What's in a name? Concordance is better than adherence for promoting partnership and self-management of chronic disease

2016 ◽  
Vol 22 (3) ◽  
pp. 181 ◽  
Author(s):  
Sue Randall ◽  
Lis Neubeck
Keyword(s):  
Chronic Disease ◽  
Healthcare Providers ◽  
Healthcare Utilisation ◽  
Potential Effect ◽  
Models Of Care ◽  
Self Management ◽  
Healthcare Outcomes ◽  
Professional Relationship ◽  
Patient Health ◽  
The Impact

The choice of language health professionals use to discuss self-management of chronic disease is important and influences patients’ self-management. The words compliance, adherence and concordance are used to discuss patients’ agreement with prescribed treatment plans, but have different tone and meanings. Models of care linked to the words compliance and adherence are underpinned by interactions between patients and healthcare providers that merely reinforce instructions about treatments. The ‘patient-professional partnership’ is introduced as a model by Bodenheimer et al. (2002, p. 2469) whereby true partnership working should be an opportunity to pool the expertise of both parties to arrive at mutually agreed goals in concordance. The impact these words might have on partnership working is important in defining the patient–health professional relationship, and for the patients’ healthcare outcomes and the potential effect on healthcare utilisation.

scholarly journals Electronic, mobile and telehealth tools for vulnerable patients with chronic disease: a systematic review and realist synthesis

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e019192 ◽  
Author(s):  
Sharon Parker ◽  
Amy Prince ◽  
Louise Thomas ◽  
Hyun Song ◽  
Diana Milosevic ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Health Literacy ◽  
Healthcare Providers ◽  
Chronic Health Condition ◽  
Vulnerable Groups ◽  
Self Management ◽  
Future Research ◽  
Ehealth Literacy ◽  
Health Technologies ◽  
Vulnerable Patients

ObjectivesThe objective of this review was to assess the benefit of using electronic, mobile and telehealth tools for vulnerable patients with chronic disease and explore the mechanisms by which these impact patient self-efficacy and self-management.DesignWe searched MEDLINE, all evidence-based medicine, CINAHL, Embase and PsychINFO covering the period 2009 to 2018 for electronic, mobile or telehealth interventions. Quality was assessed according to rigour and relevance. Those studies providing a richer description (‘thick’) were synthesised using a realist matrix.Setting and participantsStudies of any design conducted in community-based primary care involving adults with one or more diagnosed chronic health condition and vulnerability due to demographic, geographic, economic and/or cultural characteristics.ResultsEighteen trials were identified targeting a range of chronic conditions and vulnerabilities. The data provided limited insight into the mechanisms underpinning these interventions, most of which sought to persuade vulnerable patients into believing they could self-manage their conditions through improved symptom monitoring, education and support and goal setting. Patients were relatively passive in the interaction, and the level of patient response attributed to their intrinsic level of motivation. Health literacy, which may be confounded with motivation, was only measured in one study, and eHealth literacy was not assessed.ConclusionsResearch incorporating these tools with vulnerable groups is not comprehensive. Apart from intrinsic motivation, health literacy may also influence the reaction of vulnerable groups to technology. Social persuasion was the main way interventions sought to achieve better self-management. Efforts to engage patients by healthcare providers were lower than expected. Use of social networks or other eHealth mechanisms to link patients and provide opportunities for vicarious experience could be further explored in relation to vulnerable groups. Future research could also assess health and eHealth literacy and differentiate the specific needs for vulnerable groups when implementing health technologies.

scholarly journals Patient engagement and self-management in pulmonary arterial hypertension

2016 ◽  
Vol 25 (142) ◽  
pp. 399-407 ◽  
Author(s):  
Jytte Graarup ◽  
Pisana Ferrari ◽  
Luke S. Howard
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Arterial Hypertension ◽  
Patient Engagement ◽  
Healthcare Providers ◽  
Holistic Approach ◽  
Self Management ◽  
Care And Support ◽  
High Quality Information ◽  
Pulmonary Arterial ◽  
The Impact

Improved care in pulmonary arterial hypertension has led to increased longevity for patients, with a paralleled evolution in the nature of their needs. There is more focus on the impact of the disease on their day-to-day activities and quality of life, and a holistic approach is coming to the front of pulmonary arterial hypertension management, which places the patient at the centre of their own healthcare. Patients are thus becoming more proactive, involved and engaged in their self-care, and this engagement is an important factor if patient outcomes are to improve. In addition, involvement of the patient may improve their ability to cope with pulmonary arterial hypertension, as well as help them to become effective in the self-management of their disease. Successful patient engagement can be achieved through effective education and the delivery and communication of timely, high-quality information. A multidisciplinary approach involving healthcare professionals, carers, patient associations and expert patient programmes can also encourage patients to engage. Strategies that promote patient engagement can help to achieve the best possible care and support for the patient and also benefit healthcare providers.

Blockchain for Strengthening the Privacy of Healthcare Data

2021 ◽  
pp. 672-688
Author(s):  
Stefan Kendzierskyj ◽  
Hamid Jahankhani ◽  
SHU I Ndumbe
Keyword(s):  
Healthcare Providers ◽  
Patient Privacy ◽  
General Data Protection Regulation ◽  
Healthcare Data ◽  
Health And Social Care ◽  
Patient Health ◽  
Primary Care Sector ◽  
Share Data ◽  
General Data ◽  
The Impact

The desire for eHealth systems is ever-growing as public institutions, healthcare providers, and its users see the positive gains from having systems of patient health information held in a single place; a decentralized connected architecture called blockchain. This concept can solve the interoperability issues and integrate the fragmented way healthcare records are held and present a more transparent, secure method to share data and protect patient privacy. The aim of this article is to provide a supportive environment for the health and social care workplace with special reference in the Primary Care sector in England on the impact and changes to the information governance toolkit (IGTK) as a result of the new European General Data Protection Regulation (GDPR) coming into force from May 2018. These challenges will also include the implementation of the National Data Guardian (NDG) review of data security and opt-outs amongst others.

Contextualising indicators of socio-economic status: Chronic illness as lived experience of SES

2003 ◽  
Vol 9 (3) ◽  
pp. 141 ◽  
Author(s):  
Christine Walker ◽  
Chris Peterson
Keyword(s):  
Chronic Disease ◽  
Chronic Illness ◽  
Lived Experience ◽  
Work Experience ◽  
Economic Status ◽  
Self Management ◽  
General Level ◽  
Low Ses ◽  
Socio Economic Status ◽  
The Impact

The concept of socio-economic status (SES) has been recognised as playing an important role in the incidence and experience of chronic illness (Taylor, 1983; Najman 1988; Syme, 1998; Marmot, 2000). Yet just how SES interacts with the experience of chronic illness has not been well researched. For example, researchers are unable to categorically state if living conditions and life opportunities associated with low SES lead to a greater propensity for developing a chronic illness, or if the experience and consequences of having a chronic illness lead to developing low SES characteristics, or both. Neither has research provided good data on the mediating roles of factors such as ethnic background and location of residence on the relationship between SES and chronic illness. Self-management programs for chronic disease require different capacities from participants to produce good outcomes. These capacities are to some degree dependent on level of education, type of job, and general level of socio-economic status. Therefore, the level of SES of people with a chronic disease is important to understanding how they will respond to self-management approaches. For example, people with a chronic disease from lower SES backgrounds can be expected in some instances to have a different set of coping capacities with their disease (partly a function of income, education, and work experience) compared to those from higher SES backgrounds. The socio-economic status of people with a chronic disease is an important area for investigation that has implications for the efficacy of self-management programs. This paper will argue that while SES is a vital concept in understanding the impact of chronic illness on people?s lived experiences for many conditions, current approaches oversimplify it by quarantining it from its context. Researchers tend to treat SES as a stable composite concept whose application illuminates the social basis of the illness experience. More frequently, we arrive at an explanation of simplified relationships rather than an explanation of the relationships between chronic ill health and SES as lived by members of real communities (Frank, 1990; Zola, 1991).

My health, myself: a qualitative study on motivations for effective chronic disease self-management among community dwelling adults

2020 ◽  
Vol 37 (6) ◽  
pp. 839-844
Author(s):  
Muhammad Danial Hadi ◽  
Yongxing Patrick Lin ◽  
Ee-Yuee Chan
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Primary Healthcare ◽  
Healthcare Providers ◽  
Good Health ◽  
Community Dwelling ◽  
Self Control ◽  
Self Management ◽  
Management Support ◽  
Healthcare Provision

