Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.407
Filtrar
2.
Cochrane Database Syst Rev ; 1: CD006560, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33448337

RESUMEN

BACKGROUND: Many people with chronic disease have more than one chronic condition, which is referred to as multimorbidity. The term comorbidity is also used but this is now taken to mean that there is a defined index condition with other linked conditions, for example diabetes and cardiovascular disease. It is also used when there are combinations of defined conditions that commonly co-exist, for example diabetes and depression. While this is not a new phenomenon, there is greater recognition of its impact and the importance of improving outcomes for individuals affected. Research in the area to date has focused mainly on descriptive epidemiology and impact assessment. There has been limited exploration of the effectiveness of interventions to improve outcomes for people with multimorbidity. OBJECTIVES: To determine the effectiveness of health-service or patient-oriented interventions designed to improve outcomes in people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. SEARCH METHODS: We searched MEDLINE, EMBASE, CINAHL and seven other databases to 28 September 2015. We also searched grey literature and consulted experts in the field for completed or ongoing studies. SELECTION CRITERIA: Two review authors independently screened and selected studies for inclusion. We considered randomised controlled trials (RCTs), non-randomised clinical trials (NRCTs), controlled before-after studies (CBAs), and interrupted time series analyses (ITS) evaluating interventions to improve outcomes for people with multimorbidity in primary care and community settings. Multimorbidity was defined as two or more chronic conditions in the same individual. This includes studies where participants can have combinations of any condition or have combinations of pre-specified common conditions (comorbidity), for example, hypertension and cardiovascular disease. The comparison was usual care as delivered in that setting. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data from the included studies, evaluated study quality, and judged the certainty of the evidence using the GRADE approach. We conducted a meta-analysis of the results where possible and carried out a narrative synthesis for the remainder of the results. We present the results in a 'Summary of findings' table and tabular format to show effect sizes across all outcome types. MAIN RESULTS: We identified 17 RCTs examining a range of complex interventions for people with multimorbidity. Nine studies focused on defined comorbid conditions with an emphasis on depression, diabetes and cardiovascular disease. The remaining studies focused on multimorbidity, generally in older people. In 11 studies, the predominant intervention element was a change to the organisation of care delivery, usually through case management or enhanced multidisciplinary team work. In six studies, the interventions were predominantly patient-oriented, for example, educational or self-management support-type interventions delivered directly to participants. Overall our confidence in the results regarding the effectiveness of interventions ranged from low to high certainty. There was little or no difference in clinical outcomes (based on moderate certainty evidence). Mental health outcomes improved (based on high certainty evidence) and there were modest reductions in mean depression scores for the comorbidity studies that targeted participants with depression (standardized mean difference (SMD) -0.41, 95% confidence interval (CI) -0.63 to -0.2). There was probably a small improvement in patient-reported outcomes (moderate certainty evidence). The intervention may make little or no difference to health service use (low certainty evidence), may slightly improve medication adherence (low certainty evidence), probably slightly improves patient-related health behaviours (moderate certainty evidence), and probably improves provider behaviour in terms of prescribing behaviour and quality of care (moderate certainty evidence). Cost data were limited. AUTHORS' CONCLUSIONS: This review identifies the emerging evidence to support policy for the management of people with multimorbidity and common comorbidities in primary care and community settings. There are remaining uncertainties about the effectiveness of interventions for people with multimorbidity in general due to the relatively small number of RCTs conducted in this area to date, with mixed findings overall. It is possible that the findings may change with the inclusion of large ongoing well-organised trials in future updates. The results suggest an improvement in health outcomes if interventions can be targeted at risk factors such as depression in people with co-morbidity.


