scholarly journals Adapting the definition of multimorbidity – development of a locality-based consensus for selecting included Long Term Conditions

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Nasrin Hafezparast ◽  
Ellie Bragan Turner ◽  
Rupert Dunbar-Rees ◽  
Alice Vodden ◽  
Hiten Dodhia ◽  
...  
Keyword(s):  
Literature Review ◽  
Selection Process ◽  
Final Decision ◽  
Local Health ◽  
Urban Context ◽  
Long Term Conditions ◽  
Large Cities ◽  
Second Stage ◽  
Local Health Service

Abstract Background Defining multimorbidity has proved elusive in spite of attempts to standardise definitions. For national studies, a broad definition is required to capture national diversity. For locally based studies, the definition may need to reflect demographic and morbidity patterns. We aimed to define multimorbidity for an inner city, multi-ethnic, deprived, young age community typical of many large cities. Methods We used a scoping literature review to identify the international literature, standards and guidelines on Long Term Condition (LTC) definitions for inclusion in our multimorbidity definition. Consensus was categorised into high, medium or low consensus, depending on the number of literature sources citing each LTC. Findings were presented to a workshop consisting of local health service stakeholders who were asked to select LTCs for inclusion in a second stage review. In the second stage, each LTC was tested against seven evaluation domains: prevalence, impact, preventability, treatment burden, progression to multiple LTCs, impact on younger people, data quality. These domains were used to create 12 target criteria. LTC rankings according to consensus group and target criteria scores were presented to a second workshop for a final decision about LTC inclusion. Results The literature review identified 18 literature sources citing 86 LTCs: 11 were excluded because they were LTC clusters. The remainder were allocated into consensus groupings: 13 LTCs were ‘high consensus’ (cited by ≥ 11 sources); 15 were ‘medium consensus’ (cited by 5–10 sources); 47 were ‘low consensus’ (cited by < 5 sources). The first workshop excluded 31 LTCs. The remaining 44 LTCs consisted of: 13 high consensus LTCs, all with high target score (score 6–12); 15 medium consensus LTCs, 11 with high target scores; 16 low consensus LTCs, 6 with high target scores. The final workshop selected the 12 high consensus conditions, 12 medium consensus LTCs (10 with high target scores) and 8 low consensus LTCs (3 with high target scores), producing a final selection of 32 LTCs. Conclusions Redefining multimorbidity for an urban context ensures local relevance but may diminish national generalisability. We describe a detailed LTC selection process which should be generalisable to other contexts, both local and national.

scholarly journals The Year of Care approach: developing a model and delivery programme for care and support planning in long term conditions

2019 ◽  
Author(s):  
Sue Roberts ◽  
Simon Eaton ◽  
Tracy Finch ◽  
Nick Lewis-Barned ◽  
Monique Lhussier ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Professionals ◽  
Health Behaviours ◽  
Local Health ◽  
Implementation Framework ◽  
Long Term Conditions ◽  
Training Support ◽  
Care And Support ◽  
Health Communities

Abstract Background: People with long term conditions (LTCs) make most of the daily decisions and carry out the activities which affect their health and quality of life. Only a fraction of each contact with a health care professional (HCP) is spent supporting this. This paper describes how care and support planning (CSP) and an implementation framework to redesign services, were developed to address this in UK general practice. Focussed on what is important to each individual, CSP brings together traditional clinical issues and the person’s lived experience in a solution focussed, forward looking conversation with an emphasis on ‘people not diseases’. Methods: The components of CSP were developed in three health communities using diabetes as an exemplar. This model was extended and refined for other single conditions and multimorbidity across 40 sites and two nations, over 15 years. Working with local teams and communities the authors used theoretical models of care, implementation and spread, developing and tailoring training, support and resources to embed CSP as usual care, sharing learning across a community of practice. Results: The purpose, content, process, developmental hurdles and impact of this CSP model are described, alongside an implementation strategy. There is now a robust, reproducible five step model; preparation, conversation, recording, actions and review. Uniquely, preparation, involving information sharing with time for reflection, enables an uncluttered conversation with a professional focussed on what is important to each person. The components of the Year of Care House act as a checklist for implementation, a metaphor for their interdependence and a flexible framework. Spreading CSP involved developing exemplar practices and building capacity across local health communities. These reported improved patient experience, practitioner job satisfaction, health behaviours and outcomes, teamwork, practice organisation, resource use, and links with wider community activities. Conclusions: Tested in multiple settings, CSP is a reproducible and practical model of planned care applicable to all LTCs, with the capacity to be transformative for people with LTCs and health care professionals. It recaptures relational dimensions of care with transactional elements in the background. Options for applying this model and implementation framework at scale now need to be explored.

