Application of the JA-CHRODIS Integrated Multimorbidity Care Model (IMCM) to a Case Study of Diabetes and Mental Health.

The Integrated Multimorbidity Care Model (IMCM), developed by the Joint Action on Chronic Diseases and Promoting Healthy Ageing across the Life Cycle (JA-CHRODIS), proposes a set of 16 multidimensional components (i.e., recommendations) to improve the care of persons with multimorbidity in Europe. This study aimed at analyzing the potential applicability of the IMCM. We followed a qualitative approach that comprised two phases: (1) The design of a case study based on empirical clinical data, which consisted of a hypothetical woman with multimorbidity, type 2 diabetes mellitus, mental health, and associated social problems, and (2) the creation of a consensus group to gather the opinions of a multidisciplinary group of experts and consider the potential applicability of the IMCM to our case study. Experts described how care should be delivered to this patient according to each model component, suggested the use of specific rating scales and tools to assess her needs in a comprehensive and regular way, and pointed our crucial health and social resources to improve her care process. Experts also highlighted patient-centered, integrated and tailored care as one of the keystones of quality healthcare. Our results suggest that the IMCM is applicable in complex patients with multimorbidity.

Rasch analysis of the International Wellbeing Index in older adults.

BACKGROUND: The International Wellbeing Index is a measure of general quality of life formed by two scales: the Personal Wellbeing Index (PWI) and the National Wellbeing Index (NWI). This paper studies the psychometric properties of the PWI and NWI, using Rasch analysis and classic psychometric methods. METHODS: The PWI and NWI were applied to a representative sample of 1106 community-dwelling adults, aged 60 years and over, residing in Spain. Mean ± standard deviation age was 72.07 ± 7.83 years and 56.3% were women. RESULTS: Five PWI items (achieving in life, relationships, safety, community connectedness, and future security), and five NWI items (economic situation, state of environment, social conditions, business, and national security of the country) fitted the Rasch model. After adjusting the response scale format, satisfactory fit was obtained, with good reliability (person separation index of 0.91 for both the PSI and NWI), local independency of items, and strict unidimensionality. The measures showed adequate external construct validity with related measures. CONCLUSIONS: The PWI and the NWI, with fewer items and simpler response scale formats, provided valid and reliable linear measures in older adults, according to Rasch and classic psychometric analyses.

Health-related quality of life and mental health in the medium-term aftermath of the Prestige oil spill in Galiza (Spain): a cross-sectional study.

BACKGROUND: In 2002 the oil-tanker Prestige sank off the Galician coast. This study analyzes the effect of this accident on health-related quality of life (HRQoL) and mental health in the affected population. METHODS: Using random sampling stratified by age and sex, 2700 residents were selected from 7 coastal and 7 inland Galician towns. Two exposure criteria were considered: a) residential exposure, i.e., coast versus interior; and b) individual exposure-unaffected, slightly affected, or seriously affected-according to degree of personal affectation. SF-36, GHQ-28, HADS and GADS questionnaires were used to assess HRQoL and mental health. Association of exposure with suboptimal scores was summarized using adjusted odds ratios (OR) obtained from logistic regression. RESULTS: For residential exposure, the SF-36 showed coastal residents as having a lower likelihood of registering suboptimal HRQoL values in physical functioning (OR:0.69; 95%CI:0.54-0.89) and bodily pain (OR:0.74; 95%CI:0.62-0.91), and a higher frequency of suboptimal scores in mental health (OR:1.28; 95%CI:1.02-1.58). None of the dimensions of the other questionnaires displayed statistically significant differences. For individual exposure, no substantial differences were observed, though the SF-36 physical functioning dimension rose (showed better scores) with level of exposure (91.51 unaffected, 93.86 slightly affected, 95.28 seriously affected, p < 0.001). CONCLUSION: Almost one and a half years after the accident, worse HRQoL and mental health levels were not in evidence among subjects exposed to the oil-spill. Nevertheless, some of the scales suggest the possibility of slight impact on the mental health of residents in the affected areas.