Asunto(s)
Enfermedad Crónica/terapia , Multimorbilidad , Atención Primaria de Salud , Factores de Edad , Ambliopía , Servicios de Salud Comunitaria , Manejo de la Enfermedad , Trastornos del Crecimiento , Conductas Relacionadas con la Salud , Personal de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Discapacidad Intelectual , Cumplimiento de la Medicación , Medición de Resultados Informados por el Paciente , Atención Dirigida al Paciente/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto , Factores de Riesgo , Resultado del Tratamiento
3.
Homeopathy ; 110(1): 67-69, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33482667

RESUMEN

COVID-19 (coronavirus disease 2019) may present variable symptoms among infected individuals, with chronic disease patients appearing as the group most susceptible to present severe pulmonary infection, while having a higher risk of developing complications from the disease. This study demonstrates the relationship between the manifestation of COVID-19 and the presence of chronic miasmatic disease, based on the works of Samuel Hahnemann. The reaction of the individual who previously presented chronic miasmatic disease, when in contact with the stimulus of the epidemic disease, depends on the type of response that the organism was generating in the face of the pre-existing situation: if it is an intense reaction and greater than that which the stimulus of COVID-19 can generate, this individual will not develop the severe form of the epidemic disease; if the reaction is less than that generated by COVID-19, more intense symptoms may appear. Understanding that the presence of a chronic miasmatic disease interferes with the manifestation of COVID-19, which may have repercussions on other organs, can change how one must act on the treatment, as this can alter the individual's health status.


Asunto(s)
/fisiopatología , Enfermedad Crónica/terapia , Comorbilidad , Homeopatía/métodos , /epidemiología , Enfermedad Crónica/epidemiología , Humanos
4.
Ital J Pediatr ; 47(1): 1, 2021 Jan 06.
Artículo en Inglés | MEDLINE | ID: mdl-33407754

RESUMEN

Children with medical complexity represent a big challenge for the physicians, their families and the society as well. Although there is no clear definition of this type of patients, they are affected by a chronic, often very severe condition for their whole life. They also represent a huge cost for the health care system due to their needs of continuous assistance.In this review we summarized the definitions of child with medical complexity. Then we illustrated the strategies to treat and take care of these children in order to look at them not as a burden or a cost but as an opportunity to growth and improve as clinicians and to improve the society, to give them the best life they can live.We also wanted to give voice to the physicians, the parents and the children themselves to really show and understand what are their experiences and their feelings in dealing with their conditions. We concluded with the description of one example of children with medical complexity: prematurity. We discussed the progresses in their treatment so far in order to illustrate what is the future of pediatrics. Since it has been more and more acknowledged that every child with medical complexity is unique, the future of pediatric is to organize an individualized approach and to "see things with the eye of a child".


Asunto(s)
Enfermedad Crónica/terapia , Prestación de Atención de Salud , Adolescente , Niño , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , Masculino
5.
J Ethnopharmacol ; 265: 113269, 2021 Jan 30.
Artículo en Inglés | MEDLINE | ID: mdl-32937158

