, rather than onsite at the primary care practice. Health outcomes were measured pre- and post-intervention using industry standard assessments and biometrics. Descriptive and non-parametric statistics were used to evaluate change. Results: Thirty-one patients with diabetes were referred, and three (9.7%) participated in the offsite lifestyle modification program. While statistical significance was not achieved (p≥0.10), trends toward individual improvement were noted for occupational performance and satisfaction and empowerment, and reimbursement was received from the third-party payers. Conclusions: Patient participation in this study was consistent with participation rates for offsite behavioral health referrals. An offsite OT-led interprofessional lifestyle modification program demonstrated potential for meaningful change and services were reimbursed. These findings support practice redesign efforts to include OTs as part of an integrated primary care model. Offering onsite services will increase patient accessibility to care and improve referral completion rates, thus providing OTs the opportunity to further demonstrate the efficacy of delivering chronic disease management in primary care.