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Effect of Continuity of Care on Quality of Life in Older Adults With Chronic Diseases: A Meta-Analysis
Abstract
As the population ages, continuity of care (CoC) has increasingly become a particular important issue. Articles published from 1994 to 2014 were identified from electronic databases. Studies with randomized controlled design and elderly adults with chronic illness were included if Short Form-36 (SF-36) was used as an outcome indicator to evaluate the effect of CoC. Seven studies were included for analysis with the sum of 1,394 participants. The results showed that CoC intervention can significantly improve physical function, physical role function, general health, social function, and vitality of QoL for elderly people with chronic disease.
... 9 Health systems need effective and sustainable interventions to improve health outcomes and mitigate the risks of adverse events for people with multiple longterm conditions and frailty. 1,2,10,11 Several systematic reviews 10,[12][13][14][15] have examined the effectiveness of various complex interventions in improving health outcomes for these populations. This literature can be hard to interpret because there is heterogeneity in the components of complex interventions that have the same name and considerable overlap between interventions with different names. ...
... We removed eight older, highly overlapping reviews, 33-40 leaving 29 reviews with low overlap in primary studies that were included (median 8% overlap and interquartile range 5-14%; figure 2). Of the 29 included reviews, 14 (48·3%) were published between 2018 and 2022 (table 1), with the total number of included primary studies ranging from four 22 to 85. 59 12 (41·4%) of 29 reviews reported only on randomised controlled trials (RCTs), 10,12,20,42,47,51,56,57,[60][61][62][63] whereas seven (24%) reviews included more non-randomised study designs than RCTs. 22,43,46,48,52,54,64 Six (4·8%) reviews did not specify where the included interventions were implemented. ...
... 22,43,46,48,52,54,64 Six (4·8%) reviews did not specify where the included interventions were implemented. 12,42,54,55,57,61 In the 23 reviews that reported the location, approximately half of the included interventions were implemented in North America (the USA and Canada), Europe (the UK, the Netherlands, Germany, France, Italy, Spain, and Scandinavia), and Australia (appendix pp [8][9][10][11][12]. ...
Holistic assessment-based interventions (HABIs) are effective in older people admitted to hospital, but it is unclear whether similar interventions are effective in adults with multiple long-term conditions or frailty in the community. We conducted an umbrella review to comprehensively evaluate the literature on HABIs for adults (aged ≥18 years) with multiple long-term conditions, and frailty. We searched eight databases for systematic reviews reporting on experimental or quasi-experimental studies. Of 9803 titles screened, we identified 29 eligible reviews (14 with meta-analysis) reporting on 14 types of HABIs. The evidence for the effectiveness of HABIs was largely inconsistent across different types of interventions, settings, and outcomes. We found evidence of no benefit from hospital HABIs on health-related quality of life (HRQoL) and emergency department re-attendance, and evidence of no benefit from community HABIs on overall health-care utilisation rates, emergency department attendance, nursing home admissions, and mortality. The best evidence of effectiveness was for hospital comprehensive geriatric assessment (CGA) on nursing home admissions, keeping patients alive and in their own homes. There was some evidence of benefit from community CGA on hospital admissions, and from CGA spanning community and hospital settings on HRQoL. Patient-centred medical homes had beneficial effects on HRQoL, mental health, self-management, and hospital admissions.
... The current article based on 16 included studies revealed that: compared with usual care, (1) the scores of SF-36 outcomes increase as follow-up time extending, except for the general health and mental health subscales that showed a reduction in the 12-month follow-up; (2) TC significantly improved patient' s mental health, physical functioning and Fig. 1 Forest plot of mental health at 1, 3, 6 and 12 months vitality at both short term and long term after discharge; (3) TC only significantly improved patients' general health and social function at long term, and only significantly improved patients' role limitation due to physical problems and bodily pain at short term; (4) TC significantly improved the outcomes of general health, mental health, physical functioning, social function and vitality for patients with hip fracture at the long term. Compared with the previous meta-analysis [36], the current article was performed based on more included studies (16 vs. 7), which enabled us to combine the results based on short-term (1 and 3 months) and long-term (6 and 12 months) follow-up, and conduct subgroup analysis based on the diseases for hospitalization. Depending on the follow-up time, we found that TC intervention significantly improved patient's mental health at both short-and longterm follow-up, while there was no significant difference between groups in Chen et al.'s study. ...
... Hence, based on more included studies we believed that TC can significantly improve mental health in both the short and long term and role limitation due to emotional problems in short term among older adults with CDs. Furthermore, subgroup analysis on hip fracture found that in most dimensions, the TC generated significantly better outcomes than Regardless of these differences, we still obtained some consistent results with the previous one [36]. Firstly, we found that there was no significant difference between groups regarding bodily pain and role limitation due to emotional problems. ...
... Additionally, significant differences were observed in the subgroup analysis of 1 and 3 months, implying that TC was more effective in those with CDs such as cardiac, respiratory, endocrine, nervous system. In the evaluation of role limitation due to emotional problems, there was no significant difference in the subgroup of 12 months, though consistent findings were obtained at 3-6 months in the previous one [36]. The forest plot (Fig. 6s) revealed that study Shyu 2010b significantly influenced the combined result. ...
Background
Transitional care (TC) has become increasingly important for elders with chronic diseases (CDs) discharged from hospital as the population ages. This study aims to analyze the health quality of life (HQoL) in elders received TC based on the Short Form-36 (SF-36) indicator.Methods
PubMed, EMBASE, Web of Science and Science Direct were systematically search for studies. Studies compared HQoL used SF-36 between TC and usual care on elders discharged for CDs were included. Analysis was performed with respect to the 8 dimensions of SF-36.ResultsA total of 16 studies were included. Compared with usual care, (1) the scores of SF-36 outcomes increase as follow-up time extending; (2) transitional care significantly improved mental health, physical functioning and vitality at both short and long term after discharge; (3) transitional care only significantly improved general health and social function at long term; and role limitation due to emotional problems and bodily pain at short term; (4) transitional care significantly improved general health, mental health, physical functioning, social function and vitality for patients with hip fracture at long term.ConclusionTC can significantly improve physically and mentally HQoL for elder patients discharge for CDs compared with usual care.
... Autogenic exercise has been proven to be effective in reducing physical and psychological tension through increasing parasympathetic nervous system activity, which plays a role in reducing stress and anxiety in the elderly (Garcia et al., 2020). This increase in parasympathetic function contributes to reducing psychological symptoms such as anxiety and stress that are often experienced by older adults with DM, thus overall improving their quality of life (Chen et al., 2017). ...
... The decrease in quality of life in the control group indicates that without structured intervention and ongoing support, older adults with DM are at risk of experiencing decreased motivation for life and worse mental health (Chen et al., 2017). This decline is consistent with the findings of previous studies showing that older adults with chronic illnesses who do not receive physical and psychological support interventions tend to experience a progressive decline in quality of life (Garcia et al., 2020). ...
The rising number of older adults in Indonesia, particularly those living with non-communicable diseases (NCDs) like diabetes mellitus (DM), presents significant challenges in enhancing their quality of life. This study investigates the impact of combining autogenic exercise with Al-Quran murottal on the quality of life among the elderly with DM. Employing a quasi-experimental design with a pre- and post-test approach, the research involved 89 elderly participants who met the inclusion criteria. These participants were divided into two groups: an intervention group, which received regular sessions of autogenic training combined with Al-Quran murottal, and a control group, which practiced self-directed internalization. The WHOQOL-OLD instrument was used to assess quality of life, with data analyzed using paired t-test and independent t-test. The findings revealed a significant improvement in the quality of life for the intervention group, as reflected by an increase in the average score from 49.42 to 74.72 (p < 0.05). Conversely, the control group experienced a minor, statistically insignificant decline in quality of life. These results demonstrate that integrating physical and spiritual elements, such as autogenic exercises and Al-Quran murottal, effectively enhances the quality of life for older adults with DM, offering a holistic approach to improving their well-being.
... and GP satisfaction, [6][7][8][9] better patient-provider relationship, 6 8 better patient quality of life, [10][11][12] higher medication adherence, [13][14][15] lower use of hospital services, 7 15-20 better health outcomes 11 13 21 22 and an overall reduction in healthcare costs. [23][24][25] Additionally, higher levels of personal continuity are associated with a lower mortality rate. ...
... and GP satisfaction, [6][7][8][9] better patient-provider relationship, 6 8 better patient quality of life, [10][11][12] higher medication adherence, [13][14][15] lower use of hospital services, 7 15-20 better health outcomes 11 13 21 22 and an overall reduction in healthcare costs. [23][24][25] Additionally, higher levels of personal continuity are associated with a lower mortality rate. ...
Aim
To evaluate the effectiveness, feasibility and acceptability of a multicomponent intervention for improving personal continuity for older patients in general practice.
Design
A cluster randomised three-wedged, pragmatic trial during 18 months.
Setting
32 general practices in the Netherlands.
Participants
221 general practitioners (GPs), practice assistants and other practice staff were included. Practices were instructed to include a random sample of 1050 patients aged 65 or older at baseline and 12-month follow-up.
Intervention
The intervention took place at practice level and included opTimise persOnal cOntinuity for oLder (TOOL)-kit: a toolbox containing 34 strategies to improve personal continuity.
Outcomes
Data were collected at baseline and at six 3-monthly follow-up measurements. Primary outcome measure was experienced continuity of care at the patient level measured by the Nijmegen Continuity Questionnaire (NCQ) with subscales for personal continuity (GP knows me and GP shows commitment) and team/cross-boundary continuity at 12-month follow-up. Secondary outcomes were measured in GPs, practice assistants and other practice staff and included work stress and satisfaction and perceived level of personal continuity. In addition, a process evaluation was undertaken among GPs, practice assistants and other practice staff to assess the acceptability and feasibility of the intervention.
Results
No significant effect of the intervention was observed on NCQ subscales GP knows me (adjusted mean difference: 0.05 (95% CI −0.05 to 0.15), p=0.383), GP shows commitment (0.03 (95% CI −0.08 to 0.14), p=0.668) and team/cross-boundary (0.01 (95% CI −0.06 to 0.08), p=0.911). All secondary outcomes did not change significantly during follow-up. Process evaluation among GPs, practice assistants and other practice staff showed adequate acceptability of the intervention and partial implementation due to the COVID-19 pandemic and a high perceived workload.
Conclusion
Although participants viewed TOOL-kit as a practical and accessible toolbox, it did not improve personal continuity as measured with the NCQ. The absence of an effect may be explained by the incomplete implementation of TOOL-kit into practice and the choice of general outcome measures instead of outcomes more specific for the intervention.
Trial registration number
International Clinical Trials registry Platform (ICTRP), trial NL8132 (URL: ICTRP Search Portal (who.int).
... The advantages of COC have been documented in many countries [16][17][18][19][20][21][22][23][24][25]. Previous studies demonstrated that a high level of continuity of care contributed to reducing mortality [18], hospital and emergency admission, and healthcare costs [19][20][21], improving treatment adherence and disease control [22][23][24] as well as leveraging patient satisfaction and quality of life [25]. ...
... The advantages of COC have been documented in many countries [16][17][18][19][20][21][22][23][24][25]. Previous studies demonstrated that a high level of continuity of care contributed to reducing mortality [18], hospital and emergency admission, and healthcare costs [19][20][21], improving treatment adherence and disease control [22][23][24] as well as leveraging patient satisfaction and quality of life [25]. Chronic care requires coordinated care among the multidisciplinary team and multi-care levels to ensure patients do not feel frustrated when they visit different healthcare providers in the referral process and do not receive inconsistent advice and information from various providers [26]. ...
Background
Vietnam is undergoing a rapid epidemiological transition with a considerable burden of non-communicable diseases (NCDs), especially hypertension and diabetes (T2DM). Continuity of care (COC) is widely acknowledged as a benchmark for an efficient health system. This study aimed to determine the COC level for hypertension and T2DM within and across care levels and to investigate its associations with health outcomes and disease control.
Methods
A cross-sectional study was conducted on 602 people with T2DM and/or hypertension managed in primary care settings. We utilized both the Nijmegen continuity of care questionnaire (NCQ) and the Bice - Boxerman continuity of care index (COCI) to comprehensively measure three domains of COC: interpersonal, informational, and management continuity. ANOVA, paired-sample t-test, and bivariate and multivariable logistic regression analysis were performed to examine the predictors of COC.
Results
Mean values of COC indices were: NCQ: 3.59 and COCI: 0.77. The proportion of people with low NCQ levels was 68.8%, and that with low COCI levels was 47.3%. Primary care offered higher informational continuity than specialists (p < 0.01); management continuity was higher within the primary care team than between primary and specialist care (p < 0.001). Gender, living areas, hospital admission and emergency department encounters, frequency of health visits, disease duration, blood pressure and blood glucose levels, and disease control were demonstrated to be statistically associated with higher levels of COC.
Conclusions
Continuity of primary care is not sufficiently achieved for hypertension and diabetes mellitus in Vietnam. Strengthening robust primary care services, improving the collaboration between healthcare providers through multidisciplinary team-based care and integrated care approach, and promoting patient education programs and shared decision-making interventions are priorities to improve COC for chronic care.
... Continuity of Care (CoC) is a form of patient-centered care that patients and their families can obtain in a continuous and time-sensitive manner. In this form of care, medical resources are integrated through inter-professional teamwork, including physicians, nurses, nutritionists, physical therapists, occupational therapists, and pharmacists [10,11]. The CoC model provides complete care for diabetic patients [11] and improves patient care knowledge, the average length of stay, medical costs, and quality of life by evaluating and drawing up discharge plans, case management, or a CoC service pattern that combines both [10,12]. ...
... In this form of care, medical resources are integrated through inter-professional teamwork, including physicians, nurses, nutritionists, physical therapists, occupational therapists, and pharmacists [10,11]. The CoC model provides complete care for diabetic patients [11] and improves patient care knowledge, the average length of stay, medical costs, and quality of life by evaluating and drawing up discharge plans, case management, or a CoC service pattern that combines both [10,12]. The Patient Continuity of Care Questionnaire (PCCQ) can be used to help professionals understand the nature of continuity of care to enable patients with chronic diseases to self-manage their conditions [12,13]. ...
Background:
Most diabetic patients suffer from chronic diseases affecting their self-management status. This study aims to explore the relationship between the CoC and the self-management of patients with Type 2 Diabetes Mellitus (T2DM) and analyze the predictive factors affecting their self-management.
Methods:
Structured questionnaires were used for data collection. Convenient sampling was adopted to recruit inpatients diagnosed with T2DM in the endocrine ward of a medical hospital in central Taiwan.
