scholarly journals A Web-based eHealth Intervention to Improve Quality of Life for Older Adults with Multiple Chronic Conditions: Study Protocol for a Randomized Controlled Trial (Preprint)

2020 ◽  
Author(s):  
David H Gustafson Sr ◽  
Marie-Louise Mares ◽  
Darcie C Johnston ◽  
Jane E. Mahoney ◽  
Randall T. Brown ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Primary Care ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions ◽  
Healthcare Use ◽  
Health Records ◽  
Secondary Outcomes ◽  
Ehealth Intervention

BACKGROUND Multiple chronic conditions (MCCs) are common and expensive among older adults. Of Medicare beneficiaries, two-thirds have multiple conditions (eg, diabetes, osteoarthritis) and account for more than 90% of Medicare spending. At the same time, patients with MCCs experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on lab results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving the lives of patients with MCCs. OBJECTIVE To assess effects of ElderTree, an eHealth intervention for older adults with MCCs, on quality of life and related measures. METHODS In this unblinded study, 346 adults age 65+ with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, BMI 30+) were recruited from primary care clinics and randomized 1:1 to one of two conditions: (1) usual care plus laptop computer, Internet service, and ElderTree, or (2) a control consisting of usual care plus laptop and Internet but no ElderTree. Patients with ElderTree have access for 12 months and will be followed for an additional 6 months after the intervention ends, for a total of 18 months. Primary outcomes are the differences between the two groups on measures of quality of life, psychological well-being, and loneliness. Secondary outcomes are between-groups differences on lab scores, number and severity of falls, symptom distress, medication adherence, and crisis and long-term healthcare use. We will also examine mediators and moderators of the effects of ElderTree. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; lab data are collected from electronic health records; healthcare use and chronic conditions are collected from both health records and patient surveys; and ElderTree use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. RESULTS Recruitment ran from January 2018 through December 2019; a total of 346 participants were recruited. The intervention period will end June 2021. CONCLUSIONS With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ElderTree may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. CLINICALTRIAL ClinicalTrials.gov NCT03387735

scholarly journals A Web-Based eHealth Intervention to Improve the Quality of Life of Older Adults With Multiple Chronic Conditions: Protocol for a Randomized Controlled Trial

10.2196/25175 ◽  
2021 ◽  
Vol 10 (2) ◽  
pp. e25175
Author(s):  
David H Gustafson Sr ◽  
Marie-Louise Mares ◽  
Darcie C Johnston ◽  
Jane E Mahoney ◽  
Randall T Brown ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Primary Care ◽  
Health Care ◽  
Chronic Conditions ◽  
Health Care Use ◽  
Multiple Chronic Conditions ◽  
Secondary Outcomes ◽  
Ehealth Intervention

Background Multiple chronic conditions (MCCs) are common among older adults and expensive to manage. Two-thirds of Medicare beneficiaries have multiple conditions (eg, diabetes and osteoarthritis) and account for more than 90% of Medicare spending. Patients with MCCs also experience lower quality of life and worse medical and psychiatric outcomes than patients without MCCs. In primary care settings, where MCCs are generally treated, care often focuses on laboratory results and medication management, and not quality of life, due in part to time constraints. eHealth systems, which have been shown to improve multiple outcomes, may be able to fill the gap, supplementing primary care and improving these patients’ lives. Objective This study aims to assess the effects of ElderTree (ET), an eHealth intervention for older adults with MCCs, on quality of life and related measures. Methods In this unblinded study, 346 adults aged 65 years and older with at least 3 of 5 targeted high-risk chronic conditions (hypertension, hyperlipidemia, diabetes, osteoarthritis, and BMI ≥30 kg/m2) were recruited from primary care clinics and randomized in a ratio of 1:1 to one of 2 conditions: usual care (UC) plus laptop computer, internet service, and ET or a control consisting of UC plus laptop and internet but no ET. Patients with ET have access for 12 months and will be followed up for an additional 6 months, for a total of 18 months. The primary outcomes of this study are the differences between the 2 groups with regard to measures of quality of life, psychological well-being, and loneliness. The secondary outcomes are between-group differences in laboratory scores, falls, symptom distress, medication adherence, and crisis and long-term health care use. We will also examine the mediators and moderators of the effects of ET. At baseline and months 6, 12, and 18, patients complete written surveys comprising validated scales selected for good psychometric properties with similar populations; laboratory data are collected from eHealth records; health care use and chronic conditions are collected from health records and patient surveys; and ET use data are collected continuously in system logs. We will use general linear models and linear mixed models to evaluate primary and secondary outcomes over time, with treatment condition as a between-subjects factor. Separate analyses will be conducted for outcomes that are noncontinuous or not correlated with other outcomes. Results Recruitment was conducted from January 2018 to December 2019, and 346 participants were recruited. The intervention period will end in June 2021. Conclusions With self-management and motivational strategies, health tracking, educational tools, and peer community and support, ET may help improve outcomes for patients coping with ongoing, complex MCCs. In addition, it may relieve some stress on the primary care system, with potential cost implications. Trial Registration ClinicalTrials.gov NCT03387735; https://www.clinicaltrials.gov/ct2/show/NCT03387735. International Registered Report Identifier (IRRID) DERR1-10.2196/25175

