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

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.

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

2013 ◽  
Vol 3 (2) ◽  
pp. 30-35 ◽  
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.

scholarly journals Increasing Clinical, Community, and Patient-Centered Health Research for Preventing and Managing Multimorbidity

2013 ◽  
Vol 3 (2) ◽  
pp. 41-44 ◽  
Author(s):  
Jose M. Valderas
Keyword(s):  
Health Research ◽  
Chronic Conditions ◽  
Multiple Chronic Conditions ◽  
Patient Centered ◽  
Related Research ◽  
Department Of Health ◽  
Clinical Community ◽  
Usual Clinical Practice ◽  
Secondary Analyses ◽  
Research Initiatives

The report “Multiple Chronic Conditions: A Strategic Framework,” which was developed by the U.S. Department of Health & Human Services (HSS), has identified as one of the key goals for improving health and the provision of healthcare for people with multiple chronic conditions “to increase clinical, community and patient-centered research.” In their linked commentary of this special journal issue, Parekh and Goodman identify and consider the potential impact of a number of related research initiatives supported by the National Institutes of Health and the Agency for Health Research and Quality, particularly focusing on two very specific areas: behavioral medicine and secondary analyses of available datasets. In this paper, I comment on both documents and discuss the opportunities offered by the current approaches and highlight related research needs; in particular, the need for an improved and expanded conceptual model of healthcare for people with multimorbidity, and the need for further exploration of the use of multimorbidity-relevant outcomes as part of usual clinical practice.

GPS' PERCEPTION OF THE PATIENT ORIENTED INTERVENTIONS AS KEY ELEMENTS OF PATIENT CENTRED CARE FOR PEOPLE WITH MULTIMORBIDITY.pdf

2018 ◽  
Vol 28 (2) ◽  
pp. 561-565
Author(s):  
Radost Assenova ◽  
Levena Kireva ◽  
Gergana Foreva
Keyword(s):  
Chronic Conditions ◽  
Patient Centered Care ◽  
Self Management ◽  
Multiple Chronic Conditions ◽  
Positive Health ◽  
Patient Centered ◽  
Effective Response ◽  
Patient Centred Care ◽  
Centered Care ◽  
Health Related

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.

scholarly journals Onset of Multiple Chronic Conditions and Depressive Symptoms: A Life Events Perspective

2017 ◽  
Vol 1 (2) ◽  
Author(s):  
Maureen Wilson-Genderson ◽  
Allison R Heid ◽  
Rachel Pruchno
Keyword(s):  
Heart Disease ◽  
Depressive Symptoms ◽  
Pulmonary Disease ◽  
Chronic Conditions ◽  
Clinical Care ◽  
Psychological Impact ◽  
Multiple Chronic Conditions ◽  
Care Providers ◽  
The Subject ◽  
Independent Effects

Abstract Background While the association between depressive symptoms and chronic illness has been the subject of many studies, little is known about whether depressive symptoms differ as a function of the illnesses people have as they transition to living with multiple chronic conditions. Methods Self-reports of five diagnosed chronic conditions (arthritis, diabetes, heart disease, hypertension, and pulmonary disease) and depressive symptoms were provided by 3,396 people participating in three waves of the ORANJ BOWLSM research panel. Longitudinal multilevel modeling was used to examine the effects that transitioning to having a diagnosis of multiple chronic conditions has on depressive symptoms. Results Between 2006 and 2014, controlling for age, gender, income, race, and a lifetime diagnosis of depression, people who transitioned to having a diagnosis of multiple chronic conditions had significantly higher levels of depressive symptoms than people who did not make this transition. The diagnosis of arthritis, diabetes, heart disease, and pulmonary disease, but not hypertension had independent effects, increasing depressive symptoms. Conclusions Having a diagnosis of multiple chronic conditions leads to increases in depressive symptoms, but not all illnesses have the same effect. Findings highlight the need for clinicians to be aware of mental health risks in patients diagnosed with multiple chronic conditions, particularly those with a diagnosis of arthritis, diabetes, heart disease, and pulmonary disease. Clinical care providers should take account of these findings, encouraging psychosocial supports for older adults who develop multiple chronic conditions to minimize the negative psychological impact of illness diagnosis.

scholarly journals Prevalence and predictors of medication non-adherence among patients with multimorbidity: A systematic review protocol

2019 ◽  
Vol 2 ◽  
pp. 29
Author(s):  
Louise Foley ◽  
James Larkin ◽  
Richard Lombard-Vance ◽  
Andrew W. Murphy ◽  
Gerard J. Molloy
Keyword(s):  
Systematic Review ◽  
Full Text ◽  
Chronic Conditions ◽  
Data Extraction ◽  
Meta Analysis ◽  
Intervention Development ◽  
Evidence Base ◽  
Multiple Chronic Conditions ◽  
Review Protocol ◽  
Form Quality

Introduction: Patients with multimorbidity are expected to adhere to complex medication regimens in order to manage their multiple chronic conditions. It has been reported the likelihood of adherence decreases as patients are prescribed more medications. Much medication adherence research to date is dominated by a single-disease focus, which is at odds with the rising prevalence of multimorbidity and may artificially underestimate the complexity of managing chronic illness. This review aims to describe the prevalence of medication non-adherence among patients with multimorbidity, and to identify potential predictors of non-adherence in this population. Methods: A systematic review will be conducted and reported according to PRISMA guidelines. PubMed, EMBASE, CINAHL and PsycINFO will be searched using a predefined search strategy from 2009–2019. Quantitative studies will be considered eligible for review if prevalence of medication non-adherence among adults with two or more chronic conditions is reported. Studies will be included in the review if available in English full text. Titles and abstracts will be screened by single review, with 20% of screening cross-checked by a second reviewer. Full-text articles will be screened by two independent reviewers, noting reasons for exclusions. Data extraction will be performed using a predefined extraction form. Quality and risk of bias assessment will be conducted using criteria for observational studies outlined by Sanderson et al. (2007). A narrative synthesis and, if feasible, meta-analysis will be conducted. Discussion: By exploring medication non-adherence from a multimorbidity perspective, the review aims to inform an evidence base for intervention development which accounts for the rising prevalence of patients with multiple chronic conditions.  Study registration: The systematic review is prospectively registered in PROSPERO (CRD42019133849); registered on 12 June 2019.

scholarly journals Interdisciplinary Perspectives on Maintenance of Health Behavior Change

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 817-817
Author(s):  
Jaime Hughes ◽  
Janet Bettger ◽  
Susan Hughes ◽  
Mina Raj
Keyword(s):  
Health Behavior ◽  
Behavior Change ◽  
Health Behaviors ◽  
Chronic Conditions ◽  
Intervention Development ◽  
Health Behavior Change ◽  
Cognitive Capacity ◽  
Multiple Chronic Conditions ◽  
Intervention Science ◽  
Behavior Maintenance

Abstract Modifying health behaviors can be difficult, especially for older adults who are challenged by multiple chronic conditions, reduced functional and/or cognitive capacity, and limited social support. Although much attention has been given to the theories, skills, and resources behind initiating and achieving behavior change, less work has focused on maintenance of health behaviors over time. This presentation will showcase pilot research inspired by RCCN’s first workshop, Achieving and Sustaining Behavior Change. Specifically, this pilot brings together an interdisciplinary team of behavioral scientists and health services researchers working at the intersection of intervention science and implementation science to better understand the construct of maintenance and discuss emerging methods for intervention development and evaluation. The presentation will utilize physical activity as an example behavior to demonstrate the value of interdisciplinary research, including recommendations on how some of the six NIA research centers can make unique contributions to understanding health behavior maintenance.

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

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.

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