Results:
A total of 160 patients were recruited. The average age of the patients is 66.60 ± 14.57 years old. Among the four dimensions of the self-management scale, the average score of the problem-solving dimension was the highest, and that of the self-monitoring of blood glucose was the lowest. The analysis results showed that the overall regression model could explain 20.7% of the total variance in self-management.
Conclusions:
Healthcare providers should attach importance to the CoC of T2DM patients and encourage patients to maintain good interaction with healthcare providers during their hospitalization. It is recommended to strengthen CoC for patients with diabetes who are single or with low educational levels in clinical practice to enhance their blood glucose control and improve diabetes self-management.
... encompasses the relationship between practitioner and patient (relationship continuity), coordination and teamwork (management continuity), and availability of records (information continuity). 21 Better relationship continuity is associated with lower mortality, 22 fewer hospital admissions, 23 fewer emergency department attendances, 24 and better patient experience; 19,25 however, relationship continuity of care has been falling over recent years in England. 26 Close collaborative working and merging may threaten relationship continuity because patients may be more likely to see an unfamiliar health professional. ...
... Continuity of care was measured using a single question from the GP Patient Survey, which aims to measure relationship continuity of care with a single GP. Although this has been associated with positive effects on mortality, quality of life, and hospital admissions, 22,23,25,45 it reflects only perceptions of continuity with a single GP. It may be that satisfactory continuity of care that maximises benefits for individual patients may be achieved by providing team-based care that either includes other GPs or other health professionals. ...
Background
For the last few years, English general practices — which are, traditionally, small — have been encouraged to serve larger populations of registered patients by merging or collaborating with each other. Meanwhile, patient surveys have suggested that continuity of care and access to care are worsening.
Aim
To explore whether increasing the size of the practice population and working collaboratively are linked to changes in continuity of care or access to care.
Design and setting
This observational study in English general practice used data on patient experience, practice size, and collaborative working. Data were drawn from the English GP Patient Survey, NHS Digital, and from a previous study.
Method
The main outcome measures were the proportions of patients at practice level reporting positive experiences of both access and relationship continuity of care in the GP Patient Survey. Changes in proportions between 2013 and 2018 among practices that had grown and those that had, roughly, stayed the same size were compared, as were patients’ experiences, categorised by whether or not practices were working in close collaborations in 2018.
Results
Practices that had grown in population size had a greater fall in continuity of care (by 6.6%, 95% confidence interval = 4.3% to 8.9%), than practices that had roughly stayed the same size, after controlling for other factors. Differences in falls in access to care were smaller (4.3% difference for being able to get through easily on the telephone; 1.5% for being able to get an appointment; 0.9% in satisfaction with opening hours), but were statistically significant. Practices collaborating closely with others had marginally worse continuity of care than those not working in collaboration, and no differences in access.
Conclusion
Larger general practice size in England may be associated with slightly poorer continuity of care and may not improve patient access. Close collaborative working did not have any demonstrable effect on patient experience.
... Another finding in the study was that CoC and overall QoL were positively correlated among patients with diabetes. Better continuity in patients' relationships with providers during hospitalization and information transfer to patients was linked with better QoL, which was consistent with findings about the use of CoC interventions (discharge preparation services, case management, and a combination of both) to improve QoL among older adult patients with chronic diseases [41,42]. The regression analysis showed that patients' relationship with providers during hospitalization could predict the QoL of patients with diabetes and explain 4.20% of the variance, and the results showed that the better the relationship with providers during hospitalization, the better the quality of life. ...
... The inability to see a specific physician or maintain relational continuity with medical providers directly affects patients' QoL [43]. Improving the QoL of patients with diabetes requires strengthening their CoC, understanding patients' expectations and care requirements, and providing disease-related information and emotional support to inspire confidence about follow-up care after discharge, achieve effective disease management, and improve disease outcomes [22,41,42]. ...
Background:
Understanding factors associated with the quality of life (QoL) of patients with type 2 diabetes (T2DM) is an important health issue. This study aimed to explore the correlation between continuity of care and quality of life in patients with T2DM and to probe for important explanatory factors affecting quality of life.
Methods:
This study used a cross-sectional correlation research design. Convenience sampling was adopted to recruit 157 patients, aged 20-80 years and diagnosed with T2DM in the medical ward of a regional hospital in central Taiwan.
Results:
The overall mean (standard deviation, SD) QOL score was 53.42 (9.48). Hierarchical regression linear analysis showed that age, depression, two variables of potential disability (movement and depression), and the inability to see a specific physician or maintain relational continuity with medical providers were important predictors that could effectively explain 62.0% of the variance of the overall QoL.
Conclusions:
The relationship between patients and physicians and maintaining relational continuity with the medical providers directly affect patients' QoL during hospitalization and should be prioritized clinically. Timely interventions should be provided for older adult patients with T2DM, depression, or an inability to exercise to maintain their QoL.
... However, several studies have included evaluations of quality of life. A recent meta-analysis showed that developed care-planning services, consistent coordination among care providers and case management all had positive effects on quality of life among frail older people, especially with respect to general health and physical functioning (Chen, Tu, & Chen, 2017). Subjective well-being has also been evaluated in several studies. ...
... Evaluations of life satisfaction seem to be rare in previous programmes targeting frail older people. However, similar programmes have shown positive outcomes with respect to quality of life (Chen et al., 2017). A recent intervention study involving comprehensive assessment, case management and interprofessional teamwork and care planning, showed a moderate, significant effect on frail older people's quality of life after 12 months (Looman, Fabbricotti, de Kuyper, & Huijsman, 2016). ...
Aim
The aim of this study was to analyse the effects of a full‐scale implementation of a care process programme on life satisfaction among frail older people, as compared with those receiving usual care.
Design
The study includes participants from a full‐scale care process programme (N = 77) and participants from a historical control group (N = 66). The care process programme establishes a comprehensive continuum of care through components including case management, interprofessional teamwork and care‐planning meetings in the older people's own homes.
Methods
Questionnaires were used and data were collected at baseline, with follow‐ups at three, six and 12 months.
Results
The implementation of the full‐scale care process programme had a positive effect on life satisfaction among frail older people. From 6‐month–12‐month follow‐ups, a higher proportion of participants in the care process programme had positive life satisfaction outcomes, as compared with the historical control group.
... Support for this theory can be seen in studies showing that better continuity of care with general practitioners can lead to better healthcare outcomes. 24,25,26 This also aligns to evidence suggesting that women with lived experience of IPVA would trust their dentist to act appropriately after disclosure of violence. 27 Training Many dentists felt that they had received little to no training on IPVA before graduating. ...
Introduction Intimate partner violence and abuse (IPVA) is a public health crisis with long-term implications for an individual's mental and physical health. IPVA can result in head and neck trauma, including oral injuries, placing dentists in a unique position to be able to identify at-risk patients. It is therefore important to understand any barriers dentists may experience when supporting IPVA patients.
Aims The aim of this study was to explore whether dentists and dental students are prepared to support patients with lived experience of IPVA.
Method This study adopted a qualitative cross-sectional research design using focus groups and interviews. Data were collected using the principles of grounded theory and analysed using thematic analysis.
Results Data were collected from 14 dentists and 22 dental students showing that they did not feel confident or prepared in identifying and responding to patients they suspected were experiencing IPVA. Barriers included a lack of practical knowledge and fear of ‘getting it wrong', resulting in professional paralysis.
Conclusion Improving current safeguarding educational frameworks at both the undergraduate and postgraduate stage could be key to improving the confidence and practical knowledge of dental practitioners.
... Higher scores in meeting needs were linked to reduced symptoms. (Chen, Tu, & Chen, 2017). ...
Background: One of the major health challenges in the 21st century is managing chronic diseases, which place a burden on every country. The frequency of repeat care for patients with chronic conditions is rising, resulting in increased medical and treatment costs for the state. The World Health Organization suggests discharge planning through continuity of care (COC), which involves consistent communication and coordination to distribute the workload evenly among healthcare teams. Purpose: To identify the benefits of a continuous nursing system for patients. Method: Applying a literature review following the guidelines of the Preferred Reporting Items for Literature Review and Meta-Analyses (PRISMA). Articles were gathered from online databases including Proquest, SAGE Journals, Science Direct, and Wiley Online. The keywords used were "affect," "continuity of care," and "patient." Articles were selected based on the following inclusion criteria: focus on the benefits of a continuous nursing system for patients, publication years between 2010 and 2021, and use of cross-sectional, cohort, mixed research, and review methods. Results: The benefits of a continuous nursing system include lower mortality rates, reduced risk of complications, better quality of care, reduced treatment costs, improved interpersonal relationships, higher patient satisfaction, and enhanced bodily functions. Conclusion: A continuous nursing system offers significant benefits to patients and can be adopted across all healthcare services and patient groups.
... These types of episodic care models have grown over the course of the pandemic 30 but are not in line with what respondents said they valued most in primary care: an ongoing relationship with a clinician. Numerous studies have shown that relational continuity positively affects patient outcomes, health care use, and costs, [31][32][33][34][35][36] and our findings clearly show it is also what respond ents most desire -particularly people with more complex care needs. ...
Background
Through medicare, residents in Canada are entitled to medically necessary physician services without paying out of pocket, but still many people struggle to access primary care. We conducted a survey to explore people’s experience with and priorities for primary care.
Methods
We conducted an online, bilingual survey of adults in Canada in fall 2022. We distributed an anonymous link through diverse channels and a closed link to 122 053 people via a national public opinion firm. We weighted completed responses to mirror Canada’s population and adjusted for sociodemographic characteristics using regression models.
Results
We analyzed 9279 completed surveys (5.9% response rate via closed link). More than one-fifth of respondents (21.8%) reported having no primary care clinician, and among those who did, 34.5% reported getting a same or next-day appointment for urgent issues. Of respondents, 89.4% expressed comfort seeing another team member if their doctor recommended it, but only 35.9%, 9.5%, and 12.4% reported that their practice had a nurse, social worker, or pharmacist, respectively. The primary care attribute that mattered most was having a clinician who “knows me as a person and considers all the factors that affect my health.” After we adjusted for respondent characteristics, people in Quebec, the Atlantic region, and British Columbia had lower odds of reporting a primary care clinician than people in Ontario (adjusted odds ratio 0.30, 0.33, and 0.39, respectively; p < 0.001). We also observed large provincial variations in timely access, interprofessional care, and walk-in clinic use.
Interpretation
More than 1 in 5 respondents did not have access to primary care, with large variation by province. Reforms should strive to expand access to relationship-based, longitudinal care in a team setting.
... Specifically, the medical literature has demonstrated various direct health benefits for patients and improved management of health conditions for those who receive care continuity. For instance, studies have shown improvements in quality of life outcomes (Drury et al. 2020, Chen et al. 2017, Ye et al. 2016), blood pressure for diabetic and hypertensive patients (Leniz and Gulliford 2019), mortality (Gray et al. 2018, Cho et al. 2015, adherence to medication plans (Dossa et al. 2017), and the likelihood of filling risky prescriptions (Hallvik et al. 2018). In terms of system benefits, a meta-analysis by Huntley et al. (2014), involving participants from OECD countries, found that unscheduled secondary care usage is highly influenced by care continuity in the primary care setting. ...
Continuity of care, defined as an ongoing therapeutic relationship between a patient and a physician, is a defining characteristic of primary care. However, arranging a consultation with one’s regular doctor is increasingly difficult as practices face physician shortages. We study the effect of declining care continuity on the productivity of physicians by analyzing data of over 10 million consultations in 381 English primary care practices over a period of 11 years. Specifically, we examine whether a consultation with the patient’s regular doctor is more productive than with another doctor in the practice. Using statistical models that account for confounding and selection bias and restricting the sample to consultations with patients who had at least three consultations over the past two years, we find that the time to a patient’s next visit is on average 18.1% (95% confidence interval: 16.9%, 19.2%) longer when the patient sees the doctor they have seen most frequently over the past two years, while there is no operationally meaningful difference in consultation duration. The data show that the productivity benefit of care continuity is larger for older patients, patients with multiple chronic conditions, and patients with mental health conditions. We estimate that the total consultation demand in our sample could have fallen by up to 5.2% had all practices offered continuity of care at the level of the top decile of practices while prioritizing patients expected to yield the largest productivity benefits. We discuss operational and strategic implications of these findings for primary care practices and for third-party payers.
This paper was accepted by David Simchi-Levi, healthcare management.
Supplemental Material: The online appendix and data files are available at https://doi.org/10.1287/mnsc.2021.02015 .
... Our results suggest that a better reported continuity of care is associated with a smaller decline in HRQOL and a smaller increase in pain, insomnia, and perceived financial burden. Although this is the first study to examine this association in patients with advanced cancer, its findings are consistent with studies in other patient groups, including patients with breast cancer at different stages of their disease, 9 elderly patients with chronic diseases, 25 patients with diabetes, 26 and patients with hypertension. 27 However, continuity of care is defined differently in these studies. ...
Background
Support for health‐related quality of life (HRQOL) is an essential part of cancer care in the final stages of life, yet empirical guidance regarding HRQOL and symptom trajectories is lacking.
Aim
To assess the change in HRQOL and symptom burden in the last year of life in patients with advanced cancer and its association with health care–related factors, cancer‐specific treatment, and comorbidity.
Methods
A prospective, multicenter, observational study in patients with advanced cancer (eQuiPe). Three monthly questionnaires included European Organization for Research and Treatment of Cancer Quality of Life‐C30 and reported continuity of care. Multivariable mixed‐effects analysis was used to assess the association between HRQOL and health care–related factors.
Results
A total of 762 deceased patients were included with a mean age of 66 (SD, 10) years and 52% were male. The most common primary tumors were lung (29%), colorectal (20%), and breast cancer (13%). Mean overall HRQOL decreased in the last 9 months of life, with the greatest decrease in the last 3 months (β –16.2). Fatigue, pain, appetite loss, dyspnea, constipation, and nausea worsened significantly in the last year of life. Multimorbidity (β –7.5) and a better reported continuity of care (β 0.7) were both significantly associated with the trajectory of HRQOL.
Conclusion
Mean overall HRQOL begins to decline 9 months before death, highlighting the need for early identification and (re)assessment of different symptoms as aspects of HRQOL follow different trajectories. Multimorbidity and reported continuity of care may be associated with the trajectory of HRQOL.
... At the individual level, the promotion of quality, psychological well-being, nutritional status and health perception of the participants, as well as the reduction of neuropsychiatric symptoms, are the main benefits of the implemented models. Although the literature supports the associations described (3,9,13,35), the systematic analysis of the studies revealed inconsistent results among them. Although some articles supported a positive association between the interventions and the participants' perception of quality of life, psychological well-being and general perception of health, others did not find scientific evidence that clearly supports these conclusions. ...
Introduction
The strong association between age and the increasing prevalence of chronic diseases, makes it imperative to promote self-care throughout life. Systematic knowledge on the health findings of person-centered care models may contribute to designing effective healthcare strategies to promote empowerment for self-care in long-term care.