scholarly journals HEALTHCARE PROVIDERS’ EXPERIENCES IN CARING FOR OLDER ADULTS WITH MULTIPLE CHRONIC CONDITIONS

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S317-S318
Author(s):  
Jenny Ploeg ◽  
Marie-Lee Yous ◽  
Kimberly Fraser ◽  
Sinéad Dufour ◽  
Sharon Kaasalainen ◽  
...  
Keyword(s):  
Older Adults ◽  
Primary Care ◽  
Home Care ◽  
Family Caregivers ◽  
Chronic Conditions ◽  
Care Delivery ◽  
Healthcare Providers ◽  
Multiple Chronic Conditions ◽  
Team Approach ◽  
Personal Support

Abstract The management of multiple chronic conditions (MCC) in older adults living in the community is complex. Little is known about the experiences of interdisciplinary primary care and home providers who care for this vulnerable group. The aim of this study was to explore the experiences of healthcare providers in managing the care of community-living older adults with MCC and to highlight their recommendations for improving care delivery for this group. A qualitative interpretive description design was used. A total of 42 healthcare providers from two provinces in Canada participated in semi-structured interviews. Participants represented diverse disciplines (e.g., physicians, nurses, social workers, personal support workers) and settings (e.g., primary care and home care). Thematic analysis was used to analyze interview data. The experiences of healthcare providers managing care for older adults with MCC were organized into six major themes: (1) managing complexity associated with MCC, (2) implementing person-centred care, (3), involving and supporting family caregivers, (4) using a team approach for holistic care delivery, (5) encountering rewards and challenges in caring for older adults with MCC, and (6) recommending ways to address the challenges of the healthcare system. Healthcare providers highlighted the need for a more comprehensive integrated system of care to improve care management for older adults with MCC and their family caregivers. Specifically, they suggested increased care coordination, more comprehensive primary care visits with an interprofessional team, and increased home care support.

Challenges of Telemonitoring Programs for Complex Chronic Conditions: A Randomized Controlled Trial with an Embedded Qualitative Study (Preprint)

2021 ◽  
Author(s):  
Patrick Ware ◽  
Amika Shah ◽  
Heather Joan Ross ◽  
Alexander Gordon Logan ◽  
Phillip Segal ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Randomized Controlled Trial ◽  
Decision Support ◽  
Chronic Conditions ◽  
Controlled Trial ◽  
Self Care ◽  
Randomized Controlled ◽  
Complex Patients ◽  
Secondary Outcomes

