scholarly journals Healthcare cost of patients with multiple chronic diseases in Singapore public primary care setting

2021 ◽  
Vol 50 (11) ◽  
pp. 809-817
Author(s):  
Shu Yun Tan ◽  
Kaiwei Jeremy Lew ◽  
Ying Xie ◽  
Poay Sian Sabrina Lee ◽  
Hui Li Koh ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Healthcare Cost ◽  
Demographic Data ◽  
Healthcare Utilisation ◽  
Public Health Issue ◽  
Study Population ◽  
Per Capita ◽  
Multiple Chronic Diseases

ABSTRACT Introduction: The rising prevalence of multiple chronic diseases is an important public health issue as it is associated with increased healthcare utilisation. This paper aimed to explore the annual per capita healthcare cost in primary care for patients with multiple chronic diseases (multimorbidity). Methods: This was a retrospective cohort study conducted in a cluster of public primary care clinics in Singapore. De-identified data from electronic medical records were extracted from July 2015 to June 2017. Only patients with at least 1 chronic disease were included in the study. Basic demographic data and healthcare cost were extracted. A list of 20 chronic diseases was considered for multimorbidity. Results: There were 254,377 patients in our study population, of whom 52.8% were female. The prevalence of multimorbidity was 62.4%. The median annual healthcare cost per capita for patients with multimorbidity was about twice the amount compared to those without multimorbidity (SGD683 versus SGD344). The greatest percentage increment in cost was when the number of chronic diseases increased from 2 to 3 (43.0%). Conclusion: Multimorbidity is associated with higher healthcare cost in primary care. Since evidence for the optimal management of multimorbidity is still elusive, prevention or delay in the onset of multimorbidity in the general population is paramount. Keywords: Chronic disease, healthcare cost, multimorbidity, primary care

scholarly journals Optimising patient active role with a user-centred eHealth platform (CONCERTO+) in chronic diseases management: a study protocol for a pilot cluster randomised controlled trial

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e028554 ◽  
Author(s):  
Marie-Pierre Gagnon ◽  
Mame Awa Ndiaye ◽  
Alain Larouche ◽  
Guylaine Chabot ◽  
Christian Chabot ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Randomised Controlled Trial ◽  
Disease Management ◽  
Chronic Diseases ◽  
Chronic Disease Management ◽  
Controlled Trial ◽  
Cluster Randomised Controlled Trial ◽  
Cluster Randomised ◽  
Randomised Controlled

IntroductionMultimorbidity increases care needs and primary care use among people with chronic diseases. The Concerto Health Program (CHP) has been developed to optimise chronic disease management in primary care services. However, in its current version, the CHP primarily targets clinicians and does not aim to answer directly patients’ and their informal caregivers’ needs for chronic disease management. Various studies have shown that interventions that increase patient activation level are associated with better health outcomes. Furthermore, educational tools must be adapted to patients and caregivers in terms of health literacy and usability. This project aims to develop, implement and evaluate a user-centred, multifunctional and personalised eHealth platform (CONCERTO+) to promote a more active patient role in chronic disease management and decision-making.Methods and analysisThis project uses a collaborative research approach, aiming at the personalisation of CHP through three phases: (1) the development of one module of an eHealth platform based on scientific evidence and user-centred design; (2) a feasibility study of CONCERTO+ through a pilot cluster randomised controlled trial where patients with chronic diseases from a primary healthcare practice will receive CONCERTO+ during 6 months and be compared to patients from a control practice receiving usual care and (3) an analysis of CONCERTO+ potential for scaling up. To do so, we will conduct two focus groups with patients and informal caregivers and individual interviews with health professionals at the two study sites, as well as health care managers, information officers and representatives of the Ministry of Health.Ethics and disseminationThis study received ethical approval from Ethics Committee of Université Laval. The findings will be used to inform the effectiveness of CONCERTO+ to improve management care in chronic diseases. We will disseminate findings through presentations in scientific conferences and publication in peer-reviewed journals.Trial registration numberNCT03628963; Pre-results.