Objective
To assess the association between the implementation of person-centered care models that promote self-care training in long-term care and health-related outcomes, among adults with chronic illness.
Methods
A rapid review of the literature was performed following the Cochrane rapid review methodology. The electronic databases CINAHL, MedicLatina, MEDLINE, and Psychology and Behavioral Sciences Collection were searched for randomized experimental studies, published between 2017 and 2022, that implemented interventions based on person-centered models to promote self-care in adults aged ≥18 years with chronic diseases and needing long-term health care. Verification of the eligibility of the articles and the extraction of data were performed by two independent investigators. Quantitative data on the health-related variables assessed were collected and, through narrative synthesis, health outcomes were grouped into individual, institutional and societal levels.
Results
Eight studies, mostly conducted in European countries, were included. All satisfied more than 60% of the methodological quality score. A large variability among studies was found regarding the number of participants, the data collection period and duration of the intervention, the samples selected and the care model implemented. A high number of health-related outcomes (n = 17) were analyzed in the studies, using 52 different instruments. The main health-related outcomes were multidimensional, with implications at the individual, institutional and societal levels. The promotion of overall health and wellbeing (n = 4), the implementation of patient-centered care models (n = 1), the positive and more frequent interactions with health professionals (2), the decrease on staff psychosocial distress (n = 1), and the absence of added costs (n = 1), while improving family caregivers’ skills (n = 1) were the main health-related outcomes described.
Conclusion
There is a need to develop robust experimental studies focused on the views and experiences of all stakeholders and conducted in different countries and cultures. Short-, medium- and long-term health outcomes should be measured using internationally accepted and validated scales for chronic patients.
... Studies by Koponen and Saint Pierre et al. have emphasized that CoC plays a pivotal role in helping patients maintain optimal blood glucose levels and reduce the incidence of complications [12,13]. Moreover, a cross-sectional Taiwanese study revealed a positive correlation between continuity of care and effective diabetes self-management, inclusive of glycemic management [14].The integral role of blood glucose management and continuity of care in the effective handling of diabetes, and their intricate relationship, has been extensively documented in previous studies [15][16][17]. Nonetheless, there is a dearth of research examining the determinants of continuity of care among Chinese individuals requiring blood glucose management [18]. Consequently, the current study has been designed with the following objectives:1. ...
Objectives
Continuity of care (CoC), entailing consistent, coherent, and integrated healthcare delivery by healthcare providers throughout a patient's lifetime, is multifaceted, encompassing relational, informational, and managerial dimensions. This study delves into the prevailing consultation preferences, continuity of care, and influential determinants among Chinese patients requiring blood glucose management, with the aim of optimizing healthcare consultations and enhancing continuity of care.
Methods
Questionnaires were disseminated across multiple digital health platforms, yielding a total of 548 valid responses. Employed analytical methods included descriptive statistical analysis, scale reliability assessment, chi-square tests for multiple response frequency cross-tabulation, independent sample t-tests, one-way ANOVA, Pearson and Spearman correlation analyses, quantile regression modeling, and multiple linear regression, all executed through IBM SPSS25.
Results
Approximately 58.21% of participants underscored the importance of a physician familiar with their comprehensive medical history, while 58.03% prioritized physicians who take the time to listen. Conversely, 41.7% and 40.0% of participants, respectively, reported lacking access to physicians exhibiting these characteristics during actual consultations. Individuals with suboptimal quality of life or medication adherence reported lower CoC than their counterparts (p < 0.01). Continuity of care was significantly higher among those with access to a familiar physician (p < 0.01). Regarding online health consultations, frequent users exhibited higher CoC compared to infrequent or non-users (p < 0.01). The influence of four variables - quality of life, medication adherence, access to a familiar physician, and frequency of online health consultations - on continuity of care was statistically significant at the quantile point.
Conclusion
This research offers critical insights for healthcare practitioners and policy designers to bolster continuity of care. Factors such as diminished quality of life, inadequate medication adherence, absence of a familiar physician, and infrequent or non-existent online health consultations potentially contribute to low continuity of care.
... A systematic review of patients hospitalized due to coronary artery diseases describes continuity of care interventions as providing the prerequisites for patients to improve their selfcare capacity and adhere to healthy lifestyle changes 50 . Studies have also found associations between continuity of care and patient-reported measures such as health-related quality of life 29,50,[52][53][54] , and perceived control 55 . ...
... Evidence suggests that improving COC leads to improved patient-reported outcome measures (e.g., patient satisfaction [26] and quality of life [27]), reduced mortality [28,29], fewer emergency hospital admissions [30], fewer study protocols were excluded. Experimental studies were excluded as clarifying the operationalization of COC, polypharmacy, and MARO and their relationship in observational studies is a necessary step before interventions targeting COC to improve polypharmacy and MARO can be properly evaluated. ...
Introduction
Worldwide, polypharmacy and medication appropriateness-related outcomes (MARO) are growing public health concerns associated with potentially inappropriate prescribing, adverse health effects, and avoidable costs to health systems. Continuity of care (COC) is a cornerstone of high-quality care that has been shown to improve patient-relevant outcomes. However, the relationship between COC and polypharmacy/MARO has not been systematically explored.
Objective
The aim of this systematic review was to investigate the operationalization of COC, polypharmacy, and MARO as well as the relationship between COC and polypharmacy/MARO.
Methods
We performed a systematic literature search in PubMed, Embase, and CINAHL. Quantitative observational studies investigating the associations between COC and polypharmacy and/or COC and MARO by applying multivariate regression analysis techniques were eligible. Qualitative or experimental studies were not included. Information on the definition and operationalization of COC, polypharmacy, and MARO and reported associations was extracted. COC measures were assigned to the relational, informational, or management dimension of COC and further classified as objective standard, objective non-standard, or subjective. Risk of bias was assessed by using the NIH Quality Assessment Tool for Observational Cohort and Cross-Sectional Studies.
Results
Twenty-seven studies were included. Overall, substantial differences existed in terms of the COC dimensions and related COC measures. Relational COC was investigated in each study, while informational and management COC were only covered among three studies. The most frequent type of COC measure was objective non-standard (n = 16), followed by objective standard (n = 11) and subjective measures (n = 3). The majority of studies indicated that COC is strongly associated with both polypharmacy and MARO, such as potentially inappropriate medication (PIM), potentially inappropriate drug combination (PIDC), drug–drug interaction (DDI), adverse drug events (ADE), unnecessary drug use, duplicated medication, and overdose. More than half of the included studies (n = 15) had a low risk of bias, while five studies had an intermediate and seven studies a high risk of bias.
Conclusions
Differences regarding the methodological quality of included studies as well as the heterogeneity in terms of the operationalization and measurement of COC, polypharmacy, and MARO need to be considered when interpreting the results. Yet, our findings suggest that optimizing COC may be helpful in reducing polypharmacy and MARO. Therefore, COC should be acknowledged as an important risk factor for polypharmacy and MARO, and the importance of COC should be considered when designing future interventions targeting these outcomes.
... 19,20 Continuity of care has been found to improve clinical outcomes such as healthrelated quality of life and reduce rehospitalizations. 21,22 However, even though continuity is a healthcare priority, there is a lack of short, validated questionnaires to measure patients' perceptions of this aspect of care. If such questionnaires were available, the results could guide quality improvement initiatives and help to evaluate the continuity of care interventions. ...
Introduction
Hospitalization due to cardiac conditions is increasing worldwide, and follow‐up after hospitalization usually occurs in a different healthcare setting than the one providing treatment during hospitalization. This leads to a risk of fragmented care and increases the need for coordination and continuity of care after hospitalization. Furthermore, international reports highlight the importance of improving continuity of care and state that it is an essential indicator of the quality of care. Patients’ perceptions of continuity of care can be evaluated using the Patient Continuity of Care Questionnaire (PCCQ). However, the original version is extensive and may prove burdensome to complete; therefore, we aimed to develop and evaluate a short version of the PCCQ.
Methods
This was a psychometric validation study. Content validity was evaluated among user groups, including patients (n = 7), healthcare personnel (n = 15), and researchers (n = 7). Based on the results of the content validity and conceptual discussions among the authors, 12 items were included in the short version. Data from patients were collected using a consecutive sampling procedure involving patients 6 weeks after hospitalization due to cardiac conditions. Rasch analysis was used to evaluate the psychometric properties of the short version of the PCCQ.
Results
A total of 1000 patients were included [mean age 72 (SD = 10), 66% males]. The PCCQ‐12 presented a satisfactory overall model fit and a person separation index of 0.79 (Cronbach's α: .91, ordinal α: .94). However, three items presented individual item misfits. No evidence of multidimensionality was found, meaning that a total score can be calculated. A total of four items presented evidence of response dependence but, according to the analysis, this did not seem to affect the measurement properties or reliability of the PCCQ‐12. We found that the first two response options were disordered in all items. However, the reliability remained the same when these response options were amended. In future research, the benefits of the four response options could be evaluated.
Conclusion
The PCCQ‐12 has sound psychometric properties and is ready to be used in clinical and research settings to measure patients' perceptions of continuity of care after hospitalization.
Patient or Public Contribution
Patients, healthcare personnel and researchers were involved in the study because they were invited to select items relevant to the short version of the questionnaire.
... Therefore, close follow-up and professional and meticulous care are still needed for these patients after discharge to reduce complications. However, under the current medical model, parents receive medical support and care guidance during hospitalization, which is terminated once the patient is discharged from the hospital [4]. Due to the lack of professional knowledge and nursing skills, parents face challenges in early care after discharge, which puts tremendous pressure and burden on them [5,6]. ...
Objective
This study aimed to investigate parents’ understanding and attitudes toward using the WeChat platform for postoperative follow-up management of children with congenital heart disease (CHD).
Methods
A total of 196 children with CHD were followed up using the WeChat platform. A self-designed questionnaire was administered to their parents at discharge.
Results
Only 188 parents completed the questionnaire. One hundred nineteen parents (63.3%) confirmed that they heard about using the WeChat platform for postoperative follow-up, and 104 (87.4%) of them expressed that they were willing to accept the WeChat platform for their follow-up. A total of 42 parents (35.3%) were willing to undergo a follow-up of 1 to 3 months, and 32 (26.8%) were willing to undergo a long-term follow-up. Eighty parents (67.2%) had a positive attitude toward the effect of the WeChat platform on follow-up. Parents in rural areas and those educated at the middle school level or below were more willing to engage with the WeChat platform for postoperative follow-up management (P < 0.05).
Conclusions
Although the WeChat platform is an essential tool for daily communication, its application in postoperative follow-up management is still under study. Most parents who participated in the follow-up study had a positive attitude toward the WeChat platform, especially those in rural areas and with lower education levels.
... To enhance the continuity of care for rare cancer patients in the advanced disease stage, the organization of their endof-life care should be reconsidered. Enhancing the continuity of care for cancer patients leads to less demand for supportive care in the future and can improve a patient's QoL [54][55][56]. Therefore, communication methods between different healthcare professionals involved should be improved. ...
Purpose
Patients with a rare cancer face difficulties during their disease trajectory, such as delayed diagnosis and lack of expert care. However, little is known about their perceived quality of care (QoC) and quality of life (QoL) in the advanced disease stage. We aimed to assess the QoC and QoL as experienced by patients with advanced rare cancers compared to patients with advanced common cancers.Methods
In this cross-sectional study, baseline data of patients with advanced cancer from the multicentre, longitudinal, observational eQuipe study were analysed. Multivariable linear regression analyses were conducted to assess differences in experienced QoC (continuity of care, continuity of information, and satisfaction with care) and QoL (functioning, symptoms, overall QoL, and social wellbeing) between advanced rare and common cancer patients.ResultsOf the 1087 included patients, 106 (9.8%) had a rare cancer type. In comparison to patients with advanced common cancers, patients with advanced rare cancers experienced significantly lower continuity of care (77.8 vs. 71.1 respectively, p = 0.011) and social functioning (78.8 vs. 72.6 respectively, p = 0.012). No differences were found regarding continuity of information, satisfaction with care, overall QoL, and social wellbeing.Conclusions
Patients with advanced rare cancers experience less continuity of care, and the impact of the disease on social and family life seems higher compared to patients with advanced common cancers.Implications for Cancer SurvivorsTo enhance the QoC and QoL of patients with advanced rare cancers, supportive care should mainly focus on improving continuity of care and patients’ social functioning.
... Hay autores que han comparado la eficacia clínica al alta hospitalaria del modelo tradicional de atención de enfermería y el CT en pacientes con AVC, encontrando que este último incrementa significativamente la adherencia a controles, la calidad de vida, satisfacción con la atención, sin encontar efectos estadísticamente significativos en la rehospitalización y consultas de urgencia 57 . Esto es concordante con estudios que han mostrado que las intervenciones que contribuyen a la continuidad del cuidado mejoran significativamente la calidad de vida de AM con enfermedades crónicas 58 . ...
People with chronic conditions and elderly frequently use different levels of health care. If those are not coordinated, patients are exposed to complications and adverse effects. To avoid this, the implementation of transitional care (TC) is proposed, which includes the coordination and follow-up of users through the different care settings. We aimed to analyze the concept of transitional care, its characteristics and impact on people with chronic conditions. A search of articles published between 2012 and 2019 in Google Scholar, MEDLINE, CINAHL and Cochrane Library databases was conducted looking for articles related to the concept of transitional care, characteristics, and impact on people with chronic conditions. Several models of TC have been formulated and the literature identifies common interventions, namely telephone follow-up, outpatient clinics and home visits for self-management support. Reports show that TC reduces re-hospitalizations, care costs, increases quality of life and user satisfaction with the health system.
... Chronic illness is the leading cause of death worldwide, accounting for 41 million deaths each year, equivalent to 71% of all deaths globally [6]. Having chronic conditions as well as aging are negative determinants of QoL in the aging population [7] In addition to their natural aging, their chronic conditions could accelerate or worsen their declines in multiple areas of their lives which could also deteriorate their daily functioning [8] and hinder them from living to their fullest potential [9] These declines encompass their loss of memory [10], autonomy [4], status and relationship [11,12], social support [13][14][15], underestimate the QoL of their loved ones because they only believe what they see in their loved ones' agitated behaviors; this can cause family members' perceptions to be inaccurate. In addition, if caregivers are emotionally depressed and burdened, they tend to project their negative biases [42] and their negative feelings about their own QoL [10], which results in having unreliable perceptions of older adults' QoL. ...
