Self-management of hypertension using technology enabled interventions in primary care settings

2015 ◽  
Vol 23 (2) ◽  
pp. 119-128 ◽  
Author(s):  
Aastha Chandak ◽  
Ashish Joshi
Keyword(s):  
Primary Care ◽  
Self Management ◽  
Primary Care Settings

scholarly journals Effectiveness of chronic obstructive pulmonary disease self-management interventions in primary care settings: a systematic review

2019 ◽  
Vol 25 (3) ◽  
pp. 195 ◽  
Author(s):  
Hassan Hosseinzadeh ◽  
Mahmmoud Shnaigat
Keyword(s):  
Quality Of Life ◽  
Primary Care ◽  
Self Efficacy ◽  
Randomised Controlled Trials ◽  
Self Management ◽  
Chronic Obstructive ◽  
Obstructive Pulmonary Disease ◽  
Primary Care Settings ◽  
Randomised Controlled

Chronic obstructive pulmonary disease (COPD) is one of the more disabling diseases and the third cause of mortality worldwide. Self-management is considered an effective strategy for controlling and managing COPD. This review aims to summarise the available evidence on the effectiveness of COPD self-management in primary care settings. Social Sciences, Citation Index, MEDLINE, CINAHL, Academic Search Complete and Scopus were searched for randomised controlled trials of COPD self-management in general practice between 2001 and 2018. Ten randomised controlled trials of COPD self-management trials conducted in primary care settings were included in this review. The identified trials have recruited stable patients; a majority having mild to moderate COPD. The trials implemented different types of interventions and measured improvements in knowledge, skills and behaviours of self-management, mental health, self-efficacy and endpoint outcomes such as hospitalisation and quality of life. The findings showed that COPD self-management trials had positive effects on COPD knowledge and improved self-management behaviours such as adherence to medication, physical activities and smoking cessation in some cases; however, the effect of trials on hospitalisation rate, quality of life and healthcare utilisation were not conclusive. There was also not enough evidence to suggest that the trials were efficient in improving self-efficacy, a major driver of self-management behaviours. Primary care COPD self-management trials are efficient in improving surrogate outcomes such as knowledge of and adherence to self-management behaviours; however, such improvements are less likely to be sustainable in the absence of self-efficacy. Future studies should also focus on improving endpoint self-management outcomes like hospitalisation rate and quality of life to benefit both patient and healthcare system.

Cost-effectiveness of Diabetes Self-management Programs in Community Primary Care Settings

2009 ◽  
Vol 35 (5) ◽  
pp. 761-769 ◽  
Author(s):  
Carol A. Brownson ◽  
Thomas J. Hoerger ◽  
Edwin B. Fisher ◽  
Kerry E. Kilpatrick
Keyword(s):  
Primary Care ◽  
Cost Effectiveness ◽  
Simulation Model ◽  
Health Systems ◽  
Self Management ◽  
Systems Perspective ◽  
Primary Care Settings ◽  
Life Years ◽  
The Cost

Purpose The purpose of this study is to estimate the cost-effectiveness of diabetes self-management programs in real-world community primary care settings. Estimates incorporated lifetime reductions in disease progression, costs of adverse events, and increases in quality of life. Methods Clinical results and costs were based on programs of the Diabetes Initiative of the Robert Wood Johnson Foundation, implemented in primary care and community settings in disadvantaged areas with notable health disparities. Program results were used as inputs to a Markov simulation model to estimate the long-term effects of self-management interventions. A health systems perspective was adopted. Results The simulation model estimates that the intervention does reduce discounted lifetime treatment and complication costs by $3385, but this is more than offset by the $15 031 cost of implementing the intervention and maintaining its effects in subsequent years. The intervention is estimated to reduce long-term complications, leading to an increase in remaining life-years and quality-adjusted life-years (QALYs). The incremental cost-effectiveness ratio is $39 563/QALY, well below a common benchmark of $50 000/QALY. Sensitivity analyses tested the robustness of the model’s estimates under various alternative assumptions. The model generally predicts acceptable cost-effectiveness ratios. Conclusions Self-management programs for type 2 diabetes are cost-effective from a health systems perspective when the cost savings due to reductions in long-term complications are recognized. These findings may justify increased reimbursement for effective self-management programs in diverse settings.

