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1.
Med Clin North Am ; 104(2): 189-198, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32035563

RESUMO

Physicians often overlook exercise as a treatment or prophylactic measure for many common diseases and ailments. It can be used to treat comorbidities including obesity, cardiovascular disease, chronic obstructive pulmonary disease, diabetes mellitus, osteoporosis, osteoarthritis, cancer, and low back pain. Education on the general physical activity guidelines as well as easy exercise prescription methods can improve the ability of physicians to prescribe exercise as a therapeutic option. In addition, identifying barriers to compliance with exercise and ways to overcome these barriers is also necessary in order to use therapeutic exercise effectively.


Assuntos
Terapia por Exercício/métodos , Múltiplas Afecções Crônicas/terapia , Exercício , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Cooperação do Paciente
3.
BMC Health Serv Res ; 19(1): 981, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856797

RESUMO

BACKGROUND: Cancer increases the risk of developing one or more chronic conditions, yet little research describes the associations between health care costs, utilization patterns, and chronic conditions in adults with cancer. The objective of this study was to examine the treated prevalence of chronic conditions and the association between chronic conditions and health care expenses in US adults with cancer. METHODS: This retrospective observational study used US Medical Expenditure Panel Survey (MEPS) Household Component (2010-2015) data sampling adults diagnosed with cancer and one or more of 18 select chronic conditions. The measures used were treated prevalence of chronic conditions, and total and chronic condition-specific health expenses (per-person, per-year). Generalized linear models assessed chronic condition-specific expenses in adults with cancer vs. without cancer and the association of chronic conditions on total health expenses in adults with cancer, respectively, by controlling for demographic and health characteristics. Accounting for the complex survey design in MEPS, all data analyses and statistical procedures applied longitudinal weights for national estimates. RESULTS: Among 3657 eligible adults with cancer, 83.9% (n = 3040; representing 16 million US individuals per-year) had at least one chronic condition, and 29.7% reported four or more conditions. Among those with cancer, hypertension (59.7%), hyperlipidemia (53.6%), arthritis (25.6%), diabetes (22.2%), and coronary artery disease (18.2%) were the five most prevalent chronic conditions. Chronic conditions accounted for 30% of total health expenses. Total health expenses were $6388 higher for those with chronic conditions vs. those without (p < 0.001). Health expenses associated with chronic conditions increased by 34% in adults with cancer vs. those without cancer after adjustment. CONCLUSIONS: In US adults with cancer, the treated prevalence of common chronic conditions was high and health expenses associated with chronic conditions were higher than those without cancer. A holistic treatment plan is needed to improve cost outcomes.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Múltiplas Afecções Crônicas/economia , Neoplasias/economia , Adulto , Estudos Transversais , Complicações do Diabetes/complicações , Complicações do Diabetes/economia , Complicações do Diabetes/epidemiologia , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Hipertensão/complicações , Hipertensão/economia , Hipertensão/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/terapia , Neoplasias/complicações , Neoplasias/terapia , Prevalência , Estudos Retrospectivos , Inquéritos e Questionários , Estados Unidos/epidemiologia
4.
BMC Health Serv Res ; 19(1): 818, 2019 Nov 08.
Artigo em Inglês | MEDLINE | ID: mdl-31703682

RESUMO

BACKGROUND: While Medicare is a federal health insurance program, managed Medicare limits access to healthcare services to networks within states or territories. However, if a natural disaster requires evacuation, displaced patients are at risk of losing coverage for their benefits. Previous literature has discussed the quality of managed Medicare plans within Puerto Rico but has not addressed the adequacy of this coverage if residents are displaced to the continental United States. We explore Hurricane Maria's impact on a resident of Puerto Rico with chronic health problems, and the challenges he faces seeking healthcare in New York. CASE PRESENTATION: A 59-year-old male with a history of diabetes mellitus type II, coronary artery disease, peripheral vascular disease status post right foot amputation, and end-stage kidney disease on hemodialysis was admitted in October of 2017 for chest pain and swelling of legs for 5 days. The patient had missed his last three dialysis sessions after Hurricane Maria forced him to leave Puerto Rico. In examining this patient's treatment, we observe the effect of Hurricane Maria on the medical management of Puerto Rican residents and identify challenges managed Medicare may pose to patients who cross state or territory lines. CONCLUSIONS: We employ this patient's narrative to frame a larger discussion of Puerto Rican managed Medicare and provide additional recommendations for healthcare providers. Moreover, we consider this case in the context of disaster-related continuity of care for patients with complex medical conditions or treatment regimens. To address the gaps in the care of these patients, this article proposes (1) developing system-based approaches for screening displaced patients, (2) increasing the awareness of Special Enrollment Periods related to Medicare among healthcare providers, and (3) creating policy solutions to assure access to care for patients with complex medical conditions.