Older adults with chronic illnesses have diminished qualities of life (QoL) due to physical and mental decline. To promote their QoL, music therapists create meaningful shared music experiences and positive therapeutic relationships to address their psychosocial needs. However, within this relationship-building process, healthcare professionals, staff, and even caregivers appear to project their own perceptions and expectations of what positive QoL of older adults should be. This misapprehension may challenge therapists to meet older adults’ actual QoL needs adequately. To date, no studies have explored music therapists’ perspectives on QoL in building relationships with older adults experiencing chronic illness. Eleven music therapists participated in online, semi-structured phenomenological interviews that were thematically analyzed. Three themes emerged: participants gained an increased awareness of unconscious biases, a deepened understanding of older adults’ QoL, and a purposeful alignment with older adults’ QoL. These highlighted the significance of therapists’ consistent self-reflection within the relationship-building process. Identifying their shared commonalities with older adults guided therapists to engage with clients more salutogenically and empathically. Additionally, recognizing their own biases being projected onto older adults empowered therapists to be more intentional to reconcile their perceptual discrepancies while prioritizing older adults’ authentic voices and capable selves.
... Moreover, we propose a partition of patients into a dual queue configuration system based on the patient level factors we combine to calculate a "benefit score", with higher benefit score patients being offered a dedicated queue service, and lower benefit score patients, a pooled queue. , Chen et al. 2017, Ye et al. 2016), blood pressure for diabetic and hypertensive patients (Leniz and Gulliford 2019), mortality , adherence to medication plans , and the likelihood of filling risky prescriptions ). ...
Many service processes are sequences of independent transactions between customers and servers. In such contexts it is well known that pooling server time and offering an arriving customer the next available server, independently of whether they had seen the customer before, is most efficient. However, when customer episodes depend on one-another, then this is not necessarily the case. Ensuring customers have a dedicated server may offer efficiency advantages. This thesis is an empirical investigation of the productivity advantages of dedicated servers in the context of primary care. In this context, server dedication equates with the notion of continuity of care, which is the extent to which a patient has her consultations with the same doctor. The thesis is composed of two in-depth empirical studies. The first study provides evidence of the productivity implications of relational continuity of care (RC), while the second study addresses the question how practice managers can increase continuity of care. Both studies use a detailed clinical dataset from the Clinical Practice Research Datalink that collects patient-consultation level electronic health records and is representative of the UK population. From its overall database of over 11 million patients spanning 674 practices, our data consists of the entire medical record of 5 million patients who have had contact with primary care between 2007 and 2018 across different providers of care (secondary care etc.). In the first study, I show that continuity of care has a significant productivity benefit. Specifically, due to the trust-based relationship, accumulated knowledge over time and stronger accountability for the patient, the average time to next visit for a patient is longer when patients see their regular provider than after they see another doctor. The data shows that the productivity benefit of care continuity is larger for older patients, patients with multiple chronic conditions, and patients with mental health conditions. I discuss operational and strategic implications of these findings for primary care practices in capitation environments and for third-party payers of their services. This first study suggests that prioritizing continuity of care is an effective strategy to reduce demand for consultations. The second study, entitled “The Operational Determinants of Relational Continuity of Care" builds on the first part and identifies the levers and strategies that primary care practice managers can implement to promote continuity within the constraint of a diminishing workforce. We find that a sustained increase in workload - caused by demand growth - and increasing fragmentation of the workforce - due to a shift to part-time and agency work - induces significant heterogeneity between practices in their ability to provide care continuity. Specifically, these two factors alone explain more than 50% of the decline in care continuity over the ten-year window of the study, with workforce fragmentation having the greater impact. We discuss the implications for workforce management in primary care practices that wish to promote continuity of care.
... Personal continuity is highly valued by both patients and general practitioners (GPs) [5][6][7] and there is a growing body of evidence for its benefits. Personal continuity is associated with higher quality of GP care [8][9][10][11], higher medication adherence [11][12][13], higher uptake of preventive care [11,14], better patient-provider relationship [15,16], higher patient and doctor satisfaction [15][16][17][18], higher quality of life [19][20][21], less overuse of medical procedures [22], lower use of hospital services, lower admission rates [13,17,[23][24][25][26][27], and an overall reduction in healthcare costs [28][29][30]. Furthermore, several studies found that personal continuity is associated with lower mortality [29][30][31][32][33][34][35][36]. ...
Background
Continuity of care, in particular personal continuity, is a core principle of general practice and is associated with many benefits such as a better patient-provider relationship and lower mortality. However, personal continuity is under pressure due to changes in society and healthcare. This affects older patients more than younger patients. As the number of older patients will double the coming decades, an intervention to optimise personal continuity for this group is highly warranted.
Methods
Following the UK Medical Research Council framework for complex Interventions, we will develop and evaluate an intervention to optimise personal continuity for older patients in general practice. In phase 0, we will perform a literature study to provide the theoretical basis for the intervention. In phase I we will define the components of the intervention by performing surveys and focus groups among patients, general practitioners, practice assistants and practice nurses, concluded by a Delphi study among members of our group. In phase II, we will test and finalise the intervention with input from a pilot study in two general practices. In phase III, we will perform a stepped wedge cluster randomised pragmatic trial. The primary outcome measure is continuity of care from the patients’ perspective, measured by the Nijmegen Continuity Questionnaire. Secondary outcome measures are level of implementation, barriers and facilitators for implementation, acceptability and feasibility of the intervention. In phase IV, we will establish the conditions for large-scale implementation.
Discussion
This is the first study to investigate an intervention for improving personal continuity for older patients in general practice. If proven effective, our intervention will enable General practitioners to improve the quality of care for their increasing population of older patients. The pragmatic design of the study will enable evaluation in real-life conditions, facilitating future implementation.
Trial registration number
Netherlands Trial Register, trial NL8132 . Registered 2 November 2019.
... Utifrån resultaten drog de slutsatsen att det finns stöd för att interventioner för att förbättra kontinuitet hos äldre personer med kroniska sjukdomar kan förebygga återinläggning på sjukhus på kort sikt (1-3 månader), men att det råder större osäkerhet kring effekter på längre sikt. I en systematisk översikt av Chen och medarbetare från år 2017 undersökte författarna effekter av interventioner som syftade till att förbättra vårdkontinuitet hos personer 65 år eller äldre med kroniska sjukdomar[114]. Utfallet var allmän hälsa, funktion och livskvalitet, mätt med självskattningsformuläret Short Form (SF)-36. Sju randomiserade kontrollerade kliniska studier inkluderades. ...
This is an HTA report that includes a systematic review of the effects of relational continuity in care of patients with astma or chronic obstructive pulmonary disease (COPD) and in persons with severe mental illness. The report also includes health economic evaluations and an evaluation of ethical aspects. The report is in Swedish and was performed by SBU, The Swedish Agency for Health Technology Assessment and Assessment of Social Services.
Link to report: https://www.sbu.se/329
... Provider continuity is an important aspect of medical care, associated with better health, fewer hospitalizations, higher quality of life and other important health outcomes [1][2][3][4][5][6][7][8][9][10]. Continuity of care can be important both in outpatient care and across community to hospital transitions. ...
Background
Little is known about how continuity of care for hospitalized patients varies among hospitals. We describe the number of different general internal medicine physicians seeing hospitalized patients during a medical admission and how that varies by hospital.
Methods
We conducted a retrospective study of a national 20% sample of Medicare inpatients from 01/01/16 to 12/31/18. In patients with routine medical admissions (length of stay of 3–6 days, no Intensive Care Unit stay, and seen by only one generalist per day), we assessed odds of receiving all generalist care from one generalist. We calculated rates for each hospital, adjusting for patient and hospital characteristics in a multi-level logistic regression model.
Results
Among routine medical admissions with 3- to 6-day stays, only 43.1% received all their generalist care from the same physician. In those with a 3-day stay, 50.1% had one generalist providing care vs. 30.8% in those with a 6-day stay. In a two-level (admission and hospital) logistic regression model controlling for patient characteristics and length of stay, the odds of seeing just one generalist did not vary greatly by patient characteristics such as age, race/ethnicity, comorbidity or reason for admission. There were large variations in continuity of care among different hospitals and geographic areas. In the highest decile of hospitals, the adjusted mean percentage of patients receiving all generalist care from one physician was > 84.1%, vs. < 24.1% in the lowest decile. This large degree of variation persisted when hospitals were stratified by size, ownership, location or teaching status.
Conclusions
Continuity of care provided by generalist physicians to medical inpatients varies widely among hospitals. The impact of this variation on quality of care is unknown.
... Chronic diseases compromise quality of life because they result in financial losses [23]. They also cause physical and mental loss of function, and can thus impact adversely on quality of life and active aging [24]. Due to their long-term nature, chronic diseases impair the individual's quality of life, and since stress and depression are more frequent in these individuals, their self-images are negatively impacted [25]. ...
Aim: To determine the relationship between attitudes toward aging and old age, and successful aging in individuals with chronic disease aged 65 or over.
Methods: The Attitude Scale toward Aging and Elderliness and the Successful Aging Scale were employed in this descriptive, cross-sectional, comparative study. Data were expressed as frequency, percentage, mean, and standard deviation and were analyzed using the Kolmogorov-Smirnov test, the t test, One-Way ANOVA, and Pearson correlation analysis. p values <0.05 were regarded as significant.
Results: Individuals with chronic disease had greater difficulty in accepting old age, greater social exhaustion, greater abilities to cope with problems, and higher successful aging scores.
Conclusion: This study shows that despite their negative attitudes toward old age, individuals with chronic disease had greater abilities to cope with problems and aged more successfully.
... Provider continuity is an important aspect of medical care, associated with better health, fewer hospitalizations, higher quality of life and other important health outcomes [1][2][3][4][5][6][7][8][9][10]. Continuity of care can be important both in outpatient care and across community to hospital transitions. ...
Background: Little is known about how continuity of care for hospitalized patients varies among hospitals. We describe the number of different general internal medicine physicians seeing hospitalized patients during a medical admission and how that varies by hospital.
Methods: We conducted a retrospective study of a national 20% sample of Medicare inpatients from 01/01/16 to 12/31/18. In patients with routine medical admissions (length of stay of 3-6 days, no Intensive Care Unit stay, and seen by only one generalist per day), we assessed odds of receiving all generalist care from one generalist. We calculated rates for each hospital, adjusting for patient and hospital characteristics in a multi-level logistic regression model.
Results: Among routine medical admissions with 3- to 6-day stays, only 43.1% received all their generalist care from the same physician. In those with a 3-day stay, 50.1% had one generalist providing care vs. 30.8% in those with a 6-day stay. In a two-level (admission and hospital) logistic regression model controlling for patient characteristics and length of stay, the odds of seeing just one generalist did not vary greatly by patient characteristics such as age, race/ethnicity, comorbidity or reason for admission. There were large variations in continuity of care among different hospitals and geographic areas. In the highest decile of hospitals, the adjusted mean percentage of patients receiving all generalist care from one physician was >84.1%, vs. <24.1% in the lowest decile. This large degree of variation persisted when hospitals were stratified by size, ownership, location or teaching status.
Conclusions: Continuity of care provided by generalist physicians to medical inpatients varies widely among hospitals. The impact of this variation on quality of care is unknown.
... [24] Providing continuous nursing for patients is an important factor to improve prognosis. [25] It is also the embodiment and extension of nurses' high-quality nursing service. [26] As Coronary Artery Disease is greatly affected by daily life and the treatment cycle is long. ...
Background:
Coronary Artery Disease is an ischemic or necrotic heart disease caused by myocardial hypoxia caused by coronary artery stenosis or occlusion. The main symptoms are heart failure and recurrent angina pectoris. Continuous nursing refers to the nursing mode from in-hospital nursing to out-of-hospital nursing, including guiding patients' follow-up treatment and lifestyle, which can effectively improve the quality of life in patients with Coronary Artery Disease and reduce the number of angina attacks. The study implemented in this program will systematically evaluate the efficacy and safety of continuous nursing intervention on an angina attack and quality of life in Coronary Artery Disease, and provide evidence-based basis for clinical application of continuous nursing intervention in Coronary Artery Disease.
Method:
The 2 researchers search the databases of China Knowledge Network, VP Information Chinese Journal Service Platform, PubMed, Embase, the Cochrane Library and Web of Science. From the establishment of the database in December 2020, all the randomized controlled trials on continuous nursing intervention for Coronary Artery Disease are collected. The relevant data are extracted and the quality is evaluated. meta-analysis is performed on the included literature using Stata15.0 software.
Result:
In this study, the efficacy and safety of continuous nursing intervention on Coronary Artery Disease are evaluated by Seattle angina questionnaire and other indicators.
Conclusion:
This study will provide reliable evidence for the clinical application of nursing intervention in Coronary Artery Disease.
Ethics and dissemination:
Private information from individuals will not be published. This systematic review also does not involve endangering participant rights. Ethical approval will not be required. The results may be published in a peer-reviewed journal or disseminated at relevant conferences.
Osf registration number:
DOI 10.17605/OSF.IO/7QRKV.
... For patients discharged from the hospital after undergoing PCI, the conventional nursing model has little effect on improving the patient medical management level and quality of life during the follow-up period. As a new nursing model, continuous nursing extends in-hospital treatment and rehabilitation care to post-discharge care to improve patients' self-management and ensure that treatment, information, and nursing continue, which could effectively solve the problem of inadequate postdischarge nursing [12,13]. Continuous nursing has been widely used in managing patients with chronic diseases and has achieved good clinical results [14,15]. ...
Background
Percutaneous coronary intervention (PCI) is an effective treatment for coronary heart disease. However, a lack of cardiac rehabilitation and continuous nursing management leads to repeated patient hospitalizations. Long-term systematic rehabilitation and nursing management after discharge are key to ensuring quality of treatment and patient quality of life. This study aimed to explore the application of the WeChat platform in continuous nursing after PCI.
Material/Methods
This was a retrospective case-control study. The clinical data of 63 patients in our cardiac center who underwent PCI between June 2017 and January 2018 were recorded. Patients were divided into 2 groups: the continuous nursing through the WeChat platform (intervention) group and the conventional nursing (control) group. The Self-Rating Depression Scale (SDS), Self-Rating Anxiety Scale (SAS), and Seattle Angina Questionnaire (SAQ) were used as the evaluation tools.
Results
The SAQ scores in all 5 SAQ dimensions in the continuous nursing group were significantly higher than those of the control group at the 1-year follow-up. Scores on the SAS and SDS scales at 1-year follow-up were significantly better in the intervention group than in the control group. The SAS and SDS scores in both groups were better at the 1-year follow-up, but the difference was statistically significant in the continuous nursing group and not in the control group.
Conclusions
Using the WeChat platform can make continuous nursing more convenient and effective for patients after PCI. It may reduce the occurrence of complications, relieve patient depression and anxiety, and improve patient quality of life.