Costly chronic diseases: a retrospective analysis of Chronic Disease Dental Scheme expenditure

2015 ◽  
Vol 39 (4) ◽  
pp. 448 ◽  
Author(s):  
Leonard A. Crocombe ◽  
Jennifer Kraatz ◽  
Ha Hoang ◽  
Daiyi Qin ◽  
Diana Godwin
Keyword(s):  
Chronic Disease ◽  
Retrospective Analysis ◽  
Chronic Diseases ◽  
Human Services ◽  
Dental Service ◽  
Major City ◽  
Dental Practitioners ◽  
Time Region ◽  
Per Capita ◽  
Over Time

Objective The aim of the present study was to investigate Medicare rebate claim trends under the Australian Chronic Disease Dental Scheme (CDDS) over time, region and type of service. Methods CDDS data obtained from the Department of Human Services reflected all Medicare item claims lodged under the CDDS by dental practitioners and processed by Medicare. Retrospective analysis of CDDS rebate claims was conducted. Results The CDDS rebates for the period 2008–13 totalled A$2.8 billion. Just under 81% of claims were from dental practitioners working in major cities. The most frequent rebates were for crown, bridge and implant (32.4%), removable prostheses (22.4%) and restorative services (21.3%). The rebate claims of restorative services, crown and bridge, and removable prostheses per dentist in all regional areas increased over the time of the CDDS. Per capita, the rebates for every type of dental service were lower in the more remote regions. Conclusions Rebate claims increased in each of the last 3 full years of the CDDS across all areas. The majority of Medicare rebate claims were from major city areas and for crown and bridge, removable prostheses and restorative services. The service mix varied between regions. What is known about the topic? The CDDS was described as ‘unsustainable’ from the governmental budgetary perspective, being controversial around the value of the program, ‘poorly targeted’ and having implementation and administrative requirement shortfalls. What does this paper add? The CDDS rebates for the period 2008–13 totalled A$2.8 billion, with just under 81% of claims from dental practitioners working in major cities. The services with the highest rebate claims were crown and bridge, removable prostheses and restorative services. What are the implications for practitioners? In future such schemes, the type of services offered could be reviewed regularly by policymakers in order to control item expenses. The take-up of Government dental schemes may be slow to start, but will tend to increase rapidly over the life of the scheme.

scholarly journals Evaluation of “being healthy, being away from chronic diseases” public service advertisement in Chongqing, China: A cross-sectional study

2017 ◽  
Author(s):  
Ping Hu ◽  
Ting ting Wu ◽  
Cheng bin Wu ◽  
Hao Huang ◽  
Zhirong Fu ◽  
...  
Keyword(s):  
Chronic Disease ◽  
Chronic Diseases ◽  
Public Service ◽  
Cross Sectional Study ◽  
Public Health Issue ◽  
Global Public Health ◽  
Unhealthy Lifestyle ◽  
Cross Sectional ◽  
Media Campaigns ◽  
The Public

Background: Chronic diseases have become a global public health issue, and mass media campaigns are often used to encourage and sustain positive behavior change. Our aim was to evaluate the effect of public service advertising on the awareness of Chongqing citizens. Methods: The theme of the public service advertisement launched in Chongqing was “being healthy, being away from chronic diseases.” A self-designed questionnaire was used in an outdoor intercept survey to collect information about the perception of citizens toward the effect of the advertisement on cognitive situations. Results: A total of 985 valid questionnaires were received. Respondents had good understanding of chronic disease (23.6±4.1, total score: 30), but only 58.4% of participants thought cancer is one type of chronic disease. The awareness of cancer as a chronic disease among the group who had seen this advertisement (63.6%) was higher than that of the group who had not seen the advertisement (56.5%) (p=0.046). After watching the advertisement, approximately 77.4% of participants attempted to remind their family and friends to prevent chronic diseases, roughly 78.2% tried to persuade their family and friends to change their unhealthy lifestyle habits, and 73.2% of participants reported that it increased the possibility of their own lifestyle change. Logistic regression analysis indicates that occupation, educational level, watching the advertising through TV, watching the advertising through indoor LED screen, and watching the advertising through mobile TV affected the three post-viewing behavior changes Conclusion : The public service advertisement achieved a certain knowledge propaganda effect. It may help change awareness and improve health behavior of the public. Key words: Public service advertisement , Chronic diseases, Health; Awareness, Behavior

scholarly journals Digital Recruitment and Acceptance of a Stepwise Model to Prevent Chronic Disease in the Danish Primary Care Sector: Cross-Sectional Study (Preprint)

2018 ◽  
Author(s):  
Lars Bruun Larsen ◽  
Jens Sondergaard ◽  
Janus Laust Thomsen ◽  
Anders Halling ◽  
Anders Larrabee Sønderlund ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Low Cost ◽  
Cross Sectional Study ◽  
Chronic Obstructive ◽  
Chi Square ◽  
Cross Sectional ◽  
Interaction Detection ◽  
Health Checks