scholarly journals Pilot Feasibility Study of a Digital Storytelling Intervention for Immigrant and Refugee Adults With Diabetes

2017 ◽  
Vol 43 (4) ◽  
pp. 349-359 ◽  
Author(s):  
Mark L. Wieland ◽  
Jane W. Njeru ◽  
Marcelo M. Hanza ◽  
Deborah H. Boehm ◽  
Davinder Singh ◽  
...  
Keyword(s):  
Primary Care ◽  
Large Scale ◽  
Digital Storytelling ◽  
Community Based Participatory Research ◽  
Structured Interview ◽  
Self Management ◽  
Primary Care Settings ◽  
Interest Level ◽  
Immigrant And Refugee

Purpose The purpose of this pilot feasibility project was to examine the potential effectiveness of a digital storytelling intervention designed through a community-based participatory research (CBPR) approach for immigrants and refugees with type 2 diabetes mellitus (T2DM). Methods The intervention was a 12-minute culturally and linguistically tailored video consisting of an introduction, 4 stories, and a concluding educational message. A structured interview was used to assess the intervention for acceptability, interest level, and usefulness among 25 participants with T2DM (15 Latino, 10 Somali) across 5 primary care clinical sites. After watching the video, participants rated their confidence and motivation about managing T2DM as a result of the intervention. Baseline A1C and follow-up values (up to 6 months) were abstracted from medical records. Results All participants reported that the intervention got their attention, was interesting, and was useful; 96% reported that they were more confident about managing their T2DM than before they watched the video, and 92% reported that the video motivated them to change a specific behavior related to T2DM self-management. The mean baseline A1C level for the intervention participants was 9.3% (78 mmol/mol). The change from baseline to first follow-up A1C level was −0.8% (−10 mmol/mol) ( P < .05). Conclusions Implementation of a digital storytelling intervention for T2DM among immigrant populations in primary care settings is feasible and resulted in self-rated improvement in psychosocial constructs that are associated with healthy T2DM self-management behaviors, and there was some evidence of improvement in glycemic control. A large-scale efficacy trial of the intervention is warranted.

scholarly journals New Models for Primary Care Are Needed for Osteoarthritis

2009 ◽  
Vol 89 (12) ◽  
pp. 1371-1378 ◽  
Author(s):  
Krysia S. Dziedzic ◽  
Jonathan C. Hill ◽  
Mark Porcheret ◽  
Peter R. Croft
Keyword(s):  
Primary Care ◽  
Behavioral Change ◽  
Physical Therapists ◽  
Self Management ◽  
Biomedical Model ◽  
Chronic Pain Management ◽  
Primary Care Settings ◽  
Musculoskeletal Problems ◽  
Social Components ◽  
The Ideal

Musculoskeletal problems are the most common cause of restriction in daily life in most countries. Most health care for musculoskeletal problems is provided in primary care settings, and back pain and joint problems together represent the largest workload of cases of chronic disease seen and managed there. This article reflects on aspects of the occurrence, natural history, prognosis, and management of common joint problems in primary care. Although the biomedical model has contributed to major advances, a model that embraces chronic pain management and its psychological and social components is needed. In particular, primary care is the ideal arena to achieve high-impact secondary prevention of pain and disability in people with osteoarthritis. Physical therapists are in a crucial position in primary care to provide support for self-management of this condition, especially for interventions related to exercise and behavioral change.

scholarly journals mHealth Tools for the Self-Management of Patients With Multimorbidity in Primary Care Settings: Pilot Study to Explore User Experience

2018 ◽  
Vol 6 (8) ◽  
pp. e171 ◽  
Author(s):  
Anum Irfan Khan ◽  
Ashlinder Gill ◽  
Cheryl Cott ◽  
Parminder Kaur Hans ◽  
Carolyn Steele Gray
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
User Experience ◽  
The Self ◽  
Self Management ◽  
Primary Care Settings

scholarly journals mHealth Tools for the Self-Management of Patients With Multimorbidity in Primary Care Settings: Pilot Study to Explore User Experience (Preprint)