... Chronic diseases are among the major regional causes of disease burden due to the demographic and epidemiologic transition. 1 Patients with chronic conditions and/or comorbidities that require care over time from different health services, are most affected by the problems commonly encountered in the region's health systems as a result of fragmentation: long waiting times; 2 shortcomings in the cross-level transfer of clinical information and in establishing agreements on their clinical management; 3 or a limited role of primary care as care coordinator for their care. 4 Almost no study in the region analyses care continuity in a comprehensive and comparative way despite its relevance in terms of lowering health care expenditure and hospitalizations 5 and its impact on improved quality of life 6 and reductions in mortality. 7 Reid et al. 8 define continuity of care as one patient experiencing care over time as connected and coherent with their health needs and personal circumstances, and the result of care coordination. ...
Objective
To analyse the care continuity across levels of care perceived by patients with chronic conditions in public healthcare networks in six Latin American countries (Argentina, Brazil, Chile, Colombia, Mexico and Uruguay), and to explore associated factors.
Method
Cross-sectional study by means of a survey conducted to a random sample of chronic patients in primary care centres of the study networks (784 per country) using the questionnaire Cuestionario de Continuidad Asistencial Entre Niveles de Atención (CCAENA)©. Patients had at least one chronic condition and had used two levels of care in the 6 months prior to the survey for the same medical condition. Descriptive analysis and multivariable logistic regression were carried out.
Results
Although there are notable differences between the networks analysed, the results show that chronic patients perceive significant discontinuities in the exchange of clinical information between primary care and secondary care doctors and in access to secondary care following a referral; as well as, to a lesser degree, regarding clinical coherence across levels. Relational continuity with primary care and secondary care doctors and information transfer are positively associated with care continuity across levels; no individual factor is systematically associated with care continuity.
Conclusions
Main perceived discontinuities relate to information transfer and access to secondary care after a referral. The study indicates the importance of organisational factors to improve chronic patients’ quality of care.
Innovative ways of working are emerging in health care to meet the complex needs of people living with multiple long-term conditions. While these initiatives are often measured for their health and economic outcomes, few studies prioritize the patient experience. This qualitative descriptive study is one of a few studies exploring the patient experience of attending a dedicated long-term conditions annual review clinic in a primary care setting in England. The service model aims to provide a person-centered, holistic approach to the management and support of people living with multiple long-term conditions. The study presents findings from in-depth interviews with 12 participants. Data analyzed through framework analysis revealed four themes relating to the patient experience: the clinic as a place, continuity, staying healthy, and partnership opportunities. Results highlight the challenges to providing personalized care. We found that attendance at the clinic prompted self-care behaviors, however, patients wanted a more holistic, integrated, and consistent service that provided continuity of therapeutic relationships that involved them in decision-making and care planning. We conclude that the experience of patients in this study suggests this service model can enable patients to manage their health and improve well-being, however, while a person-centered philosophy may underpin service models, our research shows that ensuring this philosophy is born out in service delivery and recognized by patients is problematic. Therefore, service providers need to recognize the values and perspectives of patients, aligning these with the design and delivery of services.
Background:
Case management (CM) aims to facilitate access to and integration of health care and social services. We investigated the feasibility and effectiveness of CM.
Methods:
Randomized controlled trial with 219 patients and 114 caregivers randomly allocated to CM (109/59) or care as usual (110/55). CM was based on early and continuous online monitoring of problems and needs. Outcomes were assessed every 6 months with the Hospital Anxiety and Depression Scale (HADS). Secondary outcome domains were participant restrictions, life satisfaction, self-efficacy, caregiver burden, and needs. Multilevel modeling was used. Feasibility aspects were protocol delivery, participants' and case managers' satisfaction, and factors affecting implementation.
Results:
There were no significant differences between groups. Participation restrictions and unmet needs decreased in both groups within 6 months. Monitoring was successful in 38, and 10 participants asked the CM for support. CM consisted mostly of providing information.
Discussion:
CM based on early and continuous online monitoring does not have benefit in identifying and addressing problems early after relatively mild injury. Unsuccessful monitoring may have hindered access to the case manager and prevented us from evaluating CM as a complex intervention. It remains a challenge to early identify those who could benefit from care coordination.
Background and Objectives: We compared experiences of patients who reported usually being seen by a resident with those usually seen by a staff physician. Methods: We analyzed responses to a patient experience survey distributed at 13 family medicine teaching practices affiliated with the University of Toronto between May and June 2020. We analyzed responses to seven questions pertaining to timely access, continuity, and patient-centeredness. We compared responses between two types of usual primary care clinicians and calculated odds ratios before and after adjustment for patient characteristics. Results: We analyzed data from 6,545 unique surveys; 18.6% reported their usual clinician was a resident physician. Resident patients were more likely to be older, born outside of Canada, report a high school education or less, and report having difficulty making ends meet. Compared to patients of staff physicians, patients of resident physicians had lower odds of being able to see their preferred primary care clinician and lower odds of getting nonurgent care in a reasonable time. They also had lower odds of reporting patient-centered care, but we found no significant differences in whether the time for an urgent appointment was about right or whether accessing care after hours was easy. Conclusions: In our setting, patients who reported usually seeing resident physicians had worse continuity of care and timeliness for nonurgent care than patients who reported usually seeing staff physicians despite resident patients being older, sicker, and having a lower socioeconomic position. Postgraduate training programs need to test models to support access and continuity for resident patient panels.
Continuity of care refers to the degree to which healthcare provision is a consistent and interconnected process. It has three dimensions: relational continuity, informational continuity and management continuity. Continuity of care impacts on healthcare utilisation and health outcomes. Patients, especially those with multiple or rather complex healthcare needs, value continuity of care in terms of forming a longitudinal and trusting relationship with health professionals. In health systems, several strategies aim at achieving high continuity of care, such as case management, advanced nursing practice and integrated care. Future studies may focus on the role that patients can and want to play in enhancing continuity and how it can be optimised in fragmented healthcare systems.KeywordsHealth services researchContinuity of careCare coordinationCase managementAdvanced nursing practiceIntegrated care
Background:
Depression affects 10% to 20% of older adults worldwide. The course of Late-Life Depression (LLD) is often chronic, with a poor long-term prognosis. Lower treatment adherence, stigma, and suicide risk lead to significant challenges in the Continuity of Care (COC) for patients with late-life depression. Elderly patients with chronic diseases can benefit from COC. As a common chronic disease of the elderly, whether depression can also benefit from COC has not been systematically reviewed.
Methods:
Systematic literature search in Embase, Cochrane Library, Web of Science, Ovid, PubMed and Medline. Randomized Controlled Trials (RCTs) on the intervention effects of COC and LLD, published on April 12, 2022, were selected. Two independent researchers made research choices based on consensus. An RCT with COC as an intervention measure for the elderly with depression 60 years old was the inclusion criteria.
Results:
A total of 10 RCTs involving 1557 participants were identified in this study. The findings showed that: 1) COC significantly reduced depressive symptoms compared to Usual Care (UC) (Standardized Mean Difference [SMD] = -0.47, 95% Confidence Interval [CI]: -0.63 to -0.31), with the best improvement at 3- to 6-month follow-up; 2) The reduction in depressive symptoms was more pronounced for patients with comorbid chronic conditions with LLD (SMD = -0.93, 95% CI: -1.18 to -0.68); 3) COC was more effective than other regions for LLD in Europe and North America (SMD = -0.84, 95% CI: -1.07 to -0.61); and 4) COC had a positive impact on the quality of life of patients with LLD (SMD = 0.21, 95% CI: 0.02 to 0.40).
Limitations:
The included studies included several multi-component interventions with widely varying methods. Therefore, it was almost impossible to analyze which of these interventions had an impact on the assessed outcomes.
Conclusions:
This meta-analysis shows that COC can significantly reduce depressive symptoms and improve quality of life in patients with LLD. However, when treating and caring for patients with LLD, health care providers should also pay attention to timely adjustments of intervention plans according to follow-up, synergistic interventions for multiple co-morbidities, and actively learning from advanced COC programs at home and abroad to improve the quality and effectiveness of services. This article is protected by copyright. All rights reserved.
Background
Personal continuity – having a GP who knows his or her patients and keeps track of them -is an important dimension of continuity of care andis associated with lower mortality rates, higher quality of life and reduced healthcare costs. In the last decades, it has become more challenging for general practitioners (GPs) to provide personal continuity due to changes in society and healthcare.
Aim
To investigate GPs’ and older patients’ views on personal continuity andhow personal continuity can be improved.
Design and Setting
Cross-sectional survey study in the Netherlands
Method
A digital and postal survey was send to 499 GPs and 1599 patients aged 65 or aboveResults were analysed using descriptive statistics for quantitative data and thematic analysis for open questions.
Results
249 GPs and 582 patients completed the surveys. A large majority of GPs (92–99%) and patients(91–98%) felt it was important for patients to see their own GP for life events or psychosocial issues.GPs and patients provided suggestions on how personal continuity can be improved.The thematic analysis of these suggestions identified nine themes ¹ : personal connection, ² GP accessibility and availability, ³ communication about (dis)continuity, ⁴ GP responsibility, ⁵ triage, ⁶ time for the patient, ⁷ actions by third parties, ⁸ team continuity and ⁹ GP vocational training.
Discussion/conclusion
Both GPs andolder patients still place high value on personal continuity in the context of a changing society. GPs and patients provided a wide range of suggestions for improving personal continuity. We will use these suggestions to develop interventionsfor optimising personal continuity in general practice.
Continuity is a core component of primary care and known to differ by patient characteristics. It is unclear how primary care physician payment and organization are associated with continuity. METHODS: We analyzed administrative data from 7,110,036 individuals aged 16+ in Ontario, Canada who were enrolled to a physician and made at least 2 visits between October 1, 2017 and September 30, 2019. Continuity with physician and practice group was quantified using the usual provider of care index. We used log-binomial regression to assess the relationship between enrollment model and continuity adjusting for patient characteristics. RESULTS: Mean physician and group continuity were 67.3% and 73.8%, respectively, for patients enrolled in enhanced fee-for-service, 70.7% and 76.2% for nonteam capitation, and 70.6% and 78.7% for team-based capitation. These differences were attenuated in regression models for physician-level continuity and group-level continuity. Older age was the most notable factor associated with continuity. Compared with those 16 to 34, those 80 and older had 1.45 times higher continuity with their physician. CONCLUSION: Our results suggest that continuity does not differ substantially by physician payment or organizational model among primary care patients who are formally enrolled with a physician in a setting with universal health insurance.
Background:
The purpose of this study was to investigate the effect of applying telehealth education to home care of infants after congenital heart disease surgery.
Methods:
A prospective randomized controlled study was conducted from July 2020 to February 2021 in our hospital to compare the home care condition of infants after congenital heart disease surgery between intervention group and control group.
Results:
At 3 months after discharge, parents' caring ability and congenital heart disease knowledge in the intervention group were significantly better than those in the control group, and were significantly improved compared with those at discharge time (P<0.05). The parental care burden in the intervention group was significantly lower than that in the control group, and was significantly lower than that at discharge time (P<0.05). During the follow-up period, the rate of loss of follow-up and complications in the intervention group were significantly lower than those in the control group (P<0.05).
Conclusion:
Telehealth education via WeChat can effectively improve the knowledge of disease and home care ability of parents of infants after CHD surgery and reduce their home care burden, which can effectively reduce the incidence of complications and lost to follow-up rate after discharge.
This study analyzes the experiences of users on the continuity of clinical management between care levels. This is a cross-sectional quantitative study that uses data from a survey conducted with 407 users of a public health network in Recife, Pernambuco State, Brazil, in 2017 and 2018. The experiences on the continuity of clinical management were explored from two dimensions: coherence of care and accessibility between levels of care. Users presented more positive opinions about coherence of care than accessibility. Regarding coherence of care, most users reported that primary and specialized care physicians agree on diagnosis, treatment, and recommendations, and that the primary care physician refers them to a specialist when necessary. Only 43% of users reported collaboration between physicians to solve their health problems. Concerning accessibility, most users (77.2%) reported a long waiting time for the consultation with a specialist and less than half (48.9%) reported delay for primary care. The results of this study coincide with other investigations and highlight the need to promote strategies for achieving effective integration of care networks and thus provide users with greater continuity of health care.
Objective:
To evaluate the effect of continuity of care on health outcomes (quality of life and functionality) in patients with rheumatoid arthritis and to reveal whether treatment adherence and disease activity have a serial multiple mediator role on this relationship.
Methods:
The study was cross-sectional on 440 rheumatoid arthritis patients who applied to a university hospital rheumatology outpatient clinic. Research data were obtained from both the questionnaire method, which is the primary data source, and the patient files, which are the secondary data source. Process analysis was used in the analysis of the data.
Results:
It was found that the continuity of care has a direct effect on the quality of life and the functionality. In addition, it is seen that treatment adherence has a single partial mediator role on the relationship between continuity of care and quality of life; It has been determined that treatment adherence and disease activity have both partial single mediation and serial multiple mediation roles on the relationship between continuity of care and functionality.
Conclusion:
It is thought that these findings will provide clinicians with important data and information in the management of rheumatoid arthritis.
El notable incremento de la población adulta mayor ha ocasionado que los profesionales de enfermería fortalezcan su liderazgo en el cuidado multidisciplinar de las personas adultas mayores; por lo que es preciso analizar las perspectivas y trabajo conjunto. Este libro contiene el análisis de autoridades científicas y expertos en gerontogeriatría sobre el trabajo multidisciplinar en la atención de las personas adultas mayores y sus cuidadores. En los primeros capítulos encontrará el análisis de la gestión de enfermería en el binomio cuidador y persona cuidada, biomarcadores asociados a escalas de medición, análisis de concepto Gerotrascendencia, sustracción teórica de reflexología para disminución del dolor del adulto mayor y aplicación del proceso de atención de enfermería; en los subsecuentes, capítulos se presentan resultados de investigación en población adulta mayor y cuidadores.
To evaluate the current situation and associated factors of informational support for older adults with chronic diseases in transitional care. Study was conducted in five hospitals of five different cities in Jiangsu Province, China. A random cluster sample of 800 older adults with chronic diseases responded to the informational support questionnaire of transitional care survey. Descriptive analysis, t-tests, variance analysis, and stepwise multiple linear regression were used to analyze data. The STROBE statement for observational studies was applied. Total score of ISQTC for older adults with chronic diseases was (44.05 ± 17.21). Marital status, educational level, past occupation, close friends, medical insurance, complications, and exercise habits were significantly correlated with informational support. The level of informational support in transitional care for older adults with chronic diseases was low. Clinical staff should periodically and primarily assess their informational support, help find information resources for those who have low initial informational support, and identify which information they preferred to carry out accurate transitional care.
