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Chronic Disease Management (chronic + disease_management)
Selected AbstractsHeart Failure and Diabetes: Collateral Benefit of Chronic Disease ManagementCONGESTIVE HEART FAILURE, Issue 3 2006Molly G. Ware MD To test the hypothesis that a focus on heart failure (HF) care may be associated with inadequate diabetes care, the authors screened 78 patients (aged 64±11 years; 69% male) with diabetes enrolled in an HF disease management program for diabetes care as recommended by the American Diabetes Association (ADA). Ninety-five percent of patients had hemoglobin A1c levels measured within 12 months, and 71% monitored their glucose at least once daily. Most patients received counseling regarding diabetic diet and exercise, and approximately 80% reported receiving regular eye and foot examinations. Mean hemoglobin A1c level was 7.8±1.9%. There was no relationship between hemoglobin A1c levels and New York Heart Association class or history of HF hospitalizations. Contrary to the authors' hypothesis, patients in an HF disease management program demonstrated levels of diabetic care close to ADA goals. "Collateral benefit" of HF disease management may contribute to improved patient outcomes in diabetic patients with HF. [source] Are clinical practical guidelines (CPGs) useful for health services and health workforce planning?DIABETIC MEDICINE, Issue 5 2010A critique of diabetes CPGs Diabet. Med. 27, 570,577 (2010) Abstract Aims, Chronic disease management is increasingly informed by clinical practice guidelines (CPGs). However, their implementation requires not only knowledge of guideline content by clinicians and practice processes that support implementation, but also a health workforce with the capacity to deliver care consistent with CPGs. This has a health services planning as well as a health workforce dimension. However, it is not known whether CPGs are described in a way that can inform health services and health workforce planning and potentially drive better quality care. This study aimed to ascertain whether CPGs are useful for health service and health workforce planning. Methods, This question was explored taking diabetes mellitus as a case study. A systematic search of Medline, EMBASE, CINAHL and Scopus was carried out to identify all CPGs relating to the management of diabetes mellitus in the primary healthcare setting. The search was limited to guidelines published in the English language between 2003 and 2009. The quality of guidelines was assessed against a subset of criteria set by the Appraisal of Guidelines for Research and Evaluation (AGREE) collaboration. Results, Seventy-five diabetes-related CPGs were identified, of which 27 met the inclusion criteria. In terms of quality, many guidelines adopted evidence-based recommendations for diabetes care (59%) and most were endorsed by national authorities (70%). With regards to coverage of 17 identified subpopulations, guidelines were generally selective in the populations they covered. Whilst many provided adequate coverage of common complications and comorbidities, approaches to management for those with reduced capacity for effective diabetes self-care were largely absent, except for indigenous populations. Conclusions, Clinical practice guidelines are potentially useful for health services and health workforce planning, but would be more valuable for this purpose if they contained more detail about care protocols and specific skills and competencies, especially for subpopulations who would be expected to have reduced capacity for effective self-care. If service planning ignores these subgroups that tend to require more resource-intensive management, underprovision of services is likely. [source] Guest Editorial: Chronic disease management and self-care support for people living with long-term conditions: is the nursing workforce prepared?JOURNAL OF CLINICAL NURSING, Issue 7b 2007Felicity Astin [source] Systematic review of the effectiveness of primary care nursingINTERNATIONAL JOURNAL OF NURSING PRACTICE, Issue 1 2009Helen Keleher This paper reports on a systematic review that sought to answer the research question: What is the impact of the primary and community care nurse on patient health outcomes compared with usual doctor-led care in primary care settings? A range of pertinent text-words with medical subject headings were combined and electronic databases were searched. Because of the volume of published articles, the search was restricted to studies with high-level evidence. Overall, 31 relevant studies were identified and included in the review. We found modest international evidence that nurses in primary care settings can provide effective care and achieve positive health outcomes for patients similar to that provided by doctors. Nurses are effective in care management and achieve good patient compliance. Nurses are also effective in a more diverse range of roles including chronic disease management, illness prevention and health promotion. Nevertheless, there is insufficient evidence about primary care nurses' roles and impact on patient health outcomes. [source] Activating Seniors to Improve Chronic Disease Care: Results from a Pilot Intervention StudyJOURNAL OF AMERICAN GERIATRICS SOCIETY, Issue 8 2010Dominick L. Frosch PhD OBJECTIVES: To evaluate the effect of an activation intervention delivered in community senior centers to improve health outcomes for chronic diseases that disproportionately affect older adults. DESIGN: Two-group quasi-experimental study. SETTING: Two Los Angeles community senior centers. PARTICIPANTS: One hundred sixteen senior participants. INTERVENTION: Participants were invited to attend group screenings of video programs intended to inform about and motivate self-management of chronic conditions common in seniors. Moderated discussions reinforcing active patient participation in chronic disease management followed screenings. Screenings were scheduled over the course of 12 weeks. MEASUREMENTS: One center was assigned by coin toss to an encouragement condition in which participants received a $50 gift card if they attended at least three group screenings. Participants in the nonencouraged center received no incentive for attendance. Validated study measures for patient activation, physical activity, and health-related quality of life were completed at baseline and 12 weeks and 6 months after enrollment. RESULTS: Participants attending the encouraged senior center were more likely to attend three or more group screenings (77.8% vs 47.2%, P=.001). At 6-month follow-up, participants from either center who attended three or more group screenings (n=74, 64%) reported significantly greater activation (P<.001), more minutes walking (P<.001) and engaging in vigorous physical activity (P=.006), and better health-related quality of life (Medical Outcomes Study 12-item Short-Form Survey (SF-12) mental component summary, P<.001; SF-12 physical component summary, P=.002). CONCLUSION: Delivering this pilot intervention in community senior centers is a potentially promising approach to activating seniors that warrants further investigation for improving chronic disease outcomes. [source] Depressive symptoms amongst asthmatic children's caregiversPEDIATRIC ALLERGY AND IMMUNOLOGY, Issue 4p2 2010Alexandra Szabó Szabó A, Mezei G, K,vári É, Cserháti E. Depressive symptoms amongst asthmatic children's caregivers. Pediatr Allergy Immunol 2010: 21: e667,e673. © 2009 John Wiley & Sons A/S We wanted to find out, whether the number of depressive symptoms is higher amongst asthmatic children's caregivers, compared to international data, to the Hungarian population average, and to parents of children with chronic renal disease. Are these depressive symptoms connected to the children's psychological status, asthma severity or current asthma symptoms? One-hundred and eight, 7- to 17-yr-old asthmatic children were enrolled, who have been treated at the Semmelweis University, First Department of Pediatrics. Children were suffering from asthma for at least 1 yr, with a median of 8 yr (1,16 yr), they started to develop asthmatic symptoms between the age of 0.5,14 yr (median: 3 yr). We also identified 27 children with chronic renal diseases and their caregivers, who functioned as a control group. Children were asked to complete the Hungarian-validated versions of the Child Depression Inventory, the Spielberger State Anxiety Inventory for Children and the Juniper Pediatric Asthma Quality of Life Questionnaire. Asthma severity and current symptoms were also documented, 56% had no symptoms on the preceding week. Caregivers were asked to complete the Hungarian versions of the Beck Depression Inventory (BDI) short form, the Spielberger Anxiety Inventory and the Juniper Pediatric Asthma Caregivers' Quality of Life Questionnaire. Caregivers of asthmatic children had significantly more depressive symptoms (7.73 ± 6.69 s.d.) than the age-specific normal population (p < 0.01). Caregivers of renal patients also experience more depressive symptoms (9.61 ± 7.43 s.d.) than their healthy peers, but difference between the two chronic diseases' group did not prove to be significant. Asthmatic children's caregivers who scored more points on the BDI than the population average suffer from more anxiety symptoms, but their quality of life is not worse than the caregivers' with less depressive points. Depressive symptoms were neither connected to the children's psychological and asthmatic symptoms nor quality of life. Amongst caregivers of asthmatic children, at least mild depressive symptoms were represented amongst 39% of men and 33% of women. Gender difference was not significant, despite observations in the normal Hungarian population. Amongst caregivers of renal patients, depressive symptoms were represented in 14% of men and 50% of women. Gender difference was significant. (p = 0.05). Significant difference was observed between male asthmatic and renal caregivers, albeit difference was not significant between the female groups. No difference was found in depressive symptoms according to caregivers' level of education. Caregivers of children with asthma have more depressive symptoms than the average Hungarian population, but their results do not differ from caregivers taking care of children with chronic renal diseases. Caregivers of asthmatic children having at least mild depressive symptoms tend to have higher anxiety symptoms as well. Up to date, childhood chronic disease management and long-term care should also focus on parental psychology, mainly on depression and anxiety, as prevalence is higher than in the average population. [source] Understanding the dynamics between ethnicity and health care: Another role for health services research in chronic disease management,ARTHRITIS & RHEUMATISM, Issue 9 2002John R. Feussner No abstract is available for this article. [source] Chronic disease profiles in remote Aboriginal settings and implications for health services planningAUSTRALIAN AND NEW ZEALAND JOURNAL OF PUBLIC HEALTH, Issue 1 2010Wendy E. Hoy Abstract Objective: To report the short-term experiences and outcomes of a program to support chronic disease management in three remote communities in Top End Northern Territory and in two Aboriginal Medical Services (AMSs) in Western Australia, and to discuss the implications of findings for health service delivery and policy. Methods: Programs were health-worker centred. They espoused regular screening of all adults for chronic disease, initiation and modification of treatment where indicated and rigorous documentation. Process measures were documented and rates of hypertension, renal disease and diabetes among adults were calculated. Results: Rates of hypertension, proteinuria and diabetes rose throughout adult life and multiple diagnoses were common. Most people with these conditions were young or middle age adults. Rates were uniformly excessive relative to AusDiab data, but varied greatly among settings. Adherence to protocols improved, many new diagnoses were made, treatments were started or modified and blood pressures in treated hypertensive people fell. In the NT, productivity was seriously limited by lack of health workers and their absenteeism. In the WA AMSs, executive and staff support carried the programs forward to a sustainable future, despite various challenges. Conclusions: Integrated chronic disease testing must be repeated throughout adult life for timely diagnosis. Health workers can perform all tasks well, with appropriate supports. Blood pressure outcomes alone predict lower cardiovascular and renal mortality. The findings support incorporation of chronic disease into lifetime health care plans. [source] | ||||||||||