Assuntos
Tempestades Ciclônicas , Assistência à Saúde/normas , Desastres , Medicare/normas , Múltiplas Afecções Crônicas/terapia , Hispano-Americanos , Humanos , Seguro Saúde , Masculino , Turismo Médico , Pessoa de Meia-Idade , Múltiplas Afecções Crônicas/etnologia , Cidade de Nova Iorque , Aceitação pelo Paciente de Cuidados de Saúde , Porto Rico/etnologia , Refugiados , Diálise Renal , Estados Unidos
6.
BMC Health Serv Res ; 19(1): 843, 2019 Nov 15.
Artigo em Inglês | MEDLINE | ID: mdl-31730457

RESUMO

BACKGROUND: Patients with multiple chronic conditions represent a growing segment for healthcare. The Chronic Care Model (CCM) supports leveraging community programs to support patients and their caregivers overwhelmed by their treatment plans, but this component has lagged behind the adoption of other model elements. Community Care Teams (CCTs) leverage partnerships between healthcare delivery systems and existing community programs to address this deficiency. There remains a gap in moving CCTs from pilot phase to sustainable full-scale programs. Therefore, the purpose of this study was to identify the cognitive and structural needs of clinicians, social workers, and nurse care coordinators to effectively refer appropriate patients to the CCT and the value these stakeholders derived from referring to and receiving feedback from the CCT. We then sought to translate this knowledge into an implementation toolkit to bridge implementation gaps. METHODS: Our research process was guided by the Assess, Innovate, Develop, Engage, and Devolve (AIDED) implementation science framework. During the Assess process we conducted chart reviews, interviews, and observations and in Innovate and Develop phases, we worked with stakeholders to develop an implementation toolkit. The Engage and Devolve phases disseminate the toolkit through social networks of clinical champions and are ongoing. RESULTS: We completed 14 chart reviews, 11 interviews, and 2 observations. From these, facilitators and barriers to CCT referrals and patient re-integration into primary care were identified. These insights informed the development of a toolkit with seven components to address implementation gaps identified by the researchers and stakeholders. CONCLUSION: We identified implementation gaps to sustaining the CCT program, a community-healthcare partnership, and used this information to build an implementation toolkit. We established liaisons with clinical champions to diffuse this information. The AIDED Model, not previously used in high-income countries' primary care settings, proved adaptable and useful.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Assistência à Saúde/organização & administração , Múltiplas Afecções Crônicas/terapia , Idoso , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Equipe de Assistência ao Paciente/organização & administração , Atenção Primária à Saúde/organização & administração , Avaliação de Programas e Projetos de Saúde
7.
BMC Health Serv Res ; 19(1): 682, 2019 Oct 03.
Artigo em Inglês | MEDLINE | ID: mdl-31581947