(1) Background: Stroke is an important topic in the healthcare industry. The objective of the present study was to investigate patients’ sociodemographic characteristics, health status, continuity of care, self-management, and other predictors that affect their self-management. (2) Methods: This cross-sectional correlational study was carried out from March to September 2020, and included a total of 150 patients aged 20 and above who were diagnosed within the past 6 months. The research participants were selected from the Division of Neurology, Department of Internal Medicine/Department of Surgery, at a medical center in Central Taiwan. (3) Results: The mean self-management score of patients with stroke was 110.50 points (30–150 points). As shown in the stepwise regression analysis, the overall regression model explained approximately 44.5% of the variance in self-management. Educational level (10.8%), frequency of exercise per week (2.1%), time that patients were affected by stroke (2.4%), and continuity of care (29.2%) were the main predictors affecting the self-management of stroke patients. (4) Conclusions: To improve stroke patients’ self-management, medical teams should provide appropriate continuity of care to those with lower educational levels, those without exercise habits, and those who experienced a stroke within the past six months.
Objective
To analyze the bibliometric patterns of meta-approaches use in nursing research literature.
Methods
Descriptive, exploratory and historical bibliometrics analyses were used. The papers were harvested from the Web of Science Core Collection.
Findings
The search resulted in 2065 publications. The trends in using most individual meta approaches show that the use of meta-analysis is increasing exponentially, the use of meta-synthesis is increasing linearly, while the use of meta-ethnography is constant in last 6 years. Most productive countries were United States of America, United Kingdom and Peoples Republic of China. Most publications were published in the Journal of Advanced Nursing, International Journal of Nursing Studies, and Journal of Clinical Nursing. Twenty-seven percent of all publications were funded. Thirty-four meta approaches were identified.
Discussion
The study revealed that the trend in the literature production is positive. Research community use of meta-approaches in nursing exhibit considerable growth. Regional concentration of literature production was observed.
Continuity of care is a core dimension of high-quality care in the management of disease. The purpose of this study was to investigate the association between continuity of care and lumbar surgery in patients with moderate disc herniation. The Korean National Sample Cohort was used. The target population consisted of patients who have had disc herniation more than 6 months and didn’t get surgery and red flag signs within 6 months from onset. The population was enrolled from 2004 to 2013. The Bice-Boxerman Continuity of Care was used in measuring continuity of care. The marginal structural model with time dependent survival analysis was used. In total, 29,061 patients were enrolled in the cohort. High level of continuity of care was associated with a lower risk of lumbar surgery (HR, 0.27; 95% CI, 0.20–0.27). When the index was calculated only with outpatient visits to primary care with related specialty, the HR was 0.49 (95% CI: 0.43–0.57). In exploratory analysis, patients with lumbar stenosis and spondylolisthesis had higher risk of having a low level of continuity of care. These results indicate that continuity of care is associated with lower rates of lumbar surgery in patients with moderate disc herniation.
Purpose
A systematic review and meta-analysis was conducted to assess the types of healthcare intervention programs offered to patients with multimorbidity and their effects on key psychosocial factors.
Methods
For this systematic review and meta-analysis, we searched databases like Cochrane Library, PubMed, Embase, CINAHL RISS, KISS, etc. for studies published between January 1, 2009, and April 30, 2019. In total, 8,248 studies in English or Korean were reviewed. We included only randomized controlled trials or quasi-experimental studies that applied healthcare interventions and had major effects on the psychosocial factors in adult patients with multimorbidity. Methodological quality was assessed using Cochrane collaboration risk of bias tool. Meta-analysis was performed using the Review Manager 5.3 version to estimate the effect size.
Results
We identified six randomized controlled trials and 1446 subjects were enrolled. The results reveal that healthcare interventions have an effect on self-rated health (SMD = 0.53 95% CI: 0.26, 0.79,p < .001), reducing anxiety (SMD= -0.19 95% CI: -0.36, -0.01, p=.030) and depression (SMD= -0.27 95% CI: -0.44, -0.10, p=.002), and improving self-efficacy (SMD = 0.21 95% CI: 0.06, 0.35, p=.005) for patients with multimorbidity. However, there was no significant effect on quality of life.
Conclusion
Healthcare interventions had significant positive effects on self-rated health, anxiety, depression, and self-efficacy of patients with multimorbidity. These results are expected to serve as basic data for the development of a community-based integrated healthcare intervention program and health policy, especially for the vulnerable older population with multimorbidity.
This Centerscope article includes guidelines for calculating Cohen's d effect sizes for the relationship be- tween the independent variables and outcome measure for studies included in a practice-based research synthesis. A practice-based research synthesis includes studies where variations in practice characteristics are related to variations in outcomes. Different formulas and procedures are presented for different kinds of research designs and research studies. The guidelines were developed in order to be able to calculate effect sizes from different kinds of research studies included in the same practice-based research synthesis so that the effect sizes have the same or similar interpretive meaning.
Aims and objectives To assess the effectiveness of pre- and post-operative physiotherapy at home for unilateral total knee replacement (TKR).
Methods In this pragmatic randomized controlled trial set in participants’ homes (four primary care trust areas) and physiotherapy outpatients in a South Yorkshire teaching hospital trust, 160 osteoarthritis patients waiting for unilateral TKR were randomly allocated to intervention (home) group (n = 80) or control (hospital outpatient) group (n = 80). The intervention group had pre- and post-operative home visits for assessment and treatment by a community physiotherapist. Outcome measures were health-related quality of life (HRQoL), measured by the Western Ontario McMaster Osteoarthritis index (WOMAC) and the Short Form 36 health survey (SF-36) pre-operatively and at 12 weeks post-TKR operation; patient satisfaction; and NHS resource use.
Results No significant differences were observed between the two treatment groups in the primary outcome measure, the WOMAC pain score, or any other HRQoL score. The home group had a significantly greater mean number of physiotherapy sessions than the hospital group [mean difference 5.2 sessions, 95% confidence interval (CI) = −6.3 to −4.1; P = 0.001]. There was no significant difference in the total NHS costs per patient between groups. However, home physiotherapy for TKR was significantly more expensive (mean difference –£136.5, 95% CI = –£160 to –£113; P = 0.001). Patients were equally satisfied with physiotherapy at home or in hospital; however, more of the home group would choose their location for physiotherapy again.
Conclusions Although home physiotherapy was as effective and as acceptable to patients as hospital outpatient physiotherapy for unilateral TKR, it was more expensive. Additional pre-operative home physiotherapy did not improve patient-perceived health outcomes.
New care modes in primary care may affect patients' experienced continuity of care.
To analyse whether experienced continuity for patients with chronic obstructive pulmonary disease (COPD) changes after different care modes are introduced, and to analyse the relationship between continuity of care and patients' quality of life.
Randomised controlled trial with 2-year follow-up in general practice in the Netherlands.
A total of 180 patients with COPD were randomly assigned to three different care modes: self-management, regular monitoring by a practice nurse, and care provided by the GP at the patient's own initiative (usual care). Experienced continuity of care as personal continuity (proportion of visits with patient's own GP) and team continuity (continuity by the primary healthcare team) was measured using a self-administered patient questionnaire. Quality of life was measured using the Chronic Respiratory Questionnaire.
Of the final sample (n = 148), those patients receiving usual care experienced the highest personal continuity, although the chance of not contacting any care provider was also highest in this group (29% versus 2% receiving self-management, and 5% receiving regular monitoring). There were no differences in experienced team continuity in the three care modes. No relationship was found between continuity and changes in quality of life.
Although personal continuity decreases when new care modes are introduced, no evidence that this affects patients' experienced team continuity or patients' quality of life was found. Patients still experienced smooth, ongoing care, and considered care to be connected. Overall, no evidence was found indicating that the introduction of new care modes in primary care for patients with COPD should be discouraged.
Care management programmes are an effective approach to care for high risk patients with complex care needs resulting from multiple co-occurring medical and non-medical conditions. These patients are likely to be hospitalized for a potentially "avoidable" cause. Nurse-led care management programmes for high risk elderly patients showed promising results. Care management programmes based on health care assistants (HCAs) targeting adult patients with a high risk of hospitalisation may be an innovative approach to deliver cost-efficient intensified care to patients most in need.
PraCMan is a cluster randomized controlled trial with primary care practices as unit of randomisation. The study evaluates a complex primary care practice-based care management of patients at high risk for future hospitalizations. Eligible patients either suffer from type 2 diabetes mellitus, chronic obstructive pulmonary disease, chronic heart failure or any combination. Patients with a high likelihood of hospitalization within the following 12 months (based on insurance data) will be included in the trial. During 12 months of intervention patients of the care management group receive comprehensive assessment of medical and non-medical needs and resources as well as regular structured monitoring of symptoms. Assessment and monitoring will be performed by trained HCAs from the participating practices. Additionally, patients will receive written information, symptom diaries, action plans and a medication plan to improve self-management capabilities. This intervention is addition to usual care. Patients from the control group receive usual care. Primary outcome is the number of all-cause hospitalizations at 12 months follow-up, assessed by insurance claims data. Secondary outcomes are health-related quality of life (SF12, EQ5D), quality of chronic illness care (PACIC), health care utilisation and costs, medication adherence (MARS), depression status and severity (PHQ-9), self-management capabilities and clinical parameters. Data collection will be performed at baseline, 12 and 24 months (12 months post-intervention).
Practice-based care management for high risk individuals involving trained HCAs appears to be a promising approach to face the needs of an aging population with increasing care demands.
Review of the literature reveals a need to develop a questionnaire that measures patient perceptions of factors impacting continuity of care following discharge from hospital. Such a measure has the potential to guide quality improvement initiatives related to continuity of care.
Our objective was to develop and examine the psychometric properties of a measure that would meet this need, the Patient Continuity of Care Questionnaire (PCCQ).
The PCCQ was administered to 204 inpatients 4 weeks after discharge. The questionnaire was assessed by item and principal components analysis. Factors derived from principal components analysis were assessed for internal consistency and construct validity.
A principal components analysis resulted in six subscales including perceptions of: (1) relationships with providers in hospital, (2) information transfer to patients, (3) relationships with providers in community, (4) management of written forms, (5) management of follow-up and (6) management of communication among providers. These subscales were internally consistent in our sample and demonstrated construct validity through correlations with other related constructs.
This initial study supports the reliability and validity of the PCCQ for measuring patient perceptions of factors central to continuity of care. The questionnaire subscales correspond to the theoretical components of continuity of care that have been proposed in the literature, namely informational, relational and management continuity. The subscales may be of value for identifying problems in continuity of care and for evaluating interventions aimed at improving continuity of care for patients after hospital discharge.
One possible reason for the continued neglect of statistical power analysis in research in the behavioral sciences is the inaccessibility of or difficulty with the standard material. A convenient, although not comprehensive, presentation of required sample sizes is provided. Effect-size indexes and conventional values for these are given for operationally defined small, medium, and large effects. The sample sizes necessary for .80 power to detect effects at these levels are tabled for 8 standard statistical tests: (1) the difference between independent means, (2) the significance of a product-moment correlation, (3) the difference between independent rs, (4) the sign test, (5) the difference between independent proportions, (6) chi-square tests for goodness of fit and contingency tables, (7) 1-way analysis of variance (ANOVA), and (8) the significance of a multiple or multiple partial correlation.
The effects of intervention programs on health-related quality of life (HRQOL) of patients with hip fracture have not been well studied. We hypothesized that older patients with hip fracture who received our interdisciplinary intervention program would have better HRQOL than those who did not.
A randomized experimental design was used. Older patients with hip fracture (N = 162), 60 to 98 years old, from a medical center in northern Taiwan were randomly assigned to an experimental (n = 80) or control (n = 82) group. HRQOL was measured by the SF-36 Taiwan version at 1, 3, 6, and 12 months after discharge.
The experimental group had significantly better overall outcomes in bodily pain (β = 9.38, p = 0.002), vitality (β = 9.40, p < 0.001), mental health (β = 8.16, p = 0.004), physical function (β = 16.01, p < 0.001), and role physical (β = 22.66, p < 0.001) than the control group at any time point during the first year after discharge. Physical-related health outcomes (physical functioning, role physical, and vitality) had larger treatment effects than emotional/mental- and social functioning-related health outcomes.
This interdisciplinary intervention program may improve health outcomes of elders with hip fracture. Our results may provide a reference for health care providers in countries using similar programs with Chinese/Taiwanese immigrant populations.
NCT01052636.
To assess the impact of chronic disease and the number of diseases on the various aspects of health-related quality of life (HRQOL) among the elderly in São Paulo, Brazil.
The SF-36 Health Survey was used to assess the impact of the most prevalent chronic diseases on HRQOL. A cross-sectional and population-based study was carried out with two-stage stratified cluster sampling. Data were obtained from a multicenter health survey administered through household interviews in several municipalities in the state of São Paulo. The study evaluated seven diseases--arthritis, back-pain, depression/anxiety, diabetes, hypertension, osteoporosis, and stroke--and their effects on quality of life.
Among the 1 958 elderly individuals (60 years of age or older), 13.6% reported not having any of the illnesses, whereas 45.7% presented three or more chronic conditions. The presence of any of the seven chronic illnesses studied had a significant effect on the scores of nearly all the SF-36 scales. HRQOL achieved lower scores when related to depression/anxiety, osteoporosis, and stroke. The higher the number of diseases, the greater the negative effect on the SF-36 dimensions. The presence of three or more diseases significantly affected HRQOL in all areas. The bodily pain, general health, and vitality scales were the most affected by diseases.
The study detected a high prevalence of chronic diseases among the elderly population and found that the degree of impact on HRQOL depends on the type of disease. The results highlight the importance of preventing and controlling chronic diseases in order to reduce the number of comorbidities and lessen their impact on HRQOL among the elderly.
It has been suggested that the quality of clinical trials should be assessed by blinded raters to limit the risk of introducing bias into meta-analyses and systematic reviews, and into the peer-review process. There is very little evidence in the literature to substantiate this. This study describes the development of an instrument to assess the quality of reports of randomized clinical trials (RCTs) in pain research and its use to determine the effect of rater blinding on the assessments of quality. A multidisciplinary panel of six judges produced an initial version of the instrument. Fourteen raters from three different backgrounds assessed the quality of 36 research reports in pain research, selected from three different samples. Seven were allocated randomly to perform the assessments under blind conditions. The final version of the instrument included three items. These items were scored consistently by all the raters regardless of background and could discriminate between reports from the different samples. Blind assessments produced significantly lower and more consistent scores than open assessments. The implications of this finding for systematic reviews, meta-analytic research and the peer-review process are discussed.
Ware JE, Jr.: SF-36 Health Survey Update, in Maruish M (ed): The Use of Psychological Testing for Treatment Planning and Outcome Assessment, Volume 3. Mahwah, New Jersey: Lawrence Erlbaum Associates; 2004, pages 693-718. ISBN 0805843310, 9780805843316.
The concept - and reality - of continuity of care crosses disciplinary and organisational boundaries. The common definitions provided here should help healthcare providers evaluate continuity more rigorously and improve communication.
With the publication of its 100th paper, the new open access Journal Health and Quality of Life Outcomes (HQLO), achieves a significant milestone. Launching a journal in this field was not just a challenge with respect to nomenclature, [1] but also provided a forum for disseminating research which emphasises the unique contributions as well as the inter-relationships among determinants of health, provision of care, and outcomes. So far, prominence (as measured by the number of scientific manuscripts accepted for publication) has been given mainly to the unique contributions of health-related quality of life (HRQL). Other determinants like health needs and satisfaction have sporadically been considered [2-7]. A few additional papers have focused on approaches to detect ill health. In this editorial we would like to explore the relationship between needs, satisfaction and quality of life, identify gaps in the current knowledge base, and encourage future research in these areas.
To determine the impact of a hospital-coordinated discharge care plan, involving a multidisciplinary team of primary health care providers, on hospital length of stay, quality of life, and both patient and general practitioner inclusion in, and satisfaction with, discharge procedures.
This investigation comprised a prospective, randomized, controlled, clinical trial.
This multicentre and cross-jurisdictional study focused on areas of tertiary and primary health care as well as community allied health in Western Australia.
Patients (n = 189) with chronic cardiorespiratory diagnoses were recruited from respiratory, cardiovascular, and general medical wards at two tertiary hospitals.
Subjects were randomly assigned to one of two groups. Intervention group patients received a discharge care plan in accordance with that outlined in the Australian Enhanced Primary Care Package, completed before discharge and sent to the patient's general practitioner and other community service providers for review. Control patients were discharged under existing hospital processes. Outcome measures. Patients and general practitioners were surveyed pre-discharge and 7 days post-discharge for quality of life and opinion of discharge procedures. Hospital length of stay was also determined.
Significant improvements in discharge planning involvement, health service access, confidence with discharge procedures, and opinion of discharge based on previous experience were seen for patients who received the discharge care plan. Further, improved perceptions of mental quality of life were observed within the first week post-discharge for intervention patients. Length of stay showed no difference between groups. Extent and speed of hospital-general practitioner communication were significantly improved via the intervention.
Our results indicate that a multidisciplinary discharge care plan, initiated before separation, improves quality of life, involvement, and satisfaction with discharge care, and hospital-general practitioner integration. As such, it possesses benefits over current Western Australian hospital discharge procedures for the care of chronically ill populations.
We determined the reported value general practitioners/family physicians in 3 different health care systems place on the various types of continuity of care.
We conducted a postal questionnaire survey in England and Wales, the United States, and The Netherlands. The participants were 1,523 general practitioners/family physicians (568 from England and Wales, 453 from the United States and 502 from The Netherlands). Our main outcome measures were the perceived importance of the types of continuity of care and doctor or practice characteristics that may influence attitudes toward personal continuity of care.
The response rates were England and Wales 60% (568/946), United States 47% (453/963) and Netherlands 76% (502/660). The doctors in all 3 countries felt strongly that personal continuity remained an important aspect of good-quality care to their patients. Within a given health care system, doctors' personal and practice characteristics explained only a small part of the variance in attitudes toward the provision of personal continuity of care (England and Wales and The Netherlands r2 = 0.04, United States r2 = 0.01). The doctors in all 3 countries felt that they were currently able to provide all 3 types of continuity of care, although doctors in England and Wales were least positive about the provision of informational and management continuity across the primary-secondary care divide.
General practitioners/family physicians from 3 differing health care systems all place high value on being able to provide personal continuity of care to patients. Personal continuity of care remains a core value of general practice/family medicine and should be taken account of by policy makers when redesigning health care systems.
The primary goal of this study was to evaluate the feasibility and effectiveness of a structured, multidisciplinary intervention targeted to maintain the overall quality of life (QOL), which is more comprehensive than psychosocial distress, of patients undergoing radiation therapy for advanced-stage cancer.
Radiation therapy patients with advanced cancer and an estimated 5-year survival rate of 0% to 50% were randomly assigned to either an eight-session structured multidisciplinary intervention arm or a standard care arm. The eight 90-minute sessions addressed the five domains of QOL including cognitive, physical, emotional, spiritual, and social functioning. The primary end point of maintaining overall QOL was assessed by a single-item linear analog scale (Linear Analog Scale of Assessment or modified Spitzer Uniscale). QOL was assessed at baseline, week 4 (end of multidisciplinary intervention), week 8, and week 27.
Of the 103 participants, overall QOL at week 4 was maintained by the patients in the intervention (n = 49), whereas QOL at week 4 significantly decreased for patients in the control group (n = 54). This change reflected a 3-point increase from baseline in the intervention group and a 9-point decrease from baseline in the control group (P = .009). Intervention participants maintained their QOL, and controls gradually returned to baseline by the end of the 6-month follow-up period.
Although intervention participants maintained and actually improved their QOL during radiation therapy, control participants experienced a significant decrease in their QOL. Thus, a structured multidisciplinary intervention can help maintain or even improve QOL in patients with advanced cancer who are undergoing cancer treatment.
Continuity of care is concerned with the quality of care over time. There are two important perspectives on this. Traditionally, continuity of care is idealized in the patient's experience of a 'continuous caring relationship' with an identified health care professional. For providers in vertically integrated systems of care, the contrasting ideal is the delivery of a 'seamless service' through integration, coordination and the sharing of information between different providers. As patients' health care needs can now only rarely be met by a single professional, multidimensional models of continuity have had to be developed to accommodate the possibility of achieving both ideals simultaneously. Continuity of care may, therefore, be viewed from the perspective of either patient or provider.
Continuity in the experience of care relates conceptually to patients' satisfaction with both the interpersonal aspects of care and the coordination of that care. Experienced continuity may be valued in its own right. In contrast, continuity in the delivery of care cannot be evaluated solely through patients' experiences, and is related to important aspects of services such as 'case-management' and 'multidisciplinary team working'. From a provider perspective, the focus is on new models of service delivery and improved patient outcomes. A full consideration of continuity of care should therefore cover both of these distinct perspectives, exploring how these come together to enhance the patient-centredness of care.
The methodological quality of randomized controlled trials (RCTs) is commonly evaluated in order to assess the risk of biased estimates of treatment effects. The purpose of this systematic review was to identify scales used to evaluate the methodological quality of RCTs in health care research and summarize the content, construction, development, and psychometric properties of these scales.
Extensive electronic database searches, along with a manual search, were performed.
One hundred five relevant studies were identified. They accounted for 21 scales and their modifications. The majority of scales had not been rigorously developed or tested for validity and reliability. The Jadad Scale presented the best validity and reliability evidence; however, its validity for physical therapy trials has not been supported.
Many scales are used to evaluate the methodological quality of RCTs, but most of these scales have not been adequately developed and have not been adequately tested for validity and reliability. A valid and reliable scale for the assessment of the methodological quality of physical therapy trials needs to be developed.
The purpose of this study was to investigate quality of life and related factors in adult patients with asthma. This study adopted a cross-sectional correlation design. Purposive sampling was used to recruit adult asthma patients over 18 years of age from outpatient departments of five hospitals in Kaohsiung City, Kaohsiung County and Pingtung County. A total of 209 valid questionnaires were acquired. Structured questionnaires were administered, which collected necessary data for a hospital anxiety and depression scale, self-care behavior scale, asthma quality of life scale and asthma control test scale as well as respondent information and disease characteristics. Results showed that: (1) the standardized quality of life score was 68.3, considered as a medium level; (2) quality of life for patients holding bachelor's degrees or higher was better than for patients educated to a high school or lower level; quality of life for semi-professionals, public officials, professionals and administrative staff at middle to senior levels was better than that for unskilled or non-skilled workers; the older the individual, the worse their quality of life; (3) elevated emotional distress and self-care behavior both correlated with lower quality of life, while better asthma control correlated with better quality of life; (4) "asthma control" and "emotional distress" were important explanatory variables for quality of life, accounting for 67.5% of total variance. Results of this study may be used for future reference in clinical nursing care and education on enhancing quality of life in adult patients with asthma.
to estimate the extent to which a case-management intervention for persons newly discharged into the community following an acute stroke effected a change in stroke outcome in comparison with usual care.
a re-analysis of stratified, balanced, randomised clinical trial.
five university-affiliated acute-care hospitals in Montreal, Quebec, Canada.
a total of 190 persons (mean age 70 years) returning home directly from the acute-care hospital following a first or recurrent stroke with a need for health-care supervision post-discharge because of low function, co-morbidity or isolation.
for 6 weeks following discharge a nurse case manager delivered, depending on need, over 50 different nursing interventions (range 2-15 per person), which targeted physical, emotional and psychological impairments, role participation restrictions and health perception.
seven of the SF-36 subscales were used to measure the targeted constructs, at the post-intervention and 6 month evaluations. Seven binary response variables were created with a change of 10 points the criterion for individual response. Generalised estimating equations, equivalent to a logistic regression for multiple outcomes, were used.
the odds of responding to one or more outcomes was 41% greater in the intervention group than in the control group [odds ratio (OR): 1.41; 95% confidence interval (CI): 1.11-1.79].
an analysis considering the complexity of the intervention and outcomes targeted indicated effectiveness of the nurse case-management post-stroke, whereas the traditional one outcome analysis did not.
Musculoskeletal disorders are the major causes of the pain in the elderly population. Rheumatic conditions restrict participation in activities and mobility, as well as cause difficulties in the execution of self-care tasks. The assessment of health related quality of life (HRQOL) is an important indicator of the impact of rheumatic diseases on the physical, mental and social aspects. This study aims to analyze the influence of rheumatic diseases and chronic joint symptoms on the quality of life of the elderly (n=2209) aged 60 years or over. The effects of rheumatism and joint symptoms on quality of life were investigated by the Outcome Study Short-Form Health Survey (SF-36), and this analysis was adjusted for age and sex. The univariate analysis of variance and analysis of covariance (ANOVA and ANCOVAS) were used for statistical procedures, p≤0.05. Rheumatic diseases affected: functional capacity (F(1, 2012))=10.9 and pain (F(1, 2012))=34.77. Joint symptoms affected all components of the SF-36: physical functioning (F(1, 2012))=10.9; physical problems (F(1, 2012))=72.61; pain (F(1, 2012))=164.29; general health (F(1, 2012))=71.95; vitality (F(1, 2012))=55.78; social aspect (F(1, 2012))=73.14; emotional aspect (F(1, 2012))=49.09 and mental health (F(1, 2012))=44.72. There was a significant impact of rheumatic diseases on physical health, and that joint symptoms affected self-evaluations of physical and mental health. These results will contribute to a better understanding of this systemic disease and will be used for planning effective interventions.
Hospital readmission is an indicator of care quality. Studies have been conducted to test whether post-discharge transitional care programs can reduce hospital readmission, but results are not conclusive. The contemporary development of post-discharge support advocates a health and social partnership approach. There is a paucity of experimental studies examining the effects of such efforts. This study designed a health-social transitional care management program (HSTCMP) and subjected it to empirical testing using a randomized controlled trial in the medical units of an acute general hospital with 1700 beds in Hong Kong during the period of February 2009 to July 2010. Results using per-protocol analysis revealed that the HSTCMP significantly reduced readmission at 4-weeks (study 4.0%, control 10.2%, χ(2) = 7.98, p = 0.005). The intention-to-treat result also showed a lower readmission rate with the study group but the result was not significant (study 11.5%, control 14.7%, χ(2) = 1.53, p = 0.258). There was however significant improvement in quality of life, self-efficacy and satisfaction in the study group in both per-protocol and intention-to-treat analyses. The study suggests that a health-social partnership, using volunteers as substitutes for some of the professional care, may be effective for general medical patients.
Heart failure is a chronic and exacerbating disease, which often significantly decreases patient quality of life (QOL). Treatments continue to focus on alleviating the physical symptoms of this disease, and data on QOL factors are limited.
The purpose of this study was to explore QOL and associated factors in patients with heart failure.
A cross-sectional and correlational research design was conducted using the Kansas City Cardiomyopathy Questionnaire, Beck Depression Inventory-II, and the World Health Organization Quality of Life Assessment. A convenience sample of 200 patients aged 20 years old or above and diagnosed with heart failure were recruited from one medical center and one regional teaching hospital in southern Taiwan. Data were analyzed using SPSS 14.0 software.
Results found (1) participants had an average QOL index score of 63.0 (moderate); (2) significant differences in QOL scores for the variables of marriage, occupation type, monthly family income, concomitant diabetes/hypertension, number of complications, and treatment type; (3) participants had an average index score for symptoms of 54.1 (moderate) that was significantly correlated with QOL; (4) a majority of participants were classified in NYHA Class II, mean score of depression was 9.13±6.25 (normal), and functional status and depression were significantly related to QOL; and (5) 59.3% of QOL variance was explained by depression, symptoms and family income per month.
This study may help health professionals to understand relationships among symptoms, functional status, depression and QOL in heart failure patients. It may also provide healthcare professionals evidence-based data necessary to further improve symptoms, functional status and depression in heart failure patients, and thus significantly improve QOL in patients with heart failure.
Integrative medicine has emerged as a potential solution to the American healthcare crisis. It provides care that is patient centered, healing oriented, emphasizes the therapeutic relationship, and uses therapeutic approaches originating from conventional and alternative medicine. Initially driven by consumer demand, the attention integrative medicine places on understanding whole persons and assisting with lifestyle change is now being recognized as a strategy to address the epidemic of chronic diseases bankrupting our economy. This paper defines integrative medicine and its principles, describes the history of complementary and alternative medicine (CAM) in American healthcare, and discusses the current state and desired future of integrative medical practice. The importance of patient-centered care, patient empowerment, behavior change, continuity of care, outcomes research, and the challenges to successful integration are discussed. The authors suggest a model for an integrative healthcare system grounded in team-based care. A primary health partner who knows the patient well, is able to addresses mind, body, and spiritual needs, and coordinates care with the help of a team of practitioners is at the centerpiece. Collectively, the team can meet all the health needs of the particular patient and forms the patient-centered medical home. The paper culminates with 10 recommendations directed to key actors to facilitate the systemic changes needed for a functional healthcare delivery system. Recommendations include creating financial incentives aligned with health promotion and prevention. Insurers are requested to consider the total costs of care, the potential cost effectiveness of lifestyle approaches and CAM modalities, and the value of longer office visits to develop a therapeutic relationship and stimulate behavioral change. Outcomes research to track the effectiveness of integrative models must be funded, as well as feedback and dissemination strategies. Additional competencies for primary health partners, including CAM and conventional medical providers, will need to be developed to foster successful integrative practices. Skills include learning to develop appropriate healthcare teams that function well in a medical home, developing an understanding of the diverse healing traditions, and enhancing communication skills. For integrative medicine to flourish in the United States, new providers, new provider models, and a realignment of incentives and a commitment to health promotion and disease management will be required.