BACKGROUND Despite the growing prevalence of people with complex conditions and evidence of the positive impact of telemonitoring for single conditions, little research exists on the use of telemonitoring in this population, particularly those with multiple chronic conditions (MCCs). OBJECTIVE This randomized controlled trial (RCT) and embedded qualitative study aimed to evaluate the impact and experiences of patients and healthcare providers (HCPs) using a telemonitoring system with decision support to manage complex patients, including those with MCCs, compared to the standard of care. METHODS A pragmatic 6-month RCT sought to recruit 146 patients with a diagnosis of heart failure (HF), uncontrolled hypertension (HT), and/or insulin requiring diabetes (DM) from outpatient specialty settings in Toronto, Canada. Participants were randomized into the control and telemonitoring groups with the latter being instructed to take readings relevant to their condition(s). The telemonitoring system contained an algorithm that generated decision support in the form of actionable self-care directives to patients and alerts to HCPs. The primary outcome was health status as measured by the SF-36. Secondary outcomes included anxiety and depression, self-efficacy in chronic disease management, and self-reported healthcare utilization. HF-related quality of life and self-care measures were also collected from patients followed for HF. Within- and between-group change scores were analyzed for statistical significance (P<.05). A convenience sample of HCPs and patients in the intervention group were interviewed about their experiences RESULTS A total of 96 patients were recruited and randomized. Recruitment was terminated early due to implementation challenges and the onset of COVID-19. No significant within- and between-group differences were found for the main primary and secondary outcomes. However, a within-group analysis of HF patients found improvements in self-care maintenance (P=.036) and physical quality of life (P= .046). Opinions expressed by the 5 HCPs and 13 patients interviewed differed based on the condition(s) monitored. Although HF patients reported benefitting from actionable self-care guidance and meaningful interactions with their HCPs, patient and HCP users of the DM and HT modules did not think telemonitoring improved the clinical management of those conditions to the same degree. These differing experiences were largely attributed to the siloed nature of specialty care, and the design of the decision support whereby it was indicated that fluctuations in HT and DM patient status typically required less urgent intervention compared to HF. CONCLUSIONS Consistent with previous studies, we recommend that future research conceive telemonitoring as a program and that self-management and clinical decision support are necessary, but not sufficient components of such programs for complex patients with lower acuity. We conclude that a multidisciplinary model of care that includes care coordination must accompany telemonitoring systems which may best be operationalized through novel models of care, such as nurse-led models. CLINICALTRIAL ClinicalTrials.gov NCT03127852, ISRCTN (41238563) INTERNATIONAL REGISTERED REPORT RR2-10.2196/resprot.8367

scholarly journals Quality of life of older Chinese adults receiving primary care in Wuhan, China: a multi-center study

PeerJ ◽  
2019 ◽  
Vol 7 ◽  
pp. e6860 ◽  
Author(s):  
Bao-Liang Zhong ◽  
Yan-Min Xu ◽  
Wu-Xiang Xie ◽  
Xiu-Jun Liu
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Primary Care ◽  
General Population ◽  
Geriatric Depression Scale ◽  
Depression Scale ◽  
Psychosocial Problems ◽  
Medical Conditions ◽  
Multi Center Study

Background Quality of life (QOL) is an important primary care outcome, but the QOL of older adults treated in primary care is understudied in China. This study examined QOL and its associated factors in older adults treated in Chinese primary care. Methods A total of 752 older patients (65+ years) were consecutively recruited from 13 primary care centers in Wuhan, China, and interviewed with a standardized questionnaire, concerning socio-demographics, major medical conditions, loneliness, and depression. QOL and depression were measured with the Chinese six-item QOL questionnaire and the shortened Geriatric Depression Scale, respectively. Multiple linear regression was used to identify factors associated with poor QOL. Results The average QOL score of primary care older adults was (20.7 ± 2.5), significantly lower than that of the Chinese general population. Factors significantly associated with poor QOL of Chinese primary care older adults included engaging in manual labor before older adulthood (unstandardized coefficient [β]: −0.702, P < 0.001), no living adult children (β: −1.720, P = 0.001), physical inactivity (β: −0.696, P < 0.001), having ≥ four major medical conditions (β: −1.813, P < 0.001), hearing problem (β: −1.004, P = 0.017), depression (β: −1.153, P < 0.001), and loneliness (β: −1.396, P < 0.001). Conclusions Older adults treated in Chinese primary care have poorer QOL than the general population. Addressing psychosocial problems at Chinese primary care settings could be helpful in improving QOL in Chinese older adults.

