EFFECTS OF PATIENT CENTERED MEDICAL HOMES ON MEDICARE BENEFICIARIES WITH MULTIPLE CHRONIC CONDITIONS

Background: Patients with multimorbidity represent a significant portion of the primary healthcare population. For healthcare providers, managing patients with multiple chronic conditions represents a challenge given the complexity and the intensity of interventions. Integrated and patient-centered care is considered an effective response to the needs of people who suffer from multiple chronic conditions. According to the literature providing patient-centered care is one of the most important interventions in terms of positive health-related outcomes for patients with multimorbidity.Aim: The aim of the study is to evaluate the GPs’ perception of patient oriented interventions as key elements of patient centred care for patients with multimorbidity.Material and methods: A cross-sectional pilot study was conducted among randomly selected 73 GPs. A direct individual anonymous survey was performed to explore the opinion of respondents about the importance of two patient-oriented interventions, each one including specific elements of patient-centered care for patients with multimorbidity. The tool was developed as a result of the scoping review performed by Smith et al. (2012;2016). A 5-point Likert scale (0-not at all, 1-little, 2-rather, 3-much, 4-very strong) was used. The data were analysed using descriptive statistics. In processing the data, the software product for statistical analyses - SPSS version 17 was performed for Windows XP.Results: Our results show that both categories - providing patient-oriented approach and self-management support interventions were highly accessed by the respondents. The most frequent categories of interventions identified in our study were Creating individualized and adapted interventions, Performing regular contacts and Reinforcing adherence. Less frequently reported elements such as Considering relatives’ needs and Developing self-management plan are still underestimated by the Bulgarian GPs.Conclusions: The acceptance and understanding of innovative patient-centered interventions adapted to patients with multimorbidity could be accepted as a good indicator for improving health-related outcomes and care for patients with multiple chronic conditions.

Download Full-text

Innovative Strategies to Facilitate Patient-Centered Research in Multiple Chronic Conditions

Journal of Clinical Medicine ◽

10.3390/jcm10102112 ◽

2021 ◽

Vol 10 (10) ◽

pp. 2112

Author(s):

Tullika Garg ◽

Courtney A. Polenick ◽

Nancy Schoenborn ◽

Jane Jih ◽

Alexandra Hajduk ◽

...

Keyword(s):

Chronic Conditions ◽

Clinical Care ◽

Intervention Development ◽

Healthcare Services ◽

Multiple Chronic Conditions ◽

Patient Centered ◽

Older Americans ◽

Innovative Strategies ◽

Department Of Health ◽

Innovative Methods

Multiple chronic conditions (MCC) are one of today’s most pressing healthcare concerns, affecting 25% of all Americans and 75% of older Americans. Clinical care for individuals with MCC is often complex, condition-centric, and poorly coordinated across multiple specialties and healthcare services. There is an urgent need for innovative patient-centered research and intervention development to address the unique needs of the growing population of individuals with MCC. In this commentary, we describe innovative methods and strategies to conduct patient-centered MCC research guided by the goals and objectives in the Department of Health and Human Services MCC Strategic Framework. We describe methods to (1) increase the external validity of trials for individuals with MCC; (2) study MCC epidemiology; (3) engage clinicians, communities, and patients into MCC research; and (4) address health equity to eliminate disparities.

Download Full-text

Improving the External Validity of Clinical Trials: The Case of Multiple Chronic Conditions

Journal of Comorbidity ◽

10.15256/joc.2013.3.27 ◽

2013 ◽

Vol 3 (2) ◽

pp. 30-35 ◽

Cited By ~ 6

Author(s):

Fortin Martin ◽

Smith M. Susan

Keyword(s):

Clinical Trials ◽

External Validity ◽

Chronic Conditions ◽

Evidence Base ◽

Specific Reference ◽

Multiple Chronic Conditions ◽

Patient Centered ◽

Department Of Health ◽

Patient Groups ◽

Intervention Trials

The U.S. Department of Health and Human Services vision and strategic framework on multiple chronic conditions (MCCs) incorporates recommendations designed to facilitate research that will improve our knowledge about interventions and systems that will benefit individuals with MCCs (or multimorbidity). The evidence base supporting the management of patients with MCCs will be built through intervention trials specifically designed to address multimorbidity and identification of MCCs in participants across the clinical trial range. This article specifically focuses on issues relating to external validity with specific reference to trials involving patients with MCCs. The exclusion of such patients from clinical trials has been well documented. Randomized control trials (RCTs) are considered the “gold standard” of evidence, but may have drawbacks in relation to external validity, particularly in relation to multimorbidity. It may, therefore, be necessary to consider a broader range of research methods that can provide converging evidence on intervention effects to address MCCs. Approaches can also be taken to increase the usefulness of RCTs in general for providing evidence to inform multimorbidity management. Additional improvements to RCTs would include better reporting of inclusion and exclusion criteria and participant characteristics in relation to MCCs. New trials should be considered in terms of how they will add to the existing evidence base and should inform how interventions may work in different settings and patient groups. Research on treatments and interventions for patients with MCCs is badly needed. It is important that this research includes patient-centered measures and that generalizability issues be explicitly addressed.

Download Full-text

Quality of Mental Health Care in Integrated Veterans Affairs Patient-Centered Medical Homes: a National Observational Study

Journal of General Internal Medicine ◽

10.1007/s11606-019-05310-1 ◽

2019 ◽

Vol 34 (12) ◽

pp. 2700-2701

Author(s):

Lucinda B. Leung ◽

Edward P. Post ◽

Erin Jaske ◽

Kenneth B. Wells ◽

Lisa V. Rubenstein

Keyword(s):

Mental Health ◽

Health Care ◽

Observational Study ◽

Mental Health Care ◽

Veterans Affairs ◽

Patient Centered ◽

Patient Centered Medical Homes ◽

Medical Homes

Download Full-text

Patient-Centered Medical Homes and Adherence to Chronic Disease Medications

Annals of Internal Medicine ◽

10.7326/l17-0157 ◽

2017 ◽

Vol 166 (10) ◽

pp. 760

Author(s):

Patrick Kearns

Keyword(s):

Chronic Disease ◽

Patient Centered ◽

Patient Centered Medical Homes ◽

Medical Homes

Download Full-text

Crafting Care That Fits: Workload and Capacity Assessments Complementing Decision Aids in Implementing Shared Decision Making (Preprint)

10.2196/preprints.13763 ◽

2019 ◽

Author(s):

Thomas H Wieringa ◽

Manuel F Sanchez-Herrera ◽

Nataly R Espinoza ◽

Viet-Thi Tran ◽

Kasey Boehmer

Keyword(s):

Decision Making ◽

Shared Decision Making ◽

Chronic Conditions ◽

Decision Aids ◽

Multiple Chronic Conditions ◽

Shared Decision ◽

Patient Centered ◽

Patient Goals ◽

Minimally Disruptive Medicine ◽

Workload Capacity

UNSTRUCTURED About 42% of adults have one or more chronic conditions and 23% have multiple chronic conditions. The coordination and integration of services for the management of patients living with multimorbidity is important for care to be efficient, safe, and less burdensome. Minimally disruptive medicine may optimize this coordination and integration. It is a patient-centered approach to care that focuses on achieving patient goals for life and health by seeking care strategies that fit a patient’s context and are minimally disruptive and maximally supportive. The cumulative complexity model practically orients minimally disruptive medicine–based care. In this model, the patient workload-capacity imbalance is the central mechanism driving patient complexity. These elements should be accounted for when making decisions for patients with chronic conditions. Therefore, in addition to decision aids, which may guide shared decision making, we propose to discuss and clarify a potential workload-capacity imbalance.

Download Full-text