The Effect of Health Literacy on Health Status in Patients with Heart Failure: A Path Analysis.

Background: Managing heart failure (HF) is challenging because of its complexity and high rates of hospitalization, morbidity, and mortality. Effective management requires coordination between patients' abilities and healthcare services; however, low health literacy among patients with heart failure can adversely affect their health status. Therefore, the understanding relationship between health literacy and health status would provide the evidence for developing future intervention. Methods: This analytical study explored multilevel factors influencing health literacy and health status in patients with heart failure (HF) who underwent health service delivery at outpatient clinics. The sample consisted of 453 patients with HF from 12 hospitals located in five regional areas (north, south, east, northeast, central, and Bangkok) in Thailand. A hypothetical model was used to test the association between comorbidity, social support, patient-centered care, health service delivery, health literacy, and health status. Path analysis was used to analyze the data. Results: The results indicated that 40.8% of patients with HF exhibited low or inadequate levels of health literacy, yet perceived their health status as good, with an average of 25.2±19.8 points. Health service delivery by a cardiologist and nurse case manager directly influences health literacy. Comorbidity had a direct impact on health status, whereas social support, patient-centered care, and the aforementioned health service delivery indirectly affected health status through health literacy. Importantly, health literacy status directly influences health status. Conclusion: Comorbidity, social support, patient-centered care, and health service delivery were related with health literacy and high level of health literacy could influence the better health status. To increase the quality of health care services, health care providers should promote health literacy and integrate the concept of patient-centered care for HF patients at outpatient clinics. Recommendations include the training of nurses as case managers.

Examining determinants of control of metabolic syndrome among older adults with NCDs receiving service at NCD Plus clinics: multilevel analysis.

BACKGROUND: Metabolic syndrome (MetS) in older adults with hypertension, diabetes, and hyperlipidemia increases the risks of cardiovascular diseases by 2.5 times and type 2 diabetes by five times. This study aimed to explain the multilevel relationships between health service system factors and individual-level factors influencing the control of MetS among older adults with NCDs receiving health care services at the NCD Plus clinics of hospitals in 1 year. METHODS: This cross-sectional analytical study employed a systematic sampling method to have two groups of samples from 4 regions of Thailand: (1) 600 older adults having at least one diagnosis of NCDs receiving services at NCD Plus clinics and (2) 12 nurses in charge of the NCD Plus clinics at the hospitals providing services to these patient samples. Data were analyzed using multilevel logistic regression analysis. RESULTS: 24% of older adults with NCDs can control MetS within one year. The MetS escalation from the initial assessment to 1-year follow-up varied according to the level of the hospitals. The transition from MetS to non-MetS status was rare in older adults with NCDs. Among health service system factors, complete screening for MetS influenced 1-year MetS control (95% CI [1.06, 2.92]). Older adults who were female and who had polypharmacy had a 66% (95% CI [0.22, 0.53]) and a 54% (95% CI [0.29 - 0.71]) reduction chance in MetS control. Older adults, who were ≥ 80 years old, labor-employed, healthy dietary patterns, and medication adherence increased chances of controlling MetS by 2.38 times (95% CI [1.12, 5.05]), 2.14 times (95% CI [1.03, 4.42]), 1.61 times (95% CI [1.06-2.46]), and 3.18 times (95% CI [1.51, 6.70]), respectively. CONCLUSIONS: NCDs Plus clinics that provide complete screening for MetS significantly enhance their effectiveness in reducing the proportion of older adults with MetS. In addition, the service should pay attention to older adults who are female, are retired, and take multiple medications to achieve MetS control better. The insights gained from such an analysis could be instrumental in pinpointing the resources necessary to bolster the efficacy of NCD Plus clinics.

Determinants of continuing mental health service use among older persons diagnosed with depressive disorders in general hospitals: latent class analysis and GEE.