2017 ◽  
Author(s):  
Anum Irfan Khan ◽  
Ashlinder Gill ◽  
Cheryl Cott ◽  
Parminder Kaur Hans ◽  
Carolyn Steele Gray
Keyword(s):  
Primary Care ◽  
Pilot Study ◽  
Community Dwelling ◽  
The Self ◽  
Self Management ◽  
Management Approach ◽  
Multiple Chronic Conditions ◽  
Primary Care Settings ◽  
Patient Reported ◽  
Explicit Recognition

BACKGROUND Given the complex and evolving needs of individuals with multimorbidity, the adoption of mHealth tools to support self-management efforts is increasingly being explored, particularly in primary care settings. The electronic patient-reported outcomes (ePRO) tool was codeveloped with patients and providers in an interdisciplinary primary care team in Toronto, Canada, to help facilitate self-management in community-dwelling adults with multiple chronic conditions. OBJECTIVE The objective of study is to explore the experience and expectations of patients with multimorbidity and their providers around the use of the ePRO tool in supporting self-management efforts. METHODS We conducted a 4-week pilot study of the ePRO tool. Patients’ and providers’ experiences and expectations were explored through focus groups that were conducted at the end of the study. In addition, thematic analyses were used to assess the shared and contrasting perspectives of patients and providers on the role of the ePRO tool in facilitating self-management. Coded data were then mapped onto the Individual and Family Self-Management Theory using the framework method. RESULTS In this pilot study, 12 patients and 6 providers participated. Both patients and providers emphasized the need for a more explicit recognition of self-management context, including greater customizability of content to better adapt to the complexity and fluidity of self-management in this particular patient population. Patients and providers highlighted gaps in the extent to which the tool enables self-management processes, including how limited progress toward self-management goals and the absence of direct provider engagement through the ePRO tool inhibited patients from meeting their self-management goals. Providers highlighted proximal outcomes based on their experience of the tool and specifically, they indicated that the tool offered valuable insights into the broader patient context, which helps to inform the self-management approach and activities they recommend to patients, whereas patients recognized the tool’s potential in helping to improve access to different providers in a team-based primary care setting. CONCLUSIONS This study identifies a more explicit recognition of the contextual factors that influence patients’ ability to self-manage and greater adaptability to accommodate patient complexity and provider workflow as next steps in refining the ePRO tool to better support self-management efforts in primary care ahead of its application in a full-scale randomized pragmatic trial.

scholarly journals Evaluation of a primary care - based programme designed to increase exercise and improve nutrition in patients at risk

2014 ◽  
Vol 6 (4) ◽  
pp. 312 ◽  
Author(s):  
Felicity Goodyear-Smith ◽  
Julia McPhee ◽  
Scott Duncan ◽  
Grant Schofield
Keyword(s):  
Physical Activity ◽  
Primary Care ◽  
Nutrition Therapy ◽  
Brief Interventions ◽  
Self Management ◽  
Structured Interviews ◽  
Good Communication ◽  
Primary Care Settings ◽  
Patients At Risk ◽  
Emerging Themes

INTRODUCTION: Evidence is limited regarding the effectiveness of brief interventions delivered through primary care to improve healthy living and increase physical activity. The Healthy As programme delivering brief interventions programmes in primary care to promote physical activity, improved nutrition and weight management was developed, implemented and assessed. This study aimed to identify aspects of the programme that worked well, those that presented problems or barriers, along with suggestions for improvement. METHODS: Three provider organisations in Auckland were contracted to deliver the Healthy As intervention in primary care settings. Semi-structured interviews were conducted with those delivering the risk assessments and providing the intervention from each provider organisation. A thematic analysis approach based on grounded theory was used to analyse the emerging key themes. FINDINGS: The emerging themes related to the holistic nature of the programme, its structure, resources used with participants, engagement of the providers with the participants, and whether the programme was effective in changing behaviour. CONCLUSION: Initial engagement of participants was found to be particularly important for the success of the Healthy As programme. For a patient-centred approach, good communication between the patient and health provider is required to facilitate shared decision-making and self-management prior to implementation of an intervention. Patients need to indicate whether they want help to make changes. Advice on healthy eating and exercise should not be given in isolation. Patients may also need help with mental health or other lifestyle issues before they can actively engage in exercise or weight reduction programmes. KEYWORDS: Exercise; general practice; health behavior; motivational interviewing; nutrition therapy; primary health care

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