BACKGROUND During recent years, stepwise approaches to health checks have been advanced as an alternative to general health checks. In 2013, we set up the Early Detection and Prevention project (Tidlig Opsporing og Forebyggelse, TOF) to develop a stepwise approach aimed at patients at high or moderate risk of a chronic disease. A novel feature was the use of a personal digital mailbox for recruiting participants. A personal digital mailbox is a secure digital mailbox provided by the Danish public authorities. Apart from being both safe and secure, it is a low-cost, quick, and easy way to reach Danish residents. OBJECTIVE In this study we analyze the association between the rates of acceptance of 2 digital invitations sent to a personal digital mailbox and the sociodemographic determinants, medical treatment, and health care usage in a stepwise primary care model for the prevention of chronic diseases. METHODS We conducted a cross-sectional analysis of the rates of acceptance of 2 digital invitations sent to randomly selected residents born between 1957 and 1986 and residing in 2 Danish municipalities. The outcome was acceptance of the 2 digital invitations. Statistical associations were determined by Poisson regression. Data-driven chi-square automatic interaction detection method was used to generate a decision tree analysis, predicting acceptance of the digital invitations. RESULTS A total of 8814 patients received an invitation in their digital mailbox from 47 general practitioners. A total of 40.22% (3545/8814) accepted the first digital invitation, and 30.19 % (2661/8814) accepted both digital invitations. The rates of acceptance of both digital invitations were higher among women, older patients, patients of higher socioeconomic status, and patients not diagnosed with or being treated for diabetes mellitus, chronic obstructive pulmonary disease, or cardiovascular disease. CONCLUSIONS To our knowledge, this is the first study to report on the rates of acceptance of digital invitations to participate in a stepwise model for prevention of chronic diseases. More studies of digital invitations are needed to determine if the acceptance rates seen in this study should be expected from future studies as well. Similarly, more research is needed to determine whether a multimodal recruitment approach, including digital invitations to personal digital mailboxes will reach hard-to-reach subpopulations more effectively than digital invitations only.

scholarly journals Chronic Disease Case Definitions for Electronic Medical Records: A Canadian Validation Study

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Lisa Lix ◽  
Alexander Singer ◽  
Alan Katz ◽  
Marina Yogendran ◽  
Saeed Al-Azazi
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Prescription Drug ◽  
Chronic Diseases ◽  
Electronic Medical Records ◽  
Predictive Value ◽  
Medical Records ◽  
Case Definitions ◽  
Hospital Records ◽  
Disease Case

ABSTRACTObjectivesCanadians are investing heavily in electronic medical records (EMRs) to inform primary care practice improvements. The Canadian Primary Care Sentinel Surveillance Network (CPCSSN) is a national practice-based network that has enrolled more than one million patients to date. Accurate CPCSSN EMR data are essential for unbiased research about chronic disease prevention and management. The study purpose was to test the accuracy of chronic disease case definitions in EMR data from one CPCSSN site. ApproachThis study linked CPCSSN EMR data, hospital records, physician billing claims, prescription drug records, and population registration files for the province of Manitoba. Individuals who had at least one encounter with a CPCSSN practice between 1998 and 2012, were at least 18 years of age, and had a minimum of two years of healthcare coverage before and after the study index date were included. Separate cohorts were defined for the following chronic diseases: chronic obstructive pulmonary disease (COPD), depression, diabetes, hypertension, and osteoarthritis. Validated case definitions based on diagnoses in physician and hospital records and prescription drug data were used estimate sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and kappa of each EMR chronic disease case definition. ResultsMore than 74,000 individuals were included in each cohort, except for COPD which had 51,000. Approximately half of each cohort was comprised of urban residents. The average age ranged from 45.9 years for individuals with depression to 65.3 years for individuals with COPD. Hypertension had the highest prevalence (22.0%) in EMR data followed by depression (14.6%). Estimates of agreement (i.e., kappa) for EMR and administrative data ranged from 0.47 for COPD to 0.58 for diabetes. Sensitivity of the EMR data was lowest for COPD (37.4%; 95% CI 36.0-38.8) and highest for diabetes (57.6%; 95% confidence interval [CI] 56.6-58.6). PPV estimates were lowest for osteoarthritis (66.9%; 95% CI 66.0-67.8) and highest for hypertension (78.3%; 95% CI 77.7-78.9). Specificity estimates were consistently above 90% and NPV estimates were always greater than 80%. