Predictors of health-related quality of life in people with a complex chronic disease including multimorbidity: a longitudinal cohort study.

PURPOSE: Factors that predict the health-related quality of life (HRQoL) of people with complex chronic diseases have not been investigated to date. Determining the impact of disease on daily activities is a factor that is particularly important with this group of people. This study examined the influence of a range of predictors (including the impact of chronic diseases on daily activities), on HRQoL in patients with complex chronic diseases over a 12-month period. METHOD: A longitudinal cohort study was conducted with outcomes measured at baseline, 3, 6 and 12 months post-baseline. Adults attending an Australian community-based rehabilitation service were included. HRQoL was measured using the SF-36 and corresponding preference-based health utility. Predictor variables included sociodemographic factors, disease factors (e.g. impact of diseases on daily activities), intervention factors, psychosocial factors and HRQoL components that were not included as the dependent variable. Linear mixed-effects regression was used to examine the relationship between predictor variables and HRQoL. RESULTS: Data from 351 participants were included. The impact of chronic disease on daily activities was the most frequent significant predictor of HRQoL outcomes. Other significant predictors included the impact of chronic back pain or sciatica on daily activities, the number of comorbidities, general health functioning and psychological distress. CONCLUSION: Models of health care for people with complex chronic disease may be enhanced by greater focus on patients' daily activities during assessment and intervention delivery. The range of significant predictors highlights the importance of an interdisciplinary team for managing complex chronic disease or targeted intervention strategies.

Experiences from an interprofessional student-assisted chronic disease clinic.

Faced with significant health and workforce challenges in the region, the Central Queensland Health Service District (CQHSD) commenced a student-assisted clinical service. The Capricornia Allied Health Partnership (CAHP) is an interprofessional clinical placement program in which pre-entry students from exercise physiology, nutrition and dietetics, occupational therapy, pharmacy, podiatry and social work are embedded in a collaborative chronic disease service delivery model. The model coordinates multiple student clinical placements to: address service delivery gaps for previously underserved people with chronic disease in need of early intervention and management; provide an attractive clinical placement opportunity for students that will potentially lead to future recruitment success, and demonstrate leadership in developing future health workforce trainees to attain appropriate levels of interprofessional capacity. The CAHP clinic commenced student placements and client services in February 2010. This report provides early evaluative information regarding student experiences included self-reported changes in practice.

Capricornia Allied Health Partnership (CAHP): a case study of an innovative model of care addressing chronic disease through a regional student-assisted clinic.

Faced with significant health and workforce challenges, the Central Queensland Hospital and Health Service commenced an innovative student-assisted clinical model of care. The Capricornia Allied Health Partnership (CAHP) in 2010. The clinic supports pre-entry allied health student clinical placements to: (1) address service delivery gaps for previously underserved people with chronic disease; (2) facilitate hospital avoidance and early discharge from the local hospital; (3) provide an attractive clinical placement opportunity for allied health students that will potentially lead to future recruitment success, and (4) demonstrate leadership in developing interprofessional skills of future health workforce trainees. This case study details the conceptual background of the initial model, the key features of the clinical placement and service delivery model, and discusses the current and future evaluation of the clinic.

The health outcomes and costs of people attending an interdisciplinary chronic disease service in regional Australia: protocol for a longitudinal cohort investigation.

BACKGROUND: Rates of chronic disease are escalating around the world. To date health service evaluations have focused on interventions for single chronic diseases. However, evaluations of the effectiveness of new intervention strategies that target single chronic diseases as well as multimorbidity are required, particularly in areas outside major metropolitan centres where access to services, such as specialist care, is difficult and where the retention and recruitment of health professionals affects service provision. METHODS: This study is a longitudinal investigation with a baseline and three follow-up assessments comparing the health and health costs of people with chronic disease before and after intervention at a chronic disease clinic, in regional Australia. The clinic is led by students under the supervision of health professionals. The study will provide preliminary evidence regarding the effectiveness of the intervention, and evaluate the influence of a range of factors on the health outcomes and costs of the patients attending the clinic. Patients will be evaluated at baseline (intake to the service), and at 3-, 6-, and 12-months after intake to the service. Health will be measured using the SF-36 and health costs will be measured using government and medical record sources. The intervention involves students and health professionals from multiple professions working together to treat patients with programs that include education and exercise therapy programs for back pain, and Healthy Lifestyle programs; as well as individual consultations involving single professions. DISCUSSION: Understanding the effect of a range of factors on the health state and health costs of people attending an interdisciplinary clinic will inform health service provision for this clinical group and will determine which factors need to be controlled for in future observational studies. Preliminary evidence regarding changes in health and health costs associated with the intervention will be a platform for future clinical trials of intervention effectiveness. The results will be of interest to teams investigating new chronic disease programs particularly for people with multimorbidity, and in areas outside major metropolitan centres. TRIAL REGISTRATION: Australia and New Zealand Clinical Trials Registry: ACTRN12611000724976.