RESUMO

BACKGROUND: Person-centred care (PCC) focusing on personalised goals and care plans derived from "What matters to you?" has an impact on single disease outcomes, but studies on multi-morbid elderly are lacking. Furthermore, the combination of PCC, Integrated Care (IC) and Pro-active care are widely recognised as desirable for multi-morbid elderly, yet previous studies focus on single components only, leaving synergies unexplored. The effect of a synergistic intervention, which implements 1) Person-centred goal-oriented care driven by "What matters to you?" with 2) IC and 3) pro-active care is unknown. METHODS: Inspired by theoretical foundations, complexity science, previous health service research and a patient-driven evaluation of care quality, we designed the Patient-Centred Team (PACT) intervention across primary and secondary care. The PACT team collaborate with the patient to make and deliver a person-centred, integrated and proactive multi-morbidity care-plan. The control group receives conventional care. The study design is a pragmatic six months prospective, controlled clinical trial based on hospital electronic health record data of 439 multi-morbid frail elderly at risk for emergency (re) admissions referred to PACT and 779 propensity score matched controls in Norway, 2014-2016. Outcomes are emergency admissions, the sum of emergency inpatient bed days, 30-day readmissions, planned and emergency outpatient visits and mortality at three and six months follow-up. RESULTS: The Rate Ratios (RR) for emergency admissions was 0,9 (95%CI: 0,82-0,99), for sum of emergency bed days 0,68 (95%CI:0,52-0,79) and for 30-days emergency readmissions 0,72 (95%CI: 0,41-1,24). RRs were 2,3 (95%CI: 2,02-2,55) and 0,9 (95%CI: 0,68-1,20) for planned and emergency outpatient visits respectively. The RR for death at 3 months was 0,39 (95% CI: 0,22-0,70) and 0,57 (95% CI: 0,34-0,94) at 6 months. CONCLUSION: Compared with propensity score matched controls, the care process of frail multi-morbid elderly who received the PACT intervention had a reduced risk of high-level emergency care, increased use of low-level planned care, and substantially reduced mortality risk. Further study of process differences between groups is warranted to understand the genesis of these results better. TRIAL REGISTRATION: ClinicalTrials.gov (identifier: NCT02541474 ), registered Sept 2015.


Assuntos
Prestação Integrada de Cuidados de Saúde/métodos , Múltiplas Afecções Crônicas/terapia , Assistência Centrada no Paciente/métodos , Idoso , Serviço Hospitalar de Emergência , Feminino , Idoso Fragilizado/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Morbidade , Noruega , Planejamento de Assistência ao Paciente , Readmissão do Paciente/estatística & dados numéricos , Pontuação de Propensão , Estudos Prospectivos , Autocuidado
9.
Geriatr Gerontol Int ; 19(8): 699-704, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31397060

RESUMO

The number of older adults is increasing worldwide, including in Asian countries. Various problems associated with medical care for older adults are being highlighted in aging societies. As the number of chronic diseases increases with age, older adults are more likely to have multiple chronic diseases simultaneously (multimorbidity). Multimorbidity results in poor health-related outcomes, leading to increased use and cost of healthcare. Above all, it leads to deterioration in older adults' quality of life. However, it is unclear whether any medical interventions are effective for multimorbidity, which means medical practitioners currently offer medical care "in the dark." It is therefore necessary for researchers and medical professionals involved in geriatric medicine to establish ways to manage multimorbidity among older adults. This means that the development of research in this field is essential. Geriatr Gerontol Int 2019; 19: 699-704.


Assuntos
Geriatria , Multimorbidade/tendências , Múltiplas Afecções Crônicas , Qualidade de Vida , Idoso , Geriatria/métodos , Geriatria/tendências , Saúde Global , Serviços de Saúde para Idosos , Transição Epidemiológica , Humanos , Múltiplas Afecções Crônicas/economia , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/psicologia , Múltiplas Afecções Crônicas/terapia , Pesquisa
10.
Ned Tijdschr Geneeskd ; 1632019 08 19.
Artigo em Holandês | MEDLINE | ID: mdl-31433143

RESUMO

Complexity of patient care is rapidly increasing as a consequence of rising numbers of patients with complex multimorbidity. Not just the patient as a whole, but also the networks of organs, tissues and cells are forming a complex adaptive system (CAS). A CAS is defined as a network of several components ('agents') with lots of mutual feedback loops between which there are circular causalities; the predictability of a CAS is limited by definition. However, current guidelines and evidence-based medicine assume that diseases and the medical interventions to address them are predictable. Physicians' brains are complex neural networks that are much better at dealing with complex situations than guidelines. In the near future, physicians will also get help from advanced computer simulation models that make better diagnostic analyses on the basis of detailed phenotyping and are more accurate when predicting possible courses of disease and treatment outcomes.