Abstract Background Chronic diseases continue to be a significant cause of morbidity and mortality despite modifiable risk factors. This suggests that current primary healthcare provision needs to delve beyond patient education, to understand the motivators that drive patients to undertake chronic disease self-management. Understanding these motivations within the context of a multi-cultural community can facilitate tailored support for chronic disease self-management. Objectives To explore the motivations behind effective chronic disease self-management in community dwelling adults in Singapore. Methods A qualitative descriptive study was carried out in five clinics in a large medical centre. Twelve participants who were assessed to be optimally managing their chronic diseases were recruited using purposive sampling. Individual in-depth interviews were conducted until data saturation, with data thematically analysed. Results Three salient themes emerged from the data. Firstly, ‘Regaining self-control, avoiding complications’ describes the participants’ journey towards personal mastery in self-management, as well as a fear of debilitating complications resulting in their desire for good health. Secondly, ‘Preserving social identities and roles’ illustrates how participants yearn to maintain their pre-existing roles and functions through maintenance of their health. Finally, ‘Accessing proximal support systems’ highlights resources and supports surrounding the participants that encourage continued chronic disease self-management. Within each theme, specific motivators and challenges encountered by participants in their self-management journey were discussed. Conclusions Findings can prompt primary healthcare providers to leverage on the patients’ life goals and social roles in chronic disease self-management support. This may empower patients to engage in self-management and strengthen primary care provision.

scholarly journals The impact of chronic disease self-management programs: healthcare savings through a community-based intervention

2013 ◽  
Vol 13 (1) ◽  
Author(s):  
SangNam Ahn ◽  
Rashmita Basu ◽  
Matthew Lee Smith ◽  
Luohua Jiang ◽  
Kate Lorig ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Self Management ◽  
Community Based ◽  
The Impact

scholarly journals Evaluation of an innovative tele-education intervention in chronic pain management for primary care clinicians practicing in underserved areas

2018 ◽  
Vol 25 (8) ◽  
pp. 484-492 ◽  
Author(s):  
Andrea D Furlan ◽  
Jane Zhao ◽  
Jennifer Voth ◽  
Samah Hassan ◽  
Ruth Dubin ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Pain ◽  
Pain Management ◽  
Nurse Practitioners ◽  
Self Efficacy ◽  
Healthcare Providers ◽  
Physician Assistants ◽  
Chronic Pain Management ◽  
Healthcare Outcomes ◽  
The Impact

Introduction Inadequate knowledge and training of healthcare providers are obstacles to effective chronic pain management. ECHO (extension for community healthcare outcomes) uses case-based learning and videoconferencing to connect specialists with providers in underserved areas. ECHO aims to increase capacity in managing complex cases in areas with poor access to specialists. Methods A pre-post study was conducted to evaluate the impact of ECHO on healthcare providers’ self-efficacy, knowledge and satisfaction. Type of profession, presenting a case, and number of sessions attended were examined as potential factors that may influence the outcomes Results From June 2014 to March 2017, 296 primary care healthcare providers attended ECHO, 264 were eligible for the study, 170 (64%) completed the pre-ECHO questionnaire and 119 completed post-ECHO questionnaires. Participants were physicians (34%), nurse practitioners (21%), pharmacists (13%) and allied health professionals (32%). Participants attended a mean of 15 ± 9.19 sessions. There was a significant increase in self-efficacy ( p < 0.0001) and knowledge ( p < 0.0001). Self-efficacy improvement was significantly higher among physicians, physician assistants and nurse practitioners than the non-prescribers group ( p = 0.03). On average, 96% of participants were satisfied with ECHO. Satisfaction was higher among those who presented cases and attended more sessions. Discussion This study shows that ECHO improved providers’ self-efficacy and knowledge. We evaluated outcomes from a multidisciplinary group of providers practicing in Ontario. This diversity supports the generalisability of our findings. Therefore, we suggest that this project may be used as a template for creating other educational programs on other medical topics.

Engaging Adults With Chronic Disease in Online Depressive Symptom Self-Management

2017 ◽  
Vol 40 (6) ◽  
pp. 834-853 ◽  
Author(s):  
Marian Wilson ◽  
Casey Hewes ◽  
Celestina Barbosa-Leiker ◽  
Anne Mason ◽  
Katherine A. Wuestney ◽  
...  
Keyword(s):  
Depressive Symptoms ◽  
Chronic Disease ◽  
Treatment Group ◽  
Self Efficacy ◽  
Management Program ◽  
Self Management ◽  
Control Group ◽  
Number Needed To Treat ◽  
Participant Engagement ◽  
Patient Health

The main purpose of this study was to evaluate participant engagement and effects of an Internet-based, self-directed program for depressive symptoms piloted among adults with a chronic disease. Eligible participants ( N = 47) were randomly assigned to either the “Think Clearly About Depression” online depression self-management program or the control group. The Patient Health Questionnaire–8 and Chronic Disease Self-Efficacy Scales were administered at baseline and at Weeks 4 and 8 after initiating the intervention. Number Needed to Treat analysis indicated that one in every three treatment group participants found clinically significant reductions in depressive symptoms by Week 8. Paired-sample t tests showed that depressive symptoms and self-efficacy in management of depressive symptoms improved over time for those in the treatment group and not for those in the control group. Participants’ engagement and satisfaction with the online program were favorable.

scholarly journals Sexual reproductive healthcare utilisation and HIV testing in an integrated adolescent youth centre clinic in Cape Town, South Africa

2018 ◽  
Vol 19 (1) ◽  
Author(s):  
Andrea S. Mendelsohn ◽  
Katherine Gill ◽  
Rebecca Marcus ◽  
Dante Robbertze ◽  
Claudine Van de Venter ◽  
...  
Keyword(s):  
Healthcare Providers ◽  
Cape Town ◽  
Healthcare Utilisation ◽  
Male Youth ◽  
Sexually Transmitted ◽  
Contraception Use ◽  
Hiv Counselling And Testing ◽  
Screening And Prevention ◽  
The Impact ◽  
Youth Centre

Background: HIV prevalence is increasing among South African youth, but HIV counselling and testing (HCT) remains low. Adolescent pregnancy rates are also high.Objectives: Innovative strategies are needed to increase HIV and pregnancy screening and prevention among youth.Method: The Desmond Tutu HIV Foundation Youth Centre (DTHF-YC) offers integrated, incentivised sexual and reproductive health (SRH), educational and recreational programmes. We compared HCT and contraception rates between the DTHF-YC and a public clinic (PC) in Cape Town to estimate the impact of DTHF-YC on youth contraception and HCT utilisation.Results: In 2015, females < 18 years had 3.74 times (confidence interval [CI]: 3.37–4.15) more contraception visits at DTHF-YC versus PC. There were no differences in the contraception and adherence was suboptimal. DTHF-YC youth (aged 15–24 years) were 1.85 times (CI: 1.69–2.01) more likely to undergo HCT versus PC, while male youth were 3.83 times (CI: 3.04–4.81) more likely to test at DTHF-YC. Youth were a third less likely to test HIV-positive at DTHF-YC versus PC. Female sex, older age, clinic attendance for contraception and sexually transmitted infections (STIs), redeeming incentives and high DTHF-YC attendance were all independent factors associated with increased HCT.Conclusion: Youth were significantly more likely to access SRH services at DTHF-YC compared with the PC. The differences were greatest in contraception use by female adolescents < 18 years and HCT by male youth. Increased HCT did not increase youth HIV case detection. Data from DTHF-YC suggest that youth-friendly healthcare providers integrated into community youth spaces may increase youth HCT and contraception rates.

scholarly journals Evaluating the implementation of health coaching in a rural setting

2012 ◽  
Vol 1 (2) ◽  
pp. 17 ◽  
Author(s):  
Kaye E. Ervin ◽  
Vivienne Jeffery ◽  
Alison Koschel
Keyword(s):  
Chronic Disease ◽  
Staff Training ◽  
Models Of Care ◽  
Health Coaching ◽  
Rural Setting ◽  
Self Management ◽  
Enabling Factors ◽  
Rural Community Health ◽  
Effective Models ◽  
Management Staff

Objective: The aim of this project was to explore the barriers and enablers to implementation of staff training in Health Coaching, a model of care employed in primary care to facilitate client self management of chronic disease.Methods: Forty six staff from five rural community health settings were recruited to undertake training in Health Coaching. A simple post training quantitative evaluation was conducted by surveying staff five months post training. Results: There was a 68% response rate to the surveys. Only 50% of staff trained in Health Coaching reported implementing it into practice. Enabling factors to implementing the training were reported as peer and organisational support.Conclusion: Effective models of self management in chronic disease should not be aimed at staff training alone. This study suggests that implementation of new models of care requires a significant change in clinician practice which is not readily embraced by staff.    Key words: chronic disease, early intervention, self management, staff training, training implementation.

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