The sociodemographic and health-related characteristics of a regional population with chronic disease at an interprofessional student-assisted clinic in Queensland Capricornia Allied Health Partnership.

OBJECTIVE: This paper describes the sociodemographic and health-related characteristics of people with chronic disease attending an interprofessional student-assisted clinic in regional Queensland. DESIGN: A retrospective review of data collected during the first 10 months of operation of the clinic was conducted. SETTING, PARTICIPANTS AND OUTCOME MEASURES: Data was collected on up to 378 patients during an intake appointment at the Capricornia Allied Health Partnership (CAHP) community-based clinic and compared with normative reference groups where available. Sociodemographic characteristics included age, gender and education level; health-related characteristics included body mass index and hospitalisations in the previous 12 months; and risk factors included prescribed medications, smoking status and general practitioner-diagnosed medical conditions. RESULTS: Patients attending the CAHP clinic had a mean number of chronic conditions of 4.9 ± 2.1 per patient, and 97% of patients had multimorbidities. A high level of socioeconomic disadvantage was found in comparison with normative comparison groups based on employment, highest level of schooling completed and the index of social disadvantage. Patients predominantly lived in inner regional areas (76.7%). The most common diagnoses of patients attending the clinic for the first time were hypertension, osteoarthritis, high cholesterol, diabetes and chronic back pain. CONCLUSIONS: The CAHP clinic offers a unique student-assisted service model for interprofessional management of patients who are socioeconomically disadvantaged, have multimorbid chronic disease and live in regional areas. The description of baseline data in this paper is important to refine clinic services, to guide other chronic disease clinics and to inform future research study designs.

Health-related quality of life of people with multimorbidity at a community-based, interprofessional student-assisted clinic: Implications for assessment and intervention.

Objective This study examined the relationship between the number of comorbidities and health-related quality of life (HRQoL) and between select physical conditions and HRQoL. Differences in HRQoL in comparison to a normative sample were also examined. Method A cross-sectional study among people with multimorbidity ( n = 401) attending a community-based, interdisciplinary health clinic was conducted. HRQoL was measured using the eight dimensions of the SF-36. Multiple linear regression and t-tests were used to analyse the data. Results A downward trend in HRQoL continued from 2 to 14 concurrent comorbidities. Patients with a higher number of comorbidities reported greater deficits in HRQoL, when age, gender, education and perceived social support were controlled for (beta = -0.11 to -0.31). The impact of the number of comorbidities was greatest for the bodily pain dimension of the SF-36 (beta = -0.31). Deficits were greatest for people with gastrointestinal conditions and back pain or sciatica. Moderate to large deficits in HRQoL compared to a normative population were found (Cohen's d = 0.54-1.16). Discussion Understanding associations between the number and type of physical comorbidities and HRQoL may assist clinical services to design broad but targeted interventions to optimize HRQoL in this group of people.

Reproducibility, longitudinal validity and interpretability of the Disease Burden Morbidity Assessment in people with chronic disease.

OBJECTIVE: To evaluate the reproducibility, longitudinal validity, and interpretability of the disease burden morbidity assessment in people with chronic conditions including multimorbidity. METHODS: The study was conducted using a longitudinal cohort design. A large consecutive sample of adult patients at an Australian community-based rehabilitation service was included with testing at baseline and three-month follow-up (testing longitudinal validity and interpretability). A smaller subsample of patients completed a one-week test-retest (testing reproducibility). Outcome measures included the Disease Burden Morbidity Assessment and 36-item Short-Form Health Survey. Participants in the study received tailored, interdisciplinary intervention between baseline, and three-month follow-up but did not typically receive intervention between baseline and retest. RESULTS: The longitudinal validity and interpretability sample included 351 participants and the reproducibility sample included 56 participants. Longitudinal validity and interpretability were generally supported with hypotheses supported or partly supported and a small percentage of lowest total scores for impact on daily activities (0.6% at baseline, 1.3% at three-month follow-up). Reproducibility parameters were acceptable for the total score measuring impact on daily activities (e.g. ICC = 0.76). DISCUSSION: Reproducibility, longitudinal validity, and interpretability of the disease burden morbidity assessment were generally supported for community-based chronic disease patients.