Assuntos
Envelhecimento , Multimorbidade/tendências , Múltiplas Afecções Crônicas/terapia , Idoso , Pesquisa Biomédica/organização & administração , Simulação por Computador , Humanos
11.
Geriatr Gerontol Int ; 19(8): 705-710, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31237101

RESUMO

AIM: The purpose of this study was to investigate whether transpersonal trust (TPT) moderates the relationship between chronic conditions and general practitioner (GP) visits among the oldest old in Germany. METHODS: The multicenter prospective cohort Study on Needs, health service use, costs and health-related quality of life in a large sample of oldest old primary care patients (85+) (AgeQualiDe) was carried out. Individuals were recruited through GP offices at six study centers in Germany (follow-up wave 7). Primary care patients were aged ≥85 years (n = 861, mean age 89.0 years; range 85-100 years). The self-reported number of outpatient visits to the GP was used as the outcome measure. To explore religious and spiritual beliefs, the short form of the Transpersonal Trust scale was used. The presence or absence of 36 chronic conditions was recorded by the GP. RESULTS: Multiple Poisson regressions showed that GP visits were positively associated with the number of chronic conditions (incidence rate ratio 1.03, P < 0.05). TPT moderated the relationship between chronic conditions and GP visits (incidence rate ratio 1.01, P < 0.05). The association between chronic conditions and GP visits was significantly more pronounced when TPT was high. CONCLUSION: Our findings highlight the importance of TPT in the relationship between chronic conditions and GP visits. Future longitudinal studies are required to clarify this subject further. Geriatr Gerontol Int 2019; 19: 705-710.


Assuntos
Clínicos Gerais , Múltiplas Afecções Crônicas , Visita a Consultório Médico/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Relações Médico-Paciente , Qualidade de Vida , Espiritualidade , Confiança , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Clínicos Gerais/psicologia , Clínicos Gerais/estatística & dados numéricos , Alemanha , Serviços de Saúde para Idosos/estatística & dados numéricos , Humanos , Masculino , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/psicologia , Múltiplas Afecções Crônicas/terapia , Determinação de Necessidades de Cuidados de Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
12.
BMC Fam Pract ; 20(1): 88, 2019 06 28.
Artigo em Inglês | MEDLINE | ID: mdl-31253097

RESUMO

BACKGROUND: Multimorbid patients may experience a high burden of treatment. This has a negative impact on treatment adherence, health outcomes and health care costs. The objective of our study was to identify factors associated with the self-perceived burden of treatment of multimorbid patients in primary care and to compare them with factors associated with GPs assessment of this burden. METHOD: A cross sectional study in general practices, 100 GPs in Switzerland and up to 10 multimorbid patients per GP. Patients reported their self-perceived burden of treatment using the Treatment Burden Questionnaire (TBQ, possible score 0-150), whereas GPs evaluated the burden of treatment on a Visual Analog Scale (VAS) from 1 to 9. The study explored medical, social and psychological factors associated with burden of treatment, such as number and type of chronic conditions and drugs, severity of chronic conditions (CIRS score), age, quality of life, deprivation, health literacy. RESULTS: The GPs included 888 multimorbid patients. The overall median TBQ was 20 and the median VAS was 4. Both patients' and GPs' assessment of the burden of treatment were inversely associated with patients' age and quality of life. In addition, patients' assessment of their burden of treatment was associated with a higher deprivation score and lower health literacy, and with having diabetes or atrial fibrillation, whereas GPs' assessment of this burden was associated with the patient having a greater number of chronic conditions and drugs, and a higher CIRS score. CONCLUSION: Both from patients' and GPs' perspectives TB appears to be higher in younger patients. Whereas for patients the burden of treatment is associated with socio-economic and psychological factors, GPs' assessments of this burden are associated with medical factors. Including socio-economic and psychological factors on patients' self-perception is likely to improve GPs' assessments of their patients' burden of treatment thus favoring patient-centered care.


Assuntos
Efeitos Psicossociais da Doença , Clínicos Gerais , Múltiplas Afecções Crônicas/terapia , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Estudos Transversais , Feminino , Alfabetização em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Multimorbidade , Atenção Primária à Saúde , Qualidade de Vida , Índice de Gravidade de Doença , Classe Social , Cooperação e Adesão ao Tratamento
13.
BMC Health Serv Res ; 19(1): 237, 2019 Apr 23.
Artigo em Inglês | MEDLINE | ID: mdl-31014343

RESUMO

BACKGROUND: A comprehensive in-hospital patient management with reasonable and economic resource allocation is arguably the major challenge of health-care systems worldwide, especially in elderly, frail, and polymorbid patients. The need for patient management tools to improve the transition process and allocation of health care resources in routine clinical care particularly for the inpatient setting is obvious. To address these issues, a large prospective trial is warranted. METHODS: The "Integrative Hospital Treatment in Older patients to benchmark and improve Outcome and Length of stay" (In-HospiTOOL) study is an investigator-initiated, multicenter effectiveness trial to compare the effects of a novel in-hospital management tool on length of hospital stay, readmission rate, quality of care, and other clinical outcomes using a time-series model. The study aims to include approximately 35`000 polymorbid medical patients over an 18-month period, divided in an observation, implementation, and intervention phase. Detailed data on treatment and outcome of polymorbid medical patients during the in-hospital stay and after 30 days will be gathered to investigate differences in resource use, inter-professional collaborations and to establish representative benchmarking data to promote measurement and display of quality of care data across seven Swiss hospitals. The trial will inform whether the "In-HospiTOOL" optimizes inter-professional collaboration and thereby reduces length of hospital stay without harming subjective and objective patient-oriented outcome markers. DISCUSSION: Many of the current quality-mirroring tools do not reflect the real need and use of resources, especially in polymorbid and elderly patients. In addition, a validated tool for optimization of patient transition and discharge processes is still missing. The proposed multicenter effectiveness trial has potential to improve interprofessional collaboration and optimizes resource allocation from hospital admission to discharge. The results will enable inter-hospital comparison of transition processes and accomplish a benchmarking for inpatient care quality.


Assuntos
Benchmarking/normas , Múltiplas Afecções Crônicas/terapia , Adolescente , Adulto , Idoso , Ensaios Clínicos como Assunto , Pesquisa Comparativa da Efetividade , Assistência à Saúde/estatística & dados numéricos , Prestação Integrada de Cuidados de Saúde/normas , Hospitalização/estatística & dados numéricos , Humanos , Relações Interprofissionais , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Multicêntricos como Assunto , Alta do Paciente/normas , Readmissão do Paciente/normas , Transferência de Pacientes/normas , Ensaios Clínicos Pragmáticos como Assunto , Estudos Prospectivos , Qualidade da Assistência à Saúde , Alocação de Recursos , Adulto Jovem
14.
BMC Fam Pract ; 20(1): 53, 2019 04 22.
Artigo em Inglês | MEDLINE | ID: mdl-31010425

RESUMO

BACKGROUND: Limited studies exist on successful interventions for patients with multimorbidity. Even more limited is the knowledge on how socioeconomic factors have an impact on these interventions. The objective of this study was to analyze the effect of a multidisciplinary self-management intervention among patients with multimorbidity and the impact of socioeconomic factors on the results. METHODS: Secondary data analysis limited to multimorbid patients from of a pragmatic randomized trial evaluating an intervention that included patients (18 to 75 yrs.) from eight primary care practices in Quebec, Canada. The intervention included self-management support and patient-centred motivational approaches. Self-management was evaluated using the Health Education Impact Questionnaire (heiQ) which measures eight different domains. Changes in heiQ were analyzed following the three-month intervention with univariate and multivariate logistic regressions. RESULTS: Participants with three or more chronic conditions (n = 281), randomized to intervention or control groups, were included in this analysis. The effect of the intervention on the likelihood of an improvement in self-management was significant in six heiQ domains in the univariate analysis (Odd ratio; 95% CI): Health-directed behaviour (2.03; 1.16-3.55), Emotional well-being (1.97; 1.05-3.68), Self-monitoring and insight (2.35; 1.02-5.40), Constructive attitudes and approaches (2.91; 1.45-5.84), Skill and technique acquisition (1.96; 1.13-3.39), and Health services navigation (2.52; 1.21-5.21). After controlling for age and gender the results remained essentially the same. After additional adjustments for family income, education and self-perceived financial status, the likelihood of an improvement was no longer significant in the domains Emotional well-being and Self-monitoring and insight. CONCLUSIONS: The intervention produced significant improvements in multimorbid patients for most domains of self-management. Socioeconomic factors had a minor impact on the results. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT01319656.


Assuntos
Status Econômico , Escolaridade , Renda , Múltiplas Afecções Crônicas/terapia , Assistência Centrada no Paciente , Autogestão/educação , Adulto , Fatores Etários , Idoso , Feminino , Comportamentos Relacionados com a Saúde , Humanos , Modelos Logísticos , Masculino , Saúde Mental , Pessoa de Meia-Idade , Motivação , Multimorbidade , Análise Multivariada , Educação de Pacientes como Assunto , Ensaios Clínicos Controlados Aleatórios como Assunto , Autogestão/métodos , Fatores Sexuais , Participação Social , Fatores Socioeconômicos
15.
Rheum Dis Clin North Am ; 45(2): 303-314, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30952400

RESUMO

Project ECHO (Extension for Community Healthcare Outcomes) was developed at the University of New Mexico Health Sciences Center to educate health care professionals in underserved communities to treat chronic complex diseases, allowing patients to receive better care, closer to home, with greater convenience, and at lower cost than referral to a specialty center. Videoconferencing technology is used to create learning networks, with case-based discussions as the primary method of education. The 3-year experience of Bone Health TeleECHO, a strategy to improve the care of osteoporosis and reduce the large treatment gap, is discussed.


Assuntos
Serviços de Saúde Comunitária , Assistência à Saúde , Múltiplas Afecções Crônicas/terapia , Melhoria de Qualidade/organização & administração , Desenvolvimento de Pessoal , Telemedicina/métodos , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/normas , Alfabetização Digital , Assistência à Saúde/métodos , Assistência à Saúde/normas , Humanos
16.
BMC Fam Pract ; 20(1): 37, 2019 02 27.
Artigo em Inglês | MEDLINE | ID: mdl-30813904

RESUMO

BACKGROUND: The treatment of multimorbid patients is one crucial task in general practice as multimorbidity is highly prevalent in this setting. However, there is little evidence how to treat these patients and consequently there are but a few guidelines that focus primarily on multimorbidity. Big data analytics are defined as a method that obtains results for high volume data with high variety generated at high velocity. Yet, the explanatory power of these results is not completely understood. Nevertheless, addressing multimorbidity as a complex condition might be a promising field for big data analytics. The aim of this scoping review was to evaluate whether applying big data analytics on patient data does already contribute to the treatment of multimorbid patients in general practice. METHODS: In January 2018, a review searching the databases PubMed, The Cochrane Library, and Web of Science, using defined search terms for "big data analytics" and "multimorbidity", supplemented by a search of grey literature with Google Scholar, was conducted. Studies were not filtered by type of study, publication year or language. Validity of studies was evaluated independently by two researchers. RESULTS: In total, 2392 records were identified for screening. After title and abstract screening, six articles were included in the full-text analysis. Of those articles, one reported on a model generated with big data techniques to help caring for one group of multimorbid patients. The other five articles dealt with the analysis of multimorbidity clusters. No article defined big data analytics explicitly. CONCLUSIONS: Although the usage of the phrase "Big Data" is growing rapidly, there is nearly no practical use case for big data analysis techniques in the treatment of multimorbidity in general practice yet. Furthermore, in publications addressing big data analytics, the term is rarely defined. However, possible models and algorithms to address multimorbidity in the future are already published.


Assuntos
Big Data , Informática Médica , Múltiplas Afecções Crônicas/terapia , Medicina Geral , Humanos , Multimorbidade
17.
BMJ Open ; 9(1): e024724, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30782742

RESUMO

INTRODUCTION: The University of Utah (UofU) Health intensive outpatient clinic (IOC) is a primary care clinic for medically complex (high-cost, high-need) patients with Medicaid. The clinic consists of a multidisciplinary care team aimed at providing coordinated, comprehensive and patient-centred care. The protocol outlines the quantitative design of an evaluation study to determine the IOC's effects on reducing healthcare utilisation and costs, as well as improving patient-reported health outcomes and quality of care. METHODS AND ANALYSIS: High-risk patients, with high utilisation and multiple chronic illnesses, were identified in the Medicaid ACO population managed by the UofU Health plans for IOC eligibility. A prospective, case-control study design is being used to match 100 IOC patients to 200 control patients (receiving usual care within the UofU) based on demographics, health utilisation and medical complexity for evaluating the primary outcome of change in healthcare utilisation and costs. For the secondary outcomes of patient health and care quality, a prepost design will be used to examine within-person change across the 18 months of follow-up (ie, before and after IOC intervention). Logistic regression and hierarchical, longitudinal growth modelling are the two primary modelling approaches. ETHICS AND DISSEMINATION: This work has received ethics approval by the UofU Institutional Review Board. Results from the evaluation of primary and secondary outcomes will be disseminated in scientific research journals and presented at national conferences.