RESUMEN

ETHNOPHARMACOLOGICAL RELEVANCE: In recent years, oxidative stress (OS) and the generation of ROS have been recognized as a fundamental pathology contributing, at least partially, to a number of important diseases. However, the therapeutic application has been simplistically limited to using antioxidants with little correction of diseases, and many biomarkers of OS, although confirming and quantifying the magnitude of this pathology, are not suggestive of the underlying causes behind generation of a large amount of free radicals. Unfortunately, research has not noted the multi-implication parallel phenomenon of Ihtiraq (Combustion) in Unani Medicine, which possesses much richer etiopathological sub-typing and much more variegated selective and specific treatments (and prophylactics) corresponding to each sub-type of Ihtiraq; the identification of each sub-type's molecular counterparts can be used to develop not only sub-types of OS pathologies and corresponding selective treatments/prophylactics but also non-biomolecular factors. Eminent Unani physicians described a deteriorative phenomenon, which they termed as 'Ihtiraq' which stands for extreme metabolism or 'combustion' and is recognized as a fundamental pathology, contributing as a major factor to the development of chronic diseases. Further, Unani Medicine also possesses a pathophysiological phenomenon called 'Hararat Ghariba' (Unnatural Heat) whose diverse associations with Ihtiraq may be correlatable as upstream, parallel, or downstream associations of OS and consequent pathologies. AIM OF THE STUDY: The aim of the study is to: 1. Explore the correlation of the phenomenon and etiopathology of Ihtiraq and OS and the treatment and prevention of the pathologies arising from them. 2. Extrapolate Ihtiraq, its types, causes, prevention, and treatment to OS, hitherto existing as a fundamental and monolithic pathology of increased ROS, to hypothesize its molecular-level sub-typing, as well as to propose selective interventions in these molecular sub-types of OS in place of the existing use of only basic antioxidants such as Vitamin C. MATERIAL AND METHODS: This review is presented with a noteworthy insight into Unani concepts and a thorough study of classical Unani literature by Ibn Sina (10th century), Zakaria Razi (9th century), Ibn Rushd (12th century), Ibn al-Nafees (13th century), Majusi (10th century), and Jurjani (11th century), and comparative detailed study of modern concepts of OS from literature databases, as well as Google, recent researches, and review articles. RESULT: The study showed very close correspondences between the phenomenon, etiopathology, and treatment and prevention of Ihtiraq in Unani Medicine and OS in contemporary biomolecular medicine. It also revealed sub-types of Ihtiraq and corresponding selective Unani treatments and prophylactics including drugs and non-drug factors. CONCLUSION: After a comprehensive study and analysis of the most recent researches and classical theories, it can be stated that OS can be seen as a molecular level expression of Ihtiraq. Further, various components of Ihtiraq may be used to hypothesize molecular sub-types of OS and propose corresponding specific interventions.


Asunto(s)
Antioxidantes/farmacología , Medicina Unani/métodos , Estrés Oxidativo/efectos de los fármacos , Animales , Enfermedad Crónica/terapia , Humanos , Estrés Oxidativo/fisiología , Especies Reactivas de Oxígeno/metabolismo
6.
Healthc (Amst) ; 9(1): 100511, 2021 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-33340801

RESUMEN

The COVID-19 pandemic threatens the health and well-being of older adults with multiple chronic conditions. To date, limited information exists about how Accountable Care Organizations (ACOs) are adapting to manage these patients. We surveyed 78 Medicare ACOs about their concerns for these patients during the pandemic and strategies they are employing to address them. ACOs expressed major concerns about disruptions to necessary care for this population, including the accessibility of social services and long-term care services. While certain strategies like virtual primary and specialty care visits were being used by nearly all ACOs, other services such as virtual social services, home medication delivery, and remote lab monitoring were far less commonly accessible. ACOs expressed that support for telehealth services, investment in remote monitoring capabilities, and funding for new, targeted care innovation initiatives would help them better care for vulnerable patients during this pandemic.


Asunto(s)
Organizaciones Responsables por la Atención/normas , Enfermedad Crónica/terapia , Geriatría/economía , Organizaciones Responsables por la Atención/organización & administración , Organizaciones Responsables por la Atención/estadística & datos numéricos , Anciano , Anciano de 80 o más Años , Enfermedad Crónica/economía , Geriatría/métodos , Geriatría/estadística & datos numéricos , Humanos , Encuestas y Cuestionarios , Estados Unidos
7.
Med Care ; 59(1): 29-37, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33298706

RESUMEN

BACKGROUND: Hospital-based acute care [emergency department (ED) visits and hospitalizations] that is preventable with high-quality outpatient care contributes to health care system waste and patient harm. OBJECTIVE: To test the hypothesis that an ED-to-home transitional care intervention reduces hospital-based acute care in chronically ill, older ED visitors. RESEARCH DESIGN: Convergent, parallel, mixed-methods design including a randomized controlled trial. SETTING: Two diverse Florida EDs. SUBJECTS: Medicare fee-for-service beneficiaries with chronic illness presenting to the ED. INTERVENTION: The Coleman Care Transition Intervention adapted for ED visitors. MEASURES: The main outcome was hospital-based acute care within 60 days of index ED visit. We also assessed office-based outpatient visits during the same period. RESULTS: The Intervention did not significantly reduce return ED visits or hospitalizations or increase outpatient visits. In those with return ED visits, the Intervention Group was less likely to be hospitalized than the Usual Care Group. Interview themes describe a cycle of hospital-based acute care largely outside patients' control that may be difficult to interrupt with a coaching intervention. CONCLUSIONS AND RELEVANCE: Structural features of the health care system, including lack of access to timely outpatient care, funnel patients into the ED and hospital admission. Reducing hospital-based acute care requires increased focus on the health care system rather than patients' care-seeking decisions.


