Catalogue of socioeconomic disparities and characteristics of 199+ chronic conditions-A nationwide register-based population study.

BACKGROUND: Real-world information on socioeconomic differences within and between chronic conditions represents an important data source for treatments and decision-makers executing and prioritising healthcare resources. AIMS: The aim of this study was to estimate the prevalence and mean of socioeconomic disparities from educational, income, and socioeconomic positions of 199 chronic conditions and disease groups, including sex and age group estimates, for use in planning of care services and prioritisation, by healthcare professionals, decision-makers and researchers. METHODS: The study population includes all Danish residents 16 years and above, alive on 1 January 2013 (n = 4,555,439). The data was established by linking seven national registers encompassing educational achievements, incomes, socioeconomic positions, hospital- and general practice services, and filled-in out-of-hospital prescriptions. The health register data were used to identify the 199+ chronic conditions. Socioeconomic differences were primarily measured as differences in educational prevalence levels from low to high educational achievements using a ratio. Furthermore, multiple binary logistic regression models were carried out to control for potential confounding and residual correlations of the crude estimates. RESULTS: The prevalence of having one or more chronic conditions for patients with no educational achievement was 768 per thousand compared to 601.3 for patients with higher educational achievement (ratio 1.3). Across disease groups, the highest educational differences were found within disease group F-mental and behavioural (ratio 2.5), E-endocrine, nutritional and metabolic disease (ratio 2.4), I-diseases of the circulatory system (ratio 2.1) and, K-diseases of the digestive system (ratio 2.1). The highest educational differences among the 29 common diseases were found among schizophrenia (ratio 5.9), hyperkinetic disorders (ratio 5.2), dementia (ratio 4.9), osteoporosis (ratio 3.9), type 2 diabetes (ratio 3.8), chronic obstructive pulmonary disease COPD (ratio 3.3), heart conditions and stroke (ratios ranging from 2.3-3.1). CONCLUSIONS: A nationwide catalogue of socioeconomic disparities for 199+ chronic conditions and disease groups is catalogued and provided. The catalogue findings underline a large scope of socioeconomic disparities that exist across most chronic conditions. The data offer essential information on the socioeconomic disparities to inform future socially differentiated treatments, healthcare planning, etiological, economic, and other research areas.

Catalogue of multimorbidity mean based severity and associational prevalence rates between 199+ chronic conditions-A nationwide register-based population study.

BACKGROUND: Real-world data on multimorbidity represents an important but underutilised source of evidence for the planning of healthcare services, including prevention, treatments, and health economic modelling. AIMS: This study aimed to estimate means of multimorbidity and provide associated prevalence rates and frequencies between 199 x 199 chronic conditions and disease groups based on the total adult Danish population and sex, age, and educational attainment. Thus, this study provides an off-the-shelf catalogue for use in treatments and planning by clinicians, decision-makers and researchers. METHODS: The study population contained all Danish residents above 16 years on 1 January 2013 (n = 4,555,439). The data was based on the linkage of six national registers covering hospital contacts, services in general practice, filled-in out-of-hospital prescriptions, and educational attainments. The health registers were used to identify the 199 chronic conditions based on the ICD-10 classification system. RESULTS: The mean number of chronic conditions (NCC) was 2.2. The mean increased with age, women had a higher mean than men, and there was a social gradient with the mean increasing with lower educational attainment. The mean NCC varied from 3.3-9.8 among all conditions. Across disease groups, the highest mean NCC were found within disease group N (chronic renal failure, mean = 8.8), D (in situ and benign neoplasms; mean = 6.5), K (diseases of the digestive system; mean = 5.7), and H (diseases of the eye and the ear; mean = 5.6). The highest mean NCC among the 29 common diseases was heart failure, ischemic heart diseases, angina pectoris, stroke, and dementia, with a mean above 6.5. Several prevalent conditions like hypertension, arthritis, chronic lower respiratory diseases, depression, type 2 diabetes, and overweight transcended other conditions regarding the associated prevalence rates. As one of the most frequent, hypertensive diseases were highly associated with arthritis (50.4%), depression (37.4%), type 2 diabetes (75.4%), cancers (49.7%), and being overweight (39.7%)-meaning that 50.4% of people with arthritis, 37.4% of people with depression and so on also had hypertensive diseases. The largest differences in means between individuals with no educational attainment and individuals with high educational attainment were found within disease groups J (diseases of the respiratory system, ratio = 1.8), Q (congenital malformations, deformations, and chromosomal abnormalities, ratio = 1.7), and B (viral hepatitis and human immunodeficiency virus disease, ratio = 1.7). CONCLUSIONS: The current study provides a nationwide off-the-shelf catalogue of multimorbidity means and real-world associations estimates of 199+ chronic conditions for future clinical treatments and health care systems planning. The findings described are just one example of numerous results and underline that multimorbidity is highly prevalent in the adult Danish population and that it is a vital condition transcending all future medical treatment. The data offer essential information on the multimorbidity burden of disease in future differentiated treatments, healthcare planning, and economic, aetiological, and other research.

Taking no for an answer. Nurses' consultations with people with cardiac disease about rehabilitation: A qualitative study.