Assuntos
Assistência Ambulatorial/organização & administração , Assistência à Saúde/organização & administração , Utilização de Instalações e Serviços/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Múltiplas Afecções Crônicas/terapia , Atenção Primária à Saúde/organização & administração , Centros Médicos Acadêmicos , Assistência Ambulatorial/economia , Estudos de Casos e Controles , Assistência à Saúde/economia , Utilização de Instalações e Serviços/economia , Necessidades e Demandas de Serviços de Saúde , Humanos , Modelos Logísticos , Medicaid , Múltiplas Afecções Crônicas/economia , Equipe de Assistência ao Paciente , Medidas de Resultados Relatados pelo Paciente , Assistência Centrada no Paciente , Atenção Primária à Saúde/economia , Avaliação de Programas e Projetos de Saúde , Estudos Prospectivos , Estados Unidos , Utah
19.
BMC Fam Pract ; 20(1): 7, 2019 01 09.
Artigo em Inglês | MEDLINE | ID: mdl-30626313

RESUMO

BACKGROUND: The PR1MaC study was conducted to evaluate the integration of Chronic Disease Prevention and Management services into primary care practices and was reported effective. The aim of this study was to further explore the effects of the PR1MaC intervention on patients and their family. METHODS: We conducted a qualitative study embedded in a randomized controlled trial. The trial was implemented in eight primary health care practices in the Saguenay region, Quebec, Canada. The interdisciplinary patient-centred team-based intervention included self-management support and a motivational approach. We conducted focus groups and semi-directed individual interviews with patients, family members and healthcare professionals. RESULTS: Perceived positive effects can be grouped into six major themes: awareness, improved knowledge, improved motivation and empowerment, adoption of healthy behaviours, improvement of health status and improvement of quality of life. On the negative side, some participants reported lack of sustainability of newly acquired benefits in the months following the intervention. CONCLUSIONS: Integrating chronic disease prevention and management services into primary care settings had impacts on patients and their family members. These findings are consistent with findings that were reported in the quantitative study. Further studies should address longterm sustainabilility in terms of benefits for the patients. TRIAL REGISTRATION: ClinicalTrials.gov, no.: NCT01319656 .


Assuntos
Múltiplas Afecções Crônicas/terapia , Serviços Preventivos de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Gerenciamento Clínico , Feminino , Grupos Focais , Estilo de Vida Saudável , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Múltiplas Afecções Crônicas/prevenção & controle , Pesquisa Qualitativa , Quebeque , Ensaios Clínicos Controlados Aleatórios como Assunto , Autogestão
20.
Aging Male ; 22(3): 177-186, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29571272

RESUMO

The aim of the study was to assess the incidence and severity of the frailty syndrome assessed with the Edmonton Frailty Scale. This is a cross-sectional study conducted among 382 patients (236 men and 146 women, mean age 71.9 years). The Edmonton Frailty Scale was administered during the patient's admission to the hospital. The Polish adaptation was performed using the standard methodology. The Cronbach's alpha coefficient for the whole Edmonton Frailty Scale was 0.709. The mean correlation between positions and the overall result was r = 0.180. There were no statistically significant differences between women and men in the area of Edmonton Frailty Scale mean score (p < 0.05). The socio-clinical analysis, showed statistically significant differences in the age of respondents, educational attainment, occupational activity, number of drugs taken and co-occurrence of chronic diseases. A higher values of the Edmonton Frailty Scale were indicated for individuals >70 years than for those <70 years (p < 0.001). The Edmonton Frailty Scale proved to be a reliable tool which may be used in the Polish population. The use of this questionnaire for frailty syndrome may be helpful in everyday clinical practice.


Assuntos
Fragilidade , Avaliação Geriátrica/métodos , Múltiplas Afecções Crônicas , Pesos e Medidas , Idoso , Estudos Transversais , Feminino , Idoso Fragilizado , Fragilidade/diagnóstico , Fragilidade/epidemiologia , Humanos , Masculino , Múltiplas Afecções Crônicas/epidemiologia , Múltiplas Afecções Crônicas/terapia , Polônia/epidemiologia , Fatores Sexuais , Fatores Socioeconômicos
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