Asunto(s)
Servicio de Urgencia en Hospital/estadística & datos numéricos , Servicios de Atención de Salud a Domicilio , Medicare/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Cuidado de Transición/estadística & datos numéricos , Anciano , Enfermedad Crónica/terapia , Femenino , Florida , Hospitalización , Humanos , Masculino , Medicare/economía , Atención Primaria de Salud , Estados Unidos
8.
J Fam Pract ; 69(10): 493-498, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33348344

RESUMEN

Family medicine's leadership in primary care is slipping as it loses its vision of whole-person care. This model of care can help us better manage and combat chronic disease.


Asunto(s)
Enfermedad Crónica/terapia , Medicina Familiar y Comunitaria/normas , Salud Holística/normas , Guías de Práctica Clínica como Asunto , Atención Primaria de Salud/normas , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Persona de Mediana Edad
9.
BMJ Case Rep ; 13(12)2020 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-33370940

RESUMEN

A 17-year-old Caucasian male presented to ENT with angular stomatitis, oral ulceration and cervical lymphadenopathy. Over the subsequent 18 months he developed recurrent upper respiratory tract infections, pyrexia of unknown origin, oral ulceration and maxillary sinus osteomyelitis. Extensive investigation ensued from various specialties. Positive investigations included a mild but persistently elevated serum Epstein-Barr virus PCR; however, no unifying diagnosis was elicited. It is noteworthy that a significant factor contributing to a delay in his diagnosis was poor compliance with invasive investigations. Ultimately, deteriorating liver function prompted liver biopsy which confirmed a diagnosis of chronic active Epstein-Barr virus infection (CAEBV). This enabled referral for curative treatment in the form of a stem cell transplant. CAEBV is extremely rare in Western countries. Due to fatal complications early diagnosis is critical for successful treatment. Our case highlights the need for regular clinical re-evaluation and a comprehensive multispecialty approach in such cases.


Asunto(s)
Infecciones por Virus de Epstein-Barr/diagnóstico , Herpesvirus Humano 4/aislamiento & purificación , Hígado/patología , Grupo de Atención al Paciente , Adolescente , Biopsia , Enfermedad Crónica/terapia , ADN Viral/sangre , ADN Viral/aislamiento & purificación , Infecciones por Virus de Epstein-Barr/sangre , Infecciones por Virus de Epstein-Barr/terapia , Infecciones por Virus de Epstein-Barr/virología , Herpesvirus Humano 4/genética , Humanos , Hígado/virología , Pruebas de Función Hepática , Masculino , Derivación y Consulta , Trasplante de Células Madre
13.
S Afr Med J ; 110(7): 594-598, 2020 Jul 07.
Artículo en Inglés | MEDLINE | ID: mdl-32880327

RESUMEN

Chronic rhinitis is a troublesome condition for sufferers. It is tempting to label all patients with chronic nasal symptoms as having allergic rhinitis (AR), but many such patients have other causes of chronic rhinitis that need a specific diagnosis and management strategy. Even when the patient fully fits the definition of AR, their condition will be best served by combining medication with ongoing patient education.