scholarly journals Important Design Features of Personal Health Records to Improve Medication Adherence for Patients with Long-Term Conditions: Protocol for a Systematic Literature Review (Preprint)

2018 ◽  
Author(s):  
Elisavet Andrikopoulou ◽  
Philip James Scott ◽  
Helena Herrera
Keyword(s):  
Medication Adherence ◽  
Literature Review ◽  
Systematic Literature Review ◽  
Personal Health Records ◽  
Personal Health ◽  
Improve Medication Adherence ◽  
Long Term Conditions ◽  
Health Records ◽  
Important Design

BACKGROUND The National Health Service (NHS) England spent £15.5 billion on medication in 2015. More than a third of patients affected by at least one long-term condition do not adhere to their drug regime. Many interventions have been trialed to improve medication adherence. One promising innovation is the electronic personal health record. OBJECTIVE This systematic literature review aims to identify the important design features of personal health records to improve medication adherence for patients with long-term conditions. METHODS This protocol follows the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocol (PRISMA-P 2015) statement. The following databases will be searched for relevant articles: PubMed, Science Direct, BioMed Central, Cumulative Index to Nursing and Allied Health Literature, Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials. Studies published in the last fifteen years, in English, will be included if the participants are adults who were treated outside the hospital, have the ability to self-administer their medication, and have at least one long-term condition. The review will exclude commercial or political sources and papers without references. Papers that research pediatrics, pregnant, or terminally ill patients will also be excluded, since their medication management is typically more complex. RESULTS One reviewer will screen the included studies, extract the relevant data, and assess the quality of evidence utilizing the Grading of Recommendations Assessment, Development, and Evaluation system and the risk of bias using the Cochrane RevMan tool. The second reviewer will assess the quality of 25% of the included studies to assess interrater agreement. Any disagreement will be solved by a third reviewer. Only studies of high and moderate quality will be included for narrative synthesis. CONCLUSIONS NHS policy assumes that increasing usage of personal health records by citizens will reduce demand on health care services. There is limited evidence, however, that the use of health apps can improve patient outcomes, and, to our knowledge, this is the first systematic literature review aiming to identify important design features of the personal health record which may improve medication adherence in the adult population with long-term conditions. CLINICALTRIAL PROSPERO CRD42017060542; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=60542 (Archived by WebCite at http://www.webcitation.org/6zeuWXxVh) REGISTERED REPORT IDENTIFIER RR1-10.2196/9778

scholarly journals Historical Overview of Vascular Allograft Transplantation

2019 ◽  
Vol 2 (1) ◽  
pp. 19-22 ◽  
Author(s):  
Kerbi Alejandro Guevara-Noriega ◽  
Albert Martinez Toiran ◽  
Bruno Alvarez-Concejo ◽  
Jose Luis Pomar
Keyword(s):  
Literature Review ◽  
Current Trend ◽  
Historical Overview ◽  
Second Stage ◽  
The Third ◽  
Allograft Transplantation ◽  
Third Stage ◽  
Three Stages ◽  
A Current