BACKGROUND: Prevalence of depression in older persons was a leading cause of disability. This group has the lowest access to service and retention in care compared to other age groups. This study aimed to explore continuing mental health service use and examined the predictive power of the mental health service delivery system and individual factors on mental health service use among older persons diagnosed with depressive disorders. METHODS: We employed an analytic cross-sectional study design of individual and organizational variables in 12 general hospitals selected using multi-stratified sampling. There were 3 clusters comprising community hospitals, advanced and standard hospitals, and university hospitals. Participants in each group were 150 persons selected by purposive sampling. We included older persons with a first or recurring diagnosis of a depressive disorder in the last 6 to 12 months of the data collection date. Data at the individual level included socio-demographic characteristics, Charlson Comorbidity Index, Attitude toward Depression and its treatment, and perceived social support. Data at the organizational level had hospital level, nurse competency, nurse-patient ratio, and appointment reminders. Descriptive statistics, Pearson chi-square test, latent class analysis (LCA), and marginal logistic regression model using generalized estimating equation (GEE) were used to analyze the data. RESULTS: The continuing mental health service use among older persons diagnosed with depressive disorders was 54%. The latent class analysis of four variables in the mental health services delivery organization yielded distinct and interpretable findings in two groups: high and low resource organization. The marginal logistic multivariable regression model using GEE found that organizational group and attitude toward depression and its treatment were significantly associated with mental health service use (p-value = 0.046; p-value = 0.003). CONCLUSIONS: The findings suggest that improving continuing mental health services use in older persons diagnosed with depressive disorders should emphasize specialty resources of the mental health services delivery system and attitude toward depression and its treatment.

Incidence and Risk Factors of Clinical Deterioration during Inter-Facility Transfer of Critically Ill Patients; a Cohort Study.

INTRODUCTION: Critically ill and injured patients are at a higher risk of developing clinical deterioration during inter-facility transfers. This study aimed to determine the incidence rate and risk factors of clinical deterioration among critically ill patients during inter-facility transfers in Thailand. METHODS: The present cohort study was conducted in 22 referring hospitals and 7 receiving hospitals under the supervision of Ministry of Public Health, Thailand, between March 15 and December 31, 2018. The subjects were comprised of 839 critically ill patients aged 18 and over, 63 coordinator nurses in referral centers, and 312 referral team leaders. Data collected included pre-transfer risk score, clinical data of patient during transfer, characteristics of referral team leader, ambulance type, preparation time, time to definitive care, transfer distance, and National Early Warning Score (NEWS) (clinical deterioration). Multilevel mixed-effects regression analysis was performed. RESULTS: The incidence rate of clinical deterioration was 28.69%. The most common types of clinical deterioration were hemodynamic instability, respiratory instability, and neurological alteration. Time between 31-45 minutes was significantly associated with clinical deterioration (ß 0.133, P value 0.027). The following illnesses were associated with higher probability of clinical deterioration: body region injuries/head injury/burn/ingested poison (ß 0.670, P value 0.030), respiratory distress/convulsion (ß 0.919, P value 0.001), shock/ arrhythmias/chest pain/hemorrhage (ß 1.134, P value <0.001), comatose/alteration of consciousness/syncope (ß 1.343, P value <0.001), and post-cardiac arrest (ß 2.251, P value <0.001). Patients with unstable conditions (ß 1.689, P value 0.001) and pre-transfer risk score of 8 or higher (ß 0.625, P value 0.001) had a higher rate of deterioration. Transfer by non- emergency room (ER) nurses (ß 0.495, P value 0.008) and transportation in a mobile intensive care unit (ICU) were associated with a higher rate of deterioration (ß 0.848, P value 0.001). CONCLUSION: The incidence of clinical deterioration during inter-facility transfer in Thailand was high. Illnesses involving circulatory, respiratory, and neurological systems, clinical instability, high pre-transfer risk score, transport time of 31-45 minutes, transportation by non-ER nurse, and mobile ICU were associated with a higher rate of clinical deterioration.