BACKGROUND: Research shows that many people with cardiac disease decline cardiac rehabilitation. There is little or no knowledge on how health professionals respond to these people. OBJECTIVES: To investigate how nurses respond to people who do not wish to participate in cardiac rehabilitation and what influences the nurses´ approach towards these people. DESIGN: A qualitative study involving interviews and video-recordings using an analysis inspired by ethnographic principles and categorisation theory. SETTING: A rehabilitation clinic at a large hospital in the Capital Region of Denmark. PARTICIPANTS: Five cardiac nurses and 28 people with cardiac disease. METHODS: We video-recorded the first consultation people with cardiac disease attended regarding cardiac rehabilitation, where the nurses followed up on these people's recovery, medication, lifestyle and need for rehabilitation. We conducted semi-structured interviews with the cardiac nurses. We asked the nurses about the purpose of the first rehabilitation consultation and how they handle people with cardiac disease who say no to rehabilitation. The nurses were shown video-clips with the people they had talked to in their consultation in order to facilitate a dialogue. RESULTS: When people with cardiac disease were reluctant to participate in rehabilitation, the nurses made an individual assessment of how much effort to put into motivating them, taking a complex range of factors into account. The effort among the nurses towards people with cardiac disease who decline rehabilitation was smaller in cases when the nurses believed an individual would benefit less from rehabilitation or have difficulty participating. It was important for the nurses to balance their motivational efforts with showing respect for people's autonomy. CONCLUSION: Even when nurses endorse rehabilitation, some people with cardiac disease decline rehabilitation. The nurses' recommendation of the rehabilitation programme is influenced by the knowledge they obtain about the people with cardiac disease during consultations.

A Qualitative Exploration of Facilitators and Barriers for Diabetes Self-Management Behaviors Among Persons with Type 2 Diabetes from a Socially Disadvantaged Area.

BACKGROUND: Enhancing diabetes self-management (DSM) in patients with type 2 diabetes (T2D) can reduce the risk of complications, enhance healthier lifestyles, and improve quality of life. Furthermore, vulnerable groups struggle more with DSM. AIM: To explore barriers and facilitators related to DSM in vulnerable groups through the perspectives of patients with T2D and healthcare professionals (HCPs). METHODS: Data were collected through three interactive workshops with Danish-speaking patients with T2D (n=6), Urdu-speaking patients with T2D (n=6), and HCPs (n=16) and analyzed using systematic text condensation. RESULTS: The following barriers to DSM were found among members of vulnerable groups with T2D: 1) lack of access to DSM support, 2) interference and judgment from one's social environment, and 3) feeling powerless or helpless. The following factors facilitated DSM among vulnerable persons with T2D: 1) a person-centered approach, 2) peer support, and 3) practical and concrete knowledge about DSM. Several barriers and facilitators expressed by persons with T2D, particularly those who spoke Danish, were also expressed by HCPs. CONCLUSION: Vulnerable patients with T2D preferred individualized and practice-based education tailored to their needs. More attention should be paid to training HCPs to handle feelings of helplessness and lack of motivation among vulnerable groups, particularly among ethnic minority patients, and to tailor care to ethnic minorities.

Influence of socioeconomic factors and region of residence on cancer stage of malignant melanoma: a Danish nationwide population-based study.

BACKGROUND: Socioeconomic differences in survival after melanoma may be due to late diagnosis of the disadvantaged patients. The aim of the study was to examine the association between educational level, disposable income, cohabitating status and region of residence with stage at diagnosis of melanoma, including adjustment for comorbidity and tumor type. METHODS: From The Danish Melanoma Database, we identified 10,158 patients diagnosed with their first invasive melanoma during 2008-2014 and obtained information on stage, localization, histology, thickness and ulceration. Sociodemographic information was retrieved from registers of Statistics Denmark and data on comorbidity from the Danish National Patient Registry. We used logistic regression to analyze the associations between sociodemographic factors and cancer stage. RESULTS: Shorter education, lower income, living without partner, older age and being male were associated with increased odds ratios for advanced stage of melanoma at time of diagnosis even after adjustment for comorbidity and tumor type. Residence in the Zealand, Central and Northern region was also associated with advanced cancer stage. CONCLUSION: Socioeconomically disadvantaged patients and patients with residence in three of five health care regions were more often diagnosed with advanced melanoma. Initiatives to increase early detection should be directed at disadvantaged groups, and efforts to improve early diagnosis of nodular melanomas during increased awareness of the Elevated, Firm and Growing nodule rule and "when in doubt, cut it out" should be implemented. Further studies should investigate regional differences in delay, effects of number of specialized doctors per inhabitant as well as differences in referral patterns from primary to secondary health care across health care regions.

Relational coordination and organisational social capital association with characteristics of general practice.

Background. Relational coordination (RC) and organisational social capital (OSC) are measures of novel aspects of an organisation's performance, which have not previously been analysed together, in general practice. Objectives. The aim of this study was to analyse the associations between RC and OSC, and characteristics of general practice. Methods. Questionnaire survey study comprising 2074 practices in Denmark. Results. General practitioners (GPs) rated both RC and OSC in their general practice higher than their secretaries and nurses. The practice form was statistically significantly associated with high RC and OSC. RC was positively associated with the number of patients listed with a practice per staff, where staff is defined as all members of a practice including both owners and employees. Conclusion. The study showed that RC and OSC were significantly associated with type of profession and practice type. RC was also found to be significantly positively associated with number of patients per staff. However, the low response rate must be taken into consideration when interpreting the self-reported results of this study.