Asunto(s)
Enfermedad Crónica , Rinitis/diagnóstico , Enfermedad Crónica/terapia , Trastornos de la Motilidad Ciliar/diagnóstico , Fibrosis Quística/diagnóstico , Diagnóstico Diferencial , Humanos , Educación del Paciente como Asunto , Enfermedades de Inmunodeficiencia Primaria/diagnóstico , Rinitis/etiología , Rinitis/terapia , Sudáfrica
14.
J Med Internet Res ; 22(9): e20874, 2020 09 21.
Artículo en Inglés | MEDLINE | ID: mdl-32896833

RESUMEN

BACKGROUND: The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. OBJECTIVE: The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19-mandated lockdown. METHODS: From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. RESULTS: During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non-COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. CONCLUSIONS: Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Hepatopatías/epidemiología , Hepatopatías/terapia , Pandemias , Neumonía Viral/epidemiología , Telemedicina/estadística & datos numéricos , Atención Ambulatoria , Betacoronavirus , Enfermedad Crónica/terapia , Prestación de Atención de Salud , Brotes de Enfermedades , Femenino , Hospitalización , Humanos , Italia/epidemiología , Masculino , Estudios Prospectivos , Derivación y Consulta
15.
Rev Med Suisse ; 16(708): 1818-1821, 2020 Sep 30.
Artículo en Francés | MEDLINE | ID: mdl-32997453

RESUMEN

This study focuses on the management of chronic depression at the general practitioner's office and the collaboration between general practitioner (GP)-psychiatrist. Our study's highlights two different situations: patients able to verbalize their psychological suffering and who can be directly referred to the psychiatrist and patients expressing their psychological suffering mainly by physical symptoms. GPs consider they first have to work with their patient to help them connect their somatic symptoms and their psychological suffering, which will allow them to refer their patient to the psychiatrist. If this work does not succeed, the GP remains at the forefront of medical care. Long-term support continues, where the GP sometimes ends up giving up on curing and focusing on the doctor/patient relationship.


Asunto(s)
Depresión/terapia , Medicina Familiar y Comunitaria , Médicos Generales , Psiquiatría , Enfermedad Crónica/psicología , Enfermedad Crónica/terapia , Depresión/psicología , Humanos , Relaciones Médico-Paciente , Estrés Psicológico
17.
J Pediatr Psychol ; 45(9): 977-982, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-32929482

RESUMEN

The COVID-19 pandemic has presented unique circumstances that have the potential to both positively and negatively affect pediatric adherence and self-management in youth with chronic medical conditions. The following paper discusses how these circumstances (e.g., stay-at-home orders, school closures, changes in pediatric healthcare delivery) impact disease management at the individual, family, community, and healthcare system levels. We also discuss how barriers to pediatric adherence and self-management exacerbated by the pandemic may disproportionately affect underserved and vulnerable populations, potentially resulting in greater health disparities. Given the potential for widespread challenges to pediatric disease management during the pandemic, ongoing monitoring and promotion of adherence and self-management is critical. Technology offers several opportunities for this via telemedicine, electronic monitoring, and mobile apps. Moreover, pediatric psychologists are uniquely equipped to develop and implement adherence-promotion efforts to support youth and their families in achieving and sustaining optimal disease management as the current public health situation continues to evolve. Research efforts addressing the short- and long-term impact of the pandemic on pediatric adherence and self-management are needed to identify both risk and resilience factors affecting disease management and subsequent health outcomes during this unprecedented time.


Asunto(s)
Betacoronavirus , Enfermedad Crónica/terapia , Infecciones por Coronavirus/prevención & control , Pandemias/prevención & control , Cooperación del Paciente/estadística & datos numéricos , Neumonía Viral/prevención & control , Automanejo/estadística & datos numéricos , Telemedicina/métodos , Adolescente , Niño , Enfermedad Crónica/psicología , Infecciones por Coronavirus/psicología , Humanos , Aplicaciones Móviles , Neumonía Viral/psicología , Automanejo/métodos
18.
Nature ; 585(7824): 193-202, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32908264

RESUMEN

Advances in machine learning and contactless sensors have given rise to ambient intelligence-physical spaces that are sensitive and responsive to the presence of humans. Here we review how this technology could improve our understanding of the metaphorically dark, unobserved spaces of healthcare. In hospital spaces, early applications could soon enable more efficient clinical workflows and improved patient safety in intensive care units and operating rooms. In daily living spaces, ambient intelligence could prolong the independence of older individuals and improve the management of individuals with a chronic disease by understanding everyday behaviour. Similar to other technologies, transformation into clinical applications at scale must overcome challenges such as rigorous clinical validation, appropriate data privacy and model transparency. Thoughtful use of this technology would enable us to understand the complex interplay between the physical environment and health-critical human behaviours.