scholarly journals The role of Clinical-Functional Vulnerability Index-20 to detect quality of life in older adults assisted in primary care

2021 ◽  
Vol 67 (1) ◽  
pp. 83-87
Author(s):  
Levi Bezerra Sena ◽  
Larissa Paixão Batista ◽  
Flávia Fonseca Fernandes ◽  
Alfredo Nicodemos Cruz Santana
Keyword(s):  
Quality Of Life ◽  
Older Adults ◽  
Primary Care ◽  
Vulnerability Index

Illness Perceptions, Coping Strategies, and Quality of Life in People With Multiple Chronic Conditions

2020 ◽  
Vol 52 (2) ◽  
pp. 145-154 ◽  
Author(s):  
Cheng Cheng ◽  
Cong‐Yan Yang ◽  
Kerry Inder ◽  
Sally Wai-Chi Chan
Keyword(s):  
Quality Of Life ◽  
Coping Strategies ◽  
Chronic Conditions ◽  
Illness Perceptions ◽  
Multiple Chronic Conditions

Fear and depression as remediable causes of disability in common medical conditions in primary care

2015 ◽  
Author(s):  
Michael Von Korff
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Low Back Pain ◽  
Back Pain ◽  
Chronic Conditions ◽  
Social Role ◽  
Low Back ◽  
Psychological States ◽  
Primary Care Patients

This chapter argues that psychological states, in particular fear and depression, are potentially remediable causes of social role disability among primary care patients. Using chronic low back pain as an example, it considers how recognising and treating depression can improve disability and quality of life for primary care patients with this and many other chronic conditions.

scholarly journals Healthcare Use in Multimorbidity Patients

2019 ◽  
Vol 29 (Supplement_4) ◽  
Author(s):  
G Quinaz Romana ◽  
I Kislaya ◽  
S Cunha Goncalves ◽  
M R Salvador ◽  
B Nunes ◽  
...  
Keyword(s):  
Primary Care ◽  
Health System ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions ◽  
Health Examination ◽  
Healthcare Use ◽  
Medical Specialist ◽  
Continuous Increase ◽  
Efficient Treatment ◽  
Male And Female

Abstract Background The existence of multiple chronic conditions in the same patient is a public health problem, recognized as relevant to health systems. Individuals with multimorbidity have additional health needs, which in the context of continuous increase of life expectancy, imply a heavy burden to healthcare services. Methods We analysed the association between healthcare use (primary care, medical specialist consultations and hospitalizations) and multimorbidity in the Portuguese population aged 25-74 years old, using the Health Examination Survey (n = 4911) data. Logistic regression models adjusted for predisposing (age, education) and enabling (income, region of residence) factors were fitted separately for male and female. Odds ratios and CI95% were estimated. Results Prevalence of multimorbidity was 38.3% (95%CI: 35.4%; 41.3%). In males, after adjustment for confounding and when compared to patients without chronic conditions, multimorbidity was associated with greater use of primary care (OR = 3.7; CI95%: 2.3-5.8), medical specialist consultations (OR = 1.9; CI95%: 1.1-3.4) and hospitalizations (OR = 1.8; CI95%: 1.2-2.7). In female, statistically significant association between multimorbidity and healthcare use was observed for primary care (OR = 2.6; CI95%: 1.6-4.3) and medical specialist consultations (OR = 2.8; CI95%: 2.0-3.9), but not for hospitalizations. Both male and female with multimorbidity reported greater use of primary care, compared to individuals with only one chronic condition (OR = 2.4; CI95%: 1.3-4.4 and OR = 1.7; CI95%: 1.1-2.8, respectively). Conclusions Our results show a greater healthcare use in patients with multimorbidity, both in primary and hospital care. The availability of scientific evidence regarding the healthcare use, by patients with multimorbidity, may substantiate the discussion about the possible need for the Portuguese health system to adapt to these patients, with changes in policies that will allow better and more efficient treatment. Key messages This study may support the discussion about the adaptation of Portuguese health system to patitents with multimorbidity. Further discussion on policy change is needed, targeting an efficient management of these patients.

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