Aims and objectives:
This study aimed to evaluate the effectiveness of a comprehensive discharge-planning service for hip fracture patients, including length of stay, functional status, self-care knowledge and quality of life (QOL).
Background:
Hip fractures are the most devastating result of osteoporosis. Care of these patients from the moment they enter the hospital until discharge and postdischarge is a challenging task, requiring a coordinated approach by an interdisciplinary team.
Design:
An experimental design was used. Methods. Fifty hip fracture patients were recruited from a medical centre in Taipei, Taiwan and randomly divided into two groups. The control group received routine discharge nursing care and the experimental group received comprehensive discharge planning. After patient admission, researchers assessed discharge-planning needs, provided discharge nursing instruction, coordinated services and determined discharge placement based on assessment results.
Results:
(i) Mean age of 50 hip fracture patients was 78.75 (SD 6.99) years. Mean length of stay was 6.04 (SD 2.41) days for the experimental group and 6.29 (SD 2.17) for the control group. Difference between groups was not significant (t = -0.394, p = 0.696). (ii) The self-care knowledge of the experimental group was higher than that of the control group (F = 11.569, p = 0.001). (iii) Significant improvements were observed in functional status of both groups at three months postdischarge, with no significant differences observed between groups. However, the functional status of experimental group patients showed a slightly better trend than that of the control group. (iv) At three months postdischarge, QOL of experimental group patients was better than control group patients.
Conclusions:
A comprehensive discharge-planning service can improve hip fracture patients' self-care knowledge and QOL.
Relevance to clinical practice:
Results of this study can be used clinically as a basis for practical implementation of discharge-planning services in fracture patients.
The assessment of health status and quality of life among chronically ill patients is an area of current scientific interest. This paper considers the utility of a short but comprehensive instrument to assess the quality of life for end-stage renal failure patients. the Spitzer QL-Index was completed by 8 nurses for all patients in the Wellington region currently being treated with home hemodialysis (n = 58); hospital hemodialysis (n = 13); and continuous ambulatory peritoneal dialysis (n = 37). Results indicated that home hemodialysis patients achieve the highest quality of life in comparison to the other two treatment modalities. It is concluded that the QL-Index has some discriminative validity for this patient population, and its use may contribute to informed decision making by both patients and doctors.
Because stroke management is aimed at facilitating community reintegration, it would be logical that the sooner the patient can be discharged home, the sooner reintegration can commence. The purpose of this study was to determine the effectiveness of prompt discharge combined with home rehabilitation on function, community reintegration, and health-related quality of life during the first 3 months after stroke.
A randomized trial was carried out involving patients who required rehabilitation services and who had a caregiver at home. When medically ready for discharge, persons with stroke were randomized to either the home intervention group (n=58) or the usual care group (n=56). The home group received a 4-week, tailor-made home program of rehabilitation and nursing services; persons randomized to the usual care group received services provided through a variety of mechanisms, depending on institutional, care provider, and personal preference. The main outcome measure was the Physical Health component of the Measuring Outcomes Study Short-Form-36 (SF-36). Associated outcomes measures included the Timed Up & Go (TUG), Barthel Index (BI), the Older Americans Resource Scale for instrumental activities of daily living (OARS-IADL), Reintegration to Normal Living (RNL), and the SF-36 Mental Health component.
The total length of stay for the home group was, on average, 10 days, 6 days shorter than that for the usual care group. There were no differences between the 2 groups on the BI or on the TUG at either 1 or 3 months after stroke; however, there was a significantly beneficial impact of the home intervention on IADL and reintegration (RNL). By 3 months after stroke, the home intervention group showed a significantly higher score on the SF-36 Physical Health component than the usual care group. The total number of services received by the home group was actually lower than that received by the usual care group.
Prompt discharge combined with home rehabilitation appeared to translate motor and functional gains that occur through natural recovery and rehabilitation into a greater degree of higher-level function and satisfaction with community reintegration, and these in turn were translated into a better physical health.
In Part 2 of this two-part series, research designs, methods, and measurement of continuity of care are explored.
Qualitative, integrated literature review of a sample of 38 continuity of care nursing research article published 1990-1995.
Ganong's (1987) stages of the integrative literature research review process were followed. A data collection tool was designed and pilot tested, and rules for data analysis and interpretation were established. Research articles were systematically analyzed and reported using descriptive analysis.
Results showed few nursing models, primarily convenience sampling and nonexperimental cross-sectional study designs, varied data collection methods, and inadequate instrumentation. Measurement criteria were diverse and influenced by the perspectives of the measurer.
Continuity of patient care was identified as a construct comprised of many related and tangential concepts in need of more sophisticated review. Recommendations for researchers are discussed.
Although health care in The Netherlands is of a high quality with strong emphasis on primary care and high accessibility to hospital care, care deficits may arise in patients with chronic complex health problems who need the attention of several caregivers. Because no regular coordinating centre or person exists, coordination of care may be deficient leading to a poor continuity of care. This may be particularly true for those patients being cared for by both primary and hospital care teams, as is the case for most terminal cancer patients. Therefore, a transmural home care intervention programme for terminal cancer patients was introduced which intended to optimize coordination of care and thereby improve continuity of care. This quasi-experimental study investigated the effects of this intervention (intervention group 79 patients) on indicators of coordination and continuity of care. When compared to standard care (control group 37 patients) moderate positive effects (mainly for the nursing disciplines) on the various indicators of coordination and continuity of care by the transmural home care intervention programme were found. Future prospective studies are needed to further elucidate the effects of transmural care on these aspects of care.
In this issue, Wenger and colleagues found that preventive care, chronic care, and care of geriatric conditions in U.S. vulnerable elders are often suboptimal. We need to focus much more attention on medical care for the most vulnerable third of the older population. Reimbursement practices must change so that they support practice patterns necessary to provide such care.
To evaluate an interdisciplinary intervention program for older people with hip fracture in Taiwan.
Randomized experimental design.
A 3,800-bed medical center in northern Taiwan.
Elderly patients with hip fracture (N=137) were randomly assigned to an experimental (n=68) or control (n=69) group.
An interdisciplinary program of geriatric consultation, continuous rehabilitation, and discharge planning.
Demographic and outcome variables were measured. Outcome variables included service utilization, clinical outcomes, self-care abilities, health-related quality-of-life (HRQOL) outcomes, and depressive symptoms.
Subjects in the experimental group improved significantly more than those in the control group in the following outcomes: ratio of hip flexion 1 month after discharge (P=.02), recovery of previous walking ability at 1 month (P=.04) and 3 months (P=.001) after discharge, and activities of daily living at 1 month (P=.01) and 2 months (P=.001) after discharge. Three months after discharge, the experimental group showed significant improvement in peak force of the fractured limb's quadriceps (P=.04) and the following health outcomes: bodily pain (P=.03), vitality (P<.001), mental health (P=.02), physical function (P<.001), and role physical (P=.006). They also had fewer depressive symptoms (P=.008) 3 months after discharge.
This intervention program may benefit older people with hip fractures in Taiwan by improving their clinical outcomes, self-care abilities, and HRQOL and by decreasing depressive symptoms within 3 months after discharge.
The objective of this study was to examine the effectiveness of a discharge plan in hospitalized elderly patients with hip fracture due to falling.
Hip fractures are an important cause of morbidity and mortality among older people. Hip fracture patients require ongoing medical and long-term care services. Discharge plan services can play a very important role for these patients, since the services improved their outcome conditions.
Hip fracture patients aged 65 years and older (n = 126), hospitalized due to falling and discharged from a medical centre in northern Taiwan, were randomly assigned to either a comparison group (the routine care) or experimental group (the discharge planning intervention). The outcomes used to determine the effectiveness of the intervention were: length of hospitalized stay, rate of readmission, repeat falls and survival, and activities of daily living.
The discharge planning intervention decreased length of stay, rate of readmission and rate of survival and improved activities of daily living for intervention group compared with those of control group. Mean total SF-36 scores of patients in the experimental group were higher than for the control group and both groups had improved quality of life.
The discharge planning benefited older people with hip fractures.
A discharge planning intervention by a nurse can improve physical outcomes and quality of life in hip fracture patients.
Background data:
Depression is a common co-morbidity for patients with complaints of spinal pain, yet often goes undiagnosed in clinical practice. Depressed patients who are not identified do not receive a referral or recommendation for treatments that may help ease their total illness burden. Relative to the total outcomes of spine care this may increase costs, decrease overall functional outcomes, and limit patient satisfaction. Some spine care settings track functional outcomes using a general health status survey. Although a specific and reliable survey to detect depression could be employed, an additional survey would unnecessarily increase responder and analyst burdens if the general health status survey could be used instead.
Objective:
To identify the Mental Component Summary (MCS) cutoff score from the Short Form 36-item Health Survey (SF-36) that best predicts a positive depression score as measured by the Center for Epidemiological Study-Depression Survey (CES-D).
Study design:
An analysis of the diagnostic properties of the SF-36 MCS Scale as a predictor of depressive symptoms as measured by the CES-D.
Outcome measures:
The SF-36 is a general health survey that contains a MCS score that represents the psychological well-being and general health perception of the respondent. This composite score is norm-based (mean = 50, SD = 10) with lower scores representing poorer health. The CES-D has been well-studied in patients with chronic pain complaints and was used as the gold standard for determining the MCS cutoff score. A CES-D score of 19 or greater was considered positive for depressive symptoms.
Patient sample:
All patients entering our facility routinely complete the SF-36. Between February 2002 and October 2002, all patients scoring 30 or less on the MCS (MCS < or = 30) also completed the CES-D. Patients who scored 2 standard deviations below the mean (MCS = 30 or less) were considered most at risk for depression. Patients scoring above 30 on their MCS (MCS > 30) were considered less likely to have depressive symptoms and were randomly chosen to complete the CES-D. There were 420 patients who completed both surveys of which there were 99 MCS < or = 30 patients and 321 MCS > 30 patients.
Methods:
Receiver operating characteristic (ROC) curves were used to assess the sensitivity and specificity of the SF-36 as a screening tool for detecting depressive symptoms.
Results:
An MCS score of 35 has a sensitivity of 80% (76-83; 95% confidence interval), a specificity of 90% (87-93), an ROC area of 0.8517 (0.81-0.89), and correctly identified 87% of the sample.
Conclusion:
The SF-36 provides the benefits of a general functional health status measure and additionally appears to provide a screening tool for depressive symptoms. A cutoff score of 35 or less on the MCS scale has a high degree of sensitivity and specificity and is able to identify depressive symptoms in patients with back pain, which can help identify patients who will benefit from mental health treatments.
The aim of the study was to present a systematic review of studies that investigate the effects of robot-assisted therapy on motor and functional recovery in patients with stroke.
A database of articles published up to October 2006 was compiled using the following Medline key words: cerebral vascular accident, cerebral vascular disorders, stroke, paresis, hemiplegia, upper extremity, arm, and robot. References listed in relevant publications were also screened. Studies that satisfied the following selection criteria were included: (1) patients were diagnosed with cerebral vascular accident; (2) effects of robot-assisted therapy for the upper limb were investigated; (3) the outcome was measured in terms of motor and/or functional recovery of the upper paretic limb; and (4) the study was a randomized clinical trial (RCT). For each outcome measure, the estimated effect size (ES) and the summary effect size (SES) expressed in standard deviation units (SDU) were calculated for motor recovery and functional ability (activities of daily living [ADLs]) using fixed and random effect models. Ten studies, involving 218 patients, were included in the synthesis. Their methodological quality ranged from 4 to 8 on a (maximum) 10-point scale.
Meta-analysis showed a nonsignificant heterogeneous SES in terms of upper limb motor recovery. Sensitivity analysis of studies involving only shoulder-elbow robotics subsequently demonstrated a significant homogeneous SES for motor recovery of the upper paretic limb. No significant SES was observed for functional ability (ADL).
As a result of marked heterogeneity in studies between distal and proximal arm robotics, no overall significant effect in favor of robot-assisted therapy was found in the present meta-analysis. However, subsequent sensitivity analysis showed a significant improvement in upper limb motor function after stroke for upper arm robotics. No significant improvement was found in ADL function. However, the administered ADL scales in the reviewed studies fail to adequately reflect recovery of the paretic upper limb, whereas valid instruments that measure outcome of dexterity of the paretic arm and hand are mostly absent in selected studies. Future research into the effects of robot-assisted therapy should therefore distinguish between upper and lower robotics arm training and concentrate on kinematical analysis to differentiate between genuine upper limb motor recovery and functional recovery due to compensation strategies by proximal control of the trunk and upper limb.
Hospital discharge planning is a key element of continuity of care for persons leaving the hospital. Yet many important questions regarding processes and effects of discharge planning have not been addressed, in part because the multiple terms associated with discharge planning have not been consistently defined or used. Failure to clearly name, define, and consistently use terms creates a barrier that inhibits scientific progress and best practice. This article reviews the use of terms and definitions and compares concepts associated with hospital discharge planning across key documents frequently referenced by hospitals. A conceptual model is proposed to facilitate consistent use of these concepts.
In old age, reduction in physical function leads to loss of independence, the need for hospital and long-term nursing-home care, and premature death. We did a systematic review to assess the effectiveness of community-based complex interventions in preservation of physical function and independence in elderly people.
We searched systematically for randomised controlled trials assessing community-based multifactorial interventions in elderly people (mean age at least 65 years) living at home with at least 6 months of follow-up. Outcomes studied were living at home, death, nursing-home and hospital admissions, falls, and physical function. We did a meta-analysis of the extracted data.
We identified 89 trials including 97 984 people. Interventions reduced the risk of not living at home (relative risk [RR] 0.95, 95% CI 0.93-0.97). Interventions reduced nursing-home admissions (0.87, 0.83-0.90), but not death (1.00, 0.97-1.02). Risk of hospital admissions (0.94, 0.91-0.97) and falls (0.90, 0.86-0.95) were reduced, and physical function (standardised mean difference -0.08, -0.11 to -0.06) was better in the intervention groups than in other groups. Benefit for any specific type or intensity of intervention was not noted. In populations with increased death rates, interventions were associated with reduced nursing-home admission. Benefit in trials was particularly evident in studies started before 1993.
Complex interventions can help elderly people to live safely and independently, and could be tailored to meet individuals' needs and preferences.
Geriatric family-centered care model for hospitalized elders. Retrieved from http://www.americannursetoday.com/a-geriatric-family-centered-care-model-for-hospitalized-elders
- M Donahue
- M W Kazer
- L Smith
- J J A Fitzpatrick
Continuity of care for older hospital patients
- L Sonola
- E Poteliakhoff