Asunto(s)
Inteligencia Ambiental , Prestación de Atención de Salud/métodos , Monitoreo del Ambiente/métodos , Algoritmos , Enfermedad Crónica/terapia , Prestación de Atención de Salud/normas , Unidades Hospitalarias , Humanos , Salud Mental , Seguridad del Paciente , Privacidad
19.
PLoS One ; 15(9): e0238356, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32991624

RESUMEN

BACKGROUND: A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample. METHODS: We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health. RESULTS: Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency. IMPLICATIONS: Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.


Asunto(s)
Afroamericanos/estadística & datos numéricos , Enfermedad Crónica/terapia , Comunicación , Disparidades en Atención de Salud , Hispanoamericanos/estadística & datos numéricos , Atención Dirigida al Paciente/normas , Relaciones Médico-Paciente , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Estudios de Seguimiento , Humanos , Cobertura del Seguro , Masculino , Persona de Mediana Edad , Educación del Paciente como Asunto , Pronóstico , Racismo/estadística & datos numéricos
20.
PLoS One ; 15(9): e0236861, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32960886

RESUMEN

OBJECTIVE: Telephone based health coaching (TBHC) seems to be a promising approach to foster self-management in patients with chronic conditions. The aim of this study was to evaluate the effectiveness of a TBHC on patient-reported outcomes and health behavior for people living with chronic conditions in Germany. METHODS: Patients insured at a statutory health insurance were randomized to an intervention group (IG; TBHC) and a control group (CG; usual care), using a stratified random allocation before giving informed consent (Zelen's single-consent design). The TBHC was based on motivational interviewing, goal setting, and shared decision-making and carried out by trained nurses. All outcomes were assessed yearly for three years. We used mixed effects models utilizing all available data in a modified intention-to-treat sample for the main analysis. Participants and study centers were included as random effects. All models were adjusted for age, education and campaign affiliation. RESULTS: Of the 10,815 invited patients, 4,283 returned their questionnaires at baseline. The mean age was 67.23 years (SD = 9.3); 55.5% were female. According to the model, TBHC was statistically significant superior to CG regarding 6 of 19 outcomes: physical activity in hours per week (p = .030) and in metabolic rate per week (p = .048), BMI (p = .009) (although mainly at baseline), measuring blood pressure (p< .001), patient activation (p< .001), and health literacy (p< .001). Regarding stages of change (p = .005), the IG group also showed statistically different results than the CG group, however the conclusion remains inconclusive. Within-group contrasts indicating changes from baseline to follow-ups and significant between-group comparisons regarding these changes supported the findings. Standardized effect sizes were small. TBHC did not show any effect on mental QoL, health status, alcohol, smoking, adherence, measuring blood sugar, foot monitoring, anxiety, depression and distress. Campaign-specific subgroup effects were detected for 'foot monitoring by a physician' and 'blood sugar measurement'. CONCLUSION: TBHC interventions might have small effects on some patient reported and behavioral outcomes. PRACTICE IMPLICATIONS: Future research should focus on analyzing which intervention components are effective and who profits most from TBHC interventions. REGISTRATION: German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS): DRKS00000584.


Asunto(s)
Enfermedad Crónica/terapia , Asesoramiento a Distancia/métodos , Conductas Relacionadas con la Salud , Medición de Resultados Informados por el Paciente , Telemedicina , Anciano , Ansiedad/psicología , Glucemia/análisis , Ejercicio Físico , Femenino , Alemania , Alfabetización en Salud , Estado de Salud , Humanos , Masculino , Persona de Mediana Edad , Entrevista Motivacional , Participación del Paciente , Autocuidado
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...