There is a mix of therapeutic options for revascularisation in vascular surgery. The authors performed a literature review on the evolution of vascular allograft transplantation and its use and acceptance by vascular surgeons. This review exposed three stages: the first stage involved preliminary experimentation; the second stage was a decline in use due to long-term complications, and the third stage is its current use in special indications subject to a thorough analysis. There are few indications for the use of vascular allografts in clinical guidelines. However, there are publications of long series of case studies with variable results reflecting international use of the procedure. There is a current trend that favours its use with limited and individualised indications.

scholarly journals Project Managers’ Competences

2018 ◽  
Vol 49 (3) ◽  
pp. 82-97 ◽  
Author(s):  
João Walter Saunders Pacheco do Vale ◽  
Breno Nunes ◽  
Marly Monteiro de Carvalho
Keyword(s):  
Literature Review ◽  
Systematic Literature Review ◽  
Selection Process ◽  
Methodological Approach ◽  
Project Managers ◽  
Job Descriptions ◽  
Second Stage ◽  
Job Advertisements ◽  
The Individual ◽  
Selection Of

This article investigates the individual competences of project managers through a methodological approach that combines a systematic literature review and an analysis of employment opportunities. A comparative analysis of project manager’s competences from the literature and the job advertisements was done. The systematic literature review was the first stage of the research and consisted of adopting methods of bibliometrics and content analysis. The second stage included an analysis of project managers’ competences in the selection process. Thus, five Brazilian recruitment websites and the selection of employees were investigated. Through literature review, it was possible to classify and code competences in four categories (contextual, managerial, technical, and behavioral). The analysis of job advertisements allowed us to identify core competence requirements in the job descriptions and to develop a project manager profile expected by Brazilian organizations.

scholarly journals Home care needs of patients with long-term conditions: literature review

2004 ◽  
Vol 46 (4) ◽  
pp. 417-429 ◽  
Author(s):  
Marco Algera ◽  
Anneke L. Francke ◽  
Ada Kerkstra ◽  
Jouke van der Zee
Keyword(s):  
Literature Review ◽  
Home Care ◽  
Care Needs ◽  
Long Term Conditions

scholarly journals The Year of Care approach: developing a model and delivery programme for care and support planning in long term conditions within general practice

2019 ◽  
Vol 20 (1) ◽  
Author(s):  
Sue Roberts ◽  
Simon Eaton ◽  
Tracy Finch ◽  
Nick Lewis-Barned ◽  
Monique Lhussier ◽  
...  
Keyword(s):  
Health Care ◽  
General Practice ◽  
Health Care Professionals ◽  
Local Health ◽  
Implementation Framework ◽  
Long Term Conditions ◽  
Training Support ◽  
Care And Support ◽  
Health Communities

Abstract Background People with long term conditions (LTCs) make most of the daily decisions and carry out the activities which affect their health and quality of life. Only a fraction of each contact with a health care professional (HCP) is spent supporting this. This paper describes how care and support planning (CSP) and an implementation framework to redesign services, were developed to address this in UK general practice. Focussed on what is important to each individual, CSP brings together traditional clinical issues and the person’s lived experience in a solution focussed, forward looking conversation with an emphasis on ‘people not diseases’. Methods The components of CSP were developed in three health communities using diabetes as an exemplar. This model was extended and refined for other single conditions and multimorbidity across 40 sites and two nations, over 15 years. Working with local teams and communities the authors used theoretical models of care, implementation and spread, developing and tailoring training, support and resources to embed CSP as usual care, sharing learning across a community of practice. Results The purpose, content, process, developmental hurdles and impact of this CSP model are described, alongside an implementation strategy. There is now a robust, reproducible five step model; preparation, conversation, recording, actions and review. Uniquely, preparation, involving information sharing with time for reflection, enables an uncluttered conversation with a professional focussed on what is important to each person. The components of the Year of Care House act as a checklist for implementation, a metaphor for their interdependence and a flexible framework. Spreading CSP involved developing exemplar practices and building capacity across local health communities. These reported improved patient experience, practitioner job satisfaction, health behaviours and outcomes, teamwork, practice organisation, resource use, and links with wider community activities. Conclusions Tested in multiple settings, CSP is a reproducible and practical model of planned care applicable to all LTCs, with the capacity to be transformative for people with LTCs and health care professionals. It recaptures relational dimensions of care with transactional elements in the background. Options for applying this model and implementation framework at scale now need to be explored.

scholarly journals How to foster cities resilient to the COVID-19 pandemic through Urban Health strategies

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
S Capolongo ◽  
M Buffoli ◽  
D D'Alessandro ◽  
G M Fara ◽  
L Appolloni ◽  
...  
Keyword(s):  
Public Health ◽  
Urban Health ◽  
Local Health ◽  
Urban Context ◽  
Sustainable Mobility ◽  
Emergency Plans ◽  
Factors Affecting ◽  
Care Services ◽  
Basic Care

Abstract Background The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it's necessary to make the systems and local capacities resilient to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities? Methods According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the “period” of physical distancing. Results Immediate Actions are 01. program the flexibility of city schedules; 02. plan a smart and sustainable mobility network; 03. define a neighborhood services' plan; 04. develop a digitization of the urban context, promoting the smart communities; 05. re-think the accessibility to the places of culture and tourism. Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces; 07. re-think building typologies, fostering the presence of semi-private or collective spaces; 08. renovate the basic care services' network; 09. integrate the existing environmental emergency plans, with those related to the health emergencies; 10. improve stakeholders' awareness of the factors affecting Public Health in the cities. Conclusions The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments. Key messages The strategies described in this paper are at the basis of a social and infrastructural rethinking of the city, careful to the Welfare and Public Health needs. The physical distancing imposed, may have amplified population's social and health inequalities.

scholarly journals Why do patients with long-term conditions use unscheduled care? A qualitative literature review

2012 ◽  
Vol 21 (4) ◽  
pp. 339-351 ◽  
Author(s):  
Susanne Langer ◽  
Carolyn Chew-Graham ◽  
Cheryl Hunter ◽  
Elspeth A. Guthrie ◽  
Peter Salmon
Keyword(s):  
Literature Review ◽  
Long Term Conditions ◽  
Unscheduled Care ◽  
Qualitative Literature

scholarly journals Integration between general practice and hospital specialty for drug prescription appropriateness: the Diabetes Project of the Local Health Service Tuscany Centre

2021 ◽  
Vol 24 (3) ◽  
pp. 184
Author(s):  
Peluso, E.
Keyword(s):  
General Practice ◽  
Health Service ◽  
Drug Prescription ◽  
Pharmaceutical Expenditure ◽  
Hypoglycemic Agents ◽  
Diabetic Patients ◽  
Local Health ◽  
Significant Drop ◽  
Local Health Service

According to standards of medical care in diabetes, sulphonylureas and glinides are suggested to be abolished in the treatment of type 2 diabetes, due to their long-term adverse effects. In 2019, the Local Health Service – ASL Toscana Centro (TC) – promoted a collaboration among diabetologists, general practitioners (GPs) and pharmacists. In detail, the prescription of hypoglycemic drugs was retrieved through codes (ATCA10). After the presentation of the relative data and the recommendation/training of the diabetologist, the GPs were urged to abolish sulphonylureas and glinides, replacing them with newly generation drugs. Comparison with data in 2020 showed a significant drop in prescription of such drugs. Moreover, this project has allowed an estimate of the diabetic population within ASL TC additionally tracking other drugs, such as statins, which generally should be co-prescribed with hypoglycemic agents in the care of the diabetic patients. In conclusion, this experience has increased the knowledge relating to the most recent standards of diabetic care in general practice, promoted the appropriateness in the use of newly drugs, generated epidemiological data, and helped in better planning the long-term pharmaceutical expenditure. KEY WORDS general practice; educational training; stardards of care; sulphonylureas and glinides; statins.

Sign in / Sign up

Export Citation Format

Share Document