scholarly journals 23Multiple Chronic Conditions: Need for Ongoing Research

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Sangeeta Gupta
Keyword(s):  
Chronic Conditions ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Behavioral Risk ◽  
Obstructive Pulmonary Disease ◽  
Ongoing Research ◽  
The Public ◽  
Global Priority ◽  
Control And Prevention ◽  
Ongoing Surveillance

Abstract Background Increasing burden of Multiple Chronic Conditions (MCC) is a global priority. However, lack of a consistent definition makes it a challenge to compare burden of MCC amongst countries. The objective of this study is twofold: 1) to present research on the prevalence of MCC among US adults and 2) to reopen a global dialogue on potential areas for intervention including a consensus on the taxonomy of MCC. Methods Combined data for 2015 through 2018 from Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor and Surveillance system (n = 1373755) were analyzed to determine prevalence of MCC. Adults were categorized as having 0, 1, 2, or 3 or more of the following diagnosed chronic conditions: angina, arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, high blood pressure, high cholesterol, myocardial infarction (heart attack), obesity, or stroke. Results More than 61% of US adults had at least 1 of the 12 selected chronic conditions. Furthermore, 47.8 percent of US adults had MCC. For US adults with 2 chronic conditions, the MCC dyad with the highest prevalence was arthritis and obesity. Among adults with 3 or more chronic conditions, the MCC triad of arthritis, asthma, and obesity was the most prevalent. Conclusions The findings of this study contribute information to the field of MCC research in response to the need for ongoing surveillance. Key messages Ongoing MCC research efforts will provide a much needed paradigm shift in management of chronic conditions in the public health domain.

scholarly journals 1165Multiple Chronic Conditions: Need for Ongoing Research

2021 ◽  
Vol 50 (Supplement_1) ◽  
Author(s):  
Sangeeta Gupta
Keyword(s):  
Chronic Conditions ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Behavioral Risk ◽  
Obstructive Pulmonary Disease ◽  
Ongoing Research ◽  
The Public ◽  
Global Priority ◽  
Control And Prevention ◽  
Ongoing Surveillance

Abstract Background Increasing burden of Multiple Chronic Conditions (MCC) is a global priority. However, lack of a consistent definition makes it a challenge to compare burden of MCC amongst countries. The objective of this study is twofold: 1) to present research on the prevalence of MCC among US adults and 2) to reopen a global dialogue on potential areas for intervention including a consensus on the taxonomy of MCC. Methods Combined data for 2015 through 2018 from Centers for Disease Control and Prevention (CDC) Behavioral Risk Factor and Surveillance system (n = 1373755) were analyzed to determine prevalence of MCC. Adults were categorized as having 0, 1, 2, or 3 or more of the following diagnosed chronic conditions: angina, arthritis, asthma, cancer, chronic kidney disease, chronic obstructive pulmonary disease, diabetes, high blood pressure, high cholesterol, myocardial infarction (heart attack), obesity, or stroke. Results More than 61% of US adults had at least 1 of the 12 selected chronic conditions. Furthermore, 47.8 percent of US adults had MCC. For US adults with 2 chronic conditions, the MCC dyad with the highest prevalence was arthritis and obesity. Among adults with 3 or more chronic conditions, the MCC triad of arthritis, asthma, and obesity was the most prevalent. Conclusions The findings of this study contribute information to the field of MCC research in response to the need for ongoing surveillance. Key messages Ongoing MCC research efforts will provide a much needed paradigm shift in management of chronic conditions in the public health domain.

scholarly journals The Effects of Multiple Chronic Conditions on Adult Patient Readmissions and Hospital Finances: A Management Case Study

2017 ◽  
Vol 54 ◽  
pp. 004695801772959 ◽  
Author(s):  
Michael Mihailoff ◽  
Shreyasi Deb ◽  
James A. Lee ◽  
Joanne Lynn
Keyword(s):  
Chronic Conditions ◽  
Chronic Renal Disease ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Readmission Rates ◽  
Obstructive Pulmonary Disease ◽  
Average Patient ◽  
Patient Readmissions ◽  
Management Case Study

Medicare and other payers have launched initiatives to reduce hospital utilization, especially targeting readmissions within 30 days of discharge. Hospital managers have traditionally contended that hospitals would prosper better by ignoring the penalties for high readmission rates and keeping the beds more full. We aimed to test the financial effects of admissions and readmissions by persons with and without specified chronic conditions in one regional hospital. This is a management case study with a descriptive brief report. This study was conducted at Winchester Memorial Hospital, a general hospital in a largely rural area of Virginia, 2010-2015. The total margin per admission varied by diagnosis, with the average patient diagnosed with chronic obstructive pulmonary disease, heart failure, pneumonia, or chronic renal disease having negative margins. The largest per-patient losses were in diagnostic categories coinciding with the highest readmission rates. The margin declined into substantial losses with an increasing number of chronic conditions, which also corresponded with higher readmission rates. Patients with 5 or more clinical conditions had highest risk of readmission within 30 days (24.8%) and had an average total loss of $865 per admission in 2015. The adverse financial effects worsened between 2010 and 2015. This hospital might improve its finances by investing in strategies to reduce chronic illness hospitalizations, especially those with multiple chronic conditions and high risk of readmission. These findings counter the common claim that the hospital would do better to fill beds rather than to work on efficient utilization. Other hospitals could replicate these analyses to understand their situations.

Comorbidities of Physical and Psychiatric Syndromes in Later Life

2018 ◽  
Author(s):  
Lydia K. Manning ◽  
Lauren M. Bouchard ◽  
James L. Flanagan
Keyword(s):  
Older Adults ◽  
Chronic Conditions ◽  
Negative Impact ◽  
Later Life ◽  
The Body ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Obstructive Pulmonary Disease ◽  
Complex Interactions

There is a great deal of concern about the increasing number of older adults who suffer from chronic disease. These conditions result in persistent health consequences and have an ongoing and long-term negative impact on people and their quality of life. Furthermore, the probability that a person will experience the onset of multiple chronic conditions, known as comorbidities, increases with age. Despite the prevalence of comorbidity in later life, scant research exists regarding specific patterns of disease and the co-occurrence and complex interactions of the chronic conditions most closely associated with aging. It is important to review the body of literature on comorbidities associated with physical and psychiatric syndromes in later life to gain an overview of some of the most commonly seen disorders in older adults: hypertension, diabetes, cardiovascular disease, chronic obstructive pulmonary disease, arthritis, depression, and dementia. Specific patterns of disease and the co-occurrence and complex interactions of chronic conditions in later life are explored. In conclusion, we consider the need for a more informed understanding of comorbidity, as well as a related plan for addressing it.

scholarly journals Obesity and Morbidity Risk in the U.S. Veteran

Healthcare ◽  
2020 ◽  
Vol 8 (3) ◽  
pp. 191
Author(s):  
Jose A. Betancourt ◽  
Paula Stigler Granados ◽  
Gerardo J. Pacheco ◽  
Ramalingam Shanmugam ◽  
C. Scott Kruse ◽  
...  
Keyword(s):  
Odds Ratio ◽  
Depressive Disorders ◽  
The United States ◽  
Chronic Obstructive ◽  
Behavioral Risk ◽  
Obstructive Pulmonary Disease ◽  
Obesity Epidemic ◽  
Control And Prevention ◽  
Health Related ◽  
The U.S

The obesity epidemic in the United States has been well documented and serves as the basis for a number of health interventions across the nation. However, those who have served in the U.S. military (Veteran population) suffer from obesity in higher numbers and have an overall disproportionate poorer health status when compared to the health of the older non-Veteran population in the U.S. which may further compound their overall health risk. This study examined both the commonalities and the differences in obesity rates and the associated co-morbidities among the U.S. Veteran population, utilizing data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS). These data are considered by the Centers for Disease Control and Prevention (CDC) to be the nation’s best source for health-related survey data, and the 2018 version includes 437,467 observations. Study findings show not only a significantly higher risk of obesity in the U.S. Veteran population, but also a significantly higher level (higher odds ratio) of the associated co-morbidities when compared to non-Veterans, including coronary heart disease (CHD) or angina (odds ratio (OR) = 2.63); stroke (OR = 1.86); skin cancer (OR = 2.18); other cancers (OR = 1.73); chronic obstructive pulmonary disease (COPD) (OR = 1.52), emphysema, or chronic bronchitis; arthritis (OR = 1.52), rheumatoid arthritis, gout, lupus, or fibromyalgia; depressive disorders (OR = 0.84), and diabetes (OR = 1.61) at the 0.95 confidence interval level.

scholarly journals Study of potentially preventable hospitalisations (PPH) for chronic conditions: what proportion are preventable and what factors are associated with preventable PPH?

BMJ Open ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. e038415
Author(s):  
Jennifer Johnston ◽  
Jo Longman ◽  
Dan Ewald ◽  
Jonathan King ◽  
Sumon Das ◽  
...  
Keyword(s):  
Chronic Conditions ◽  
Hospital Admissions ◽  
Medication Management ◽  
Community Dwelling ◽  
Living Alone ◽  
Chronic Obstructive ◽  
Discharge Diagnosis ◽  
Obstructive Pulmonary Disease ◽  
Factors Associated ◽  
Study Sites

IntroductionThe proportion of potentially preventable hospitalisations (PPH) which are actually preventable is unknown, and little is understood about the factors associated with individual preventable PPH. The Diagnosing Potentially Preventable Hospitalisations (DaPPHne) Study aimed to determine the proportion of PPH for chronic conditions which are preventable and identify factors associated with chronic PPH classified as preventable.SettingThree hospitals in NSW, Australia.ParticipantsCommunity-dwelling patients with unplanned hospital admissions between November 2014 and June 2017 for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes complications or angina pectoris. Data were collected from patients, their general practitioners (GPs) and hospital records.Outcome measuresAssessments of the preventability of each admission by an Expert Panel.Results323 admissions were assessed for preventability: 46% (148/323) were assessed as preventable, 30% (98/323) as not preventable and 24% (77/323) as unclassifiable. Statistically significant differences in proportions preventable were found between the three study sites (29%; 47%; 58%; p≤0.001) and by primary discharge diagnosis (p≤0.001).Significant predictors of an admission being classified as preventable were: study site; final principal diagnosis of CHF; fewer diagnoses on discharge; shorter hospital stay; GP diagnosis of COPD; GP consultation in the last 12 months; not having had a doctor help make the decision to go to hospital; not arriving by ambulance; patient living alone; having someone help with medications and requiring help with daily tasks.ConclusionsThat less than half the chronic PPH were assessed as preventable, and the range of factors associated with preventability, including site and discharge diagnosis, are important considerations in the validity of PPH as an indicator. Opportunities for interventions to reduce chronic PPH include targeting patients with CHF and COPD, and the provision of social welfare and support services for patients living alone and those requiring help with daily tasks and medication management.

scholarly journals The Impact of the COVID-19 Pandemic on Self-Reported Management of Chronic Conditions

2021 ◽  
Vol 8 ◽  
pp. 237437352110076
Author(s):  
Hyllore Imeri ◽  
Erin Holmes ◽  
Shane Desselle ◽  
Meagen Rosenthal ◽  
Marie Barnard
Keyword(s):  
Locus Of Control ◽  
Chronic Conditions ◽  
Online Survey ◽  
Health Locus Of Control ◽  
Patient Activation ◽  
Survey Study ◽  
Chronic Obstructive ◽  
Cross Sectional ◽  
Obstructive Pulmonary Disease ◽  
The Impact

Chronic conditions (CCs) management during the COVID-19 pandemic and the impact of the pandemic on patient activation (PA) and health locus of control (HLOC) remain unknown. This cross-sectional online survey study examined the role of COVID-19 pandemic-related worry or fear in PA and HLOC among patients with CCs. Individuals with CCs (n = 300) were recruited through MTurk Amazon. The questionnaire included sociodemographic questions, the Patient Activation Measure, and the Multidimensional Health Locus of Control–Form B. Out of the 300 participants, 9.7% were diagnosed with COVID-19, and 7.3% were hospitalized. Patients with cancer, chronic kidney disease, chronic obstructive pulmonary disease, drug abuse/substance abuse, and stroke reported significant difficulties in managing their CCs due to worry or fear because of COVID-19. More than half of the sample (45.7%) reported COVID-19-related worry or fear about managing their CCs, and these patients had lower PA and lower external HLOC compared to patients not affected by COVID-19-related worry or fear. Health professionals should provide more support for patients facing difficulties in managing their CCs during the COVID-19 pandemic.

Association between E-cigarette use and chronic obstructive pulmonary disease in non-asthmatic adults in the USA

2020 ◽  
Author(s):  
Godfred O Antwi ◽  
Darson L Rhodes
Keyword(s):  
Sex Education ◽  
Smoking Status ◽  
Secondary Data ◽  
Chronic Obstructive ◽  
Behavioral Risk ◽  
Cigarette Use ◽  
Obstructive Pulmonary Disease ◽  
The Usa ◽  
Potential Link ◽  
Using Data

Abstract Background Concern about the health impacts of e-cigarette use is growing; however, limited research exists regarding potential long-term health effects of this behavior. This study explored the relationship between e-cigarette use and COPD in a sample of US adults. Methods A secondary data analysis using data from the 2018 Behavioral Risk Factor Surveillance Survey in the USA was computed to examine associations between e-cigarette use and COPD controlling for conventional cigarette smoking status, past month leisure physical activity and demographic characteristics including age, sex, education, race, marital status and body mass index. Results Significant associations between e-cigarette use and COPD among former combustible cigarette smokers and those who reported never using combustible cigarettes were found. Compared with never e-cigarette users, the odds of having COPD were significantly greater for daily e-cigarette users (OR = 1.53; 95% CI: 1.11–2.03), occasional users (OR = 1.43, 95% CI: 1.13–1.80) and former users (OR = 1.46 95% CI: 1.28–1.67). Conclusions Findings from this study indicate a potential link between e-cigarette use and COPD. Further research to explore the potential effects of e-cigarette on COPD is recommended.

scholarly journals Symptomatic Patent Foramen Ovale with Hemidiaphragm Paralysis

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Hussain Ibrahim ◽  
Adnan Khan ◽  
Shawn P. Nishi ◽  
Ken Fujise ◽  
Syed Gilani
Keyword(s):  
Right Atrium ◽  
Chronic Conditions ◽  
Patent Foramen Ovale ◽  
Hospital Admissions ◽  
Clinical Suspicion ◽  
Chronic Obstructive ◽  
Foramen Ovale ◽  
Obstructive Pulmonary Disease ◽  
Benign Condition ◽  
High Clinical Suspicion

Dyspnea accounts for more than one-fourth of the hospital admissions from Emergency Department. Chronic conditions such as Chronic Obstructive Pulmonary Disease, Congestive Heart Failure, and Asthma are being common etiologies. Less common etiologies include conditions such as valvular heart disease, pulmonary embolism, and right-to-left shunt (RLS) from patent foramen ovale (PFO). PFO is present in estimated 20–30% of the population, mostly a benign condition. RLS via PFO usually occurs when right atrium pressure exceeds left atrium pressure. RLS can also occur in absence of higher right atrium pressure. We report one such case that highlights the importance of high clinical suspicion, thorough evaluation, and percutaneous closure of the PFO leading to significant improvement in the symptoms.

Primary care oncology model (PCOM): Implementation of a model integrating primary and oncology care for patients taking oral anticancer agents.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. TPS1587-TPS1587
Author(s):  
Emily R. Mackler ◽  
Karen B. Farris ◽  
Katie S. Gatwood ◽  
Amna Rizvi-Toner ◽  
Alex Wallace ◽  
...  
Keyword(s):  
Primary Care ◽  
Anticancer Agents ◽  
Chronic Conditions ◽  
Lymphocytic Leukemia ◽  
Chronic Obstructive ◽  
Multiple Chronic Conditions ◽  
Hiv Intervention ◽  
Patient Reported ◽  
Chronic Medications ◽  
Oral Anticancer Agents

TPS1587 Background: Non-adherence to oral anticancer agents (OAA) has been reported among 30% of individuals. Often, individuals with cancer are not just managing their new OAA but also medications to treat multiple chronic conditions (MCC). Multiple factors contribute to the extent patients on OAAs and MCC medications adhere to therapy. The objective of this study is to improve medication, symptom, and disease management of patients with hematological malignancies and MCC through care coordination between pharmacists. Methods: Design. This is a multi-center prospective single arm pilot study at two academic medical centers in Michigan and Tennessee. Subjects. Ninety participants will be recruited, 60 from site 1 and 30 from site 2. Inclusion criteria are: adults > 18 years, diagnosed with and initiating oral treatment for chronic myeloid leukemia, chronic lymphocytic leukemia, or multiple myeloma, diagnoses of at least 2 chronic conditions, where one is type 2 diabetes, hypertension, congestive heart failure, depression/anxiety, gastroesophageal reflux disease, hyperlipidemia, or chronic obstructive pulmonary disease, taking at least two chronic medications, and able to provide electronic consent. Exclusion criteria are: inability to speak English, and diagnosis of type 1 diabetes or HIV. Intervention. Participants will complete two Patient Reported Outcome Measures (PROMs) for their OAA that will be reviewed by the oncology pharmacist, with follow-up to the care team if needed. Participants will be scheduled for a Comprehensive Medication Review with a primary care pharmacist for up to two visits for their chronic medications. The intervention over 2 months, and the oncology and primary care pharmacists communicate via electronic health record about medications, symptoms, and disease control. Outcomes. The primary endpoints are (a) dose-adjusted adherence by proportion days covered (PDC) for the OAA and (b) PDC for chronic condition medications, assessed using 6 months of prescription claims. Data will be collected from patients using REDCap surveys and abstracted data will be entered into REDCap. Implementation by pharmacists and patient acceptability will be examined. Analysis. The association of OAA and chronic medication adherence (PDC) will be examined via correlation. Participant demographics,clinical characteristics, and the symptom experience from the PROM will be described. Using CMR results, medication problems, recommendations, and changes will be provided. Program implementation will be assessed and patient perceptions obtained from post-CMR interviews. A joint display for the quantitative and qualitative data for feasibility, appropriateness, and acceptability from pharmacists will be completed. Results: Screening and recruitment has begun. Clinical trial information: NCT04595851 and NCT04663100.

scholarly journals High risk individuals in COVID-19 pandemic; an updated review

2020 ◽  
Vol 7 (2) ◽  
pp. e25-e25
Author(s):  
Rojin Chegini ◽  
Alireza Bolurian ◽  
Zahra Mojtahedi ◽  
Masoud Hafizi
Keyword(s):  
High Risk ◽  
Organ Transplant ◽  
Risk Groups ◽  
World Health ◽  
Chronic Obstructive ◽  
Solid Organ ◽  
Obstructive Pulmonary Disease ◽  
Gastrointestinal Complications ◽  
Control And Prevention ◽  
Health Organization

In December 2019, cases of pneumonia with an unknown pathogen were reporting in Wuhan city, China. The World Health Organization (WHO) recognized it as a pandemic, on March 11, 2020. The most frequent site of involvement is the respiratory system. The most common symptoms include cough, fatigue and fever. In some cases, neurological, respiratory and gastrointestinal complications can lead to death. Inflammatory cytokines can play a major role in pathogen damage. Due to the pandemic of COVID-19 and its severe complications, it is critical to identify the high-risk groups. Since this disease has a rapid transmission, following the instructions announced by the WHO, prevention is vital, especially in people with risk factors for disease complications and mortality. According to the latest reports by CDC (Center for Disease Control and Prevention), older age and having some medical conditions such as smoking, obesity (BMI ≥30 kg/m2 ), chronic obstructive pulmonary disease (COPD), heart disease, cancer, solid organ transplant, type 2 diabetes mellitus, chronic renal failure, and sickle cell anemia in younger adults are known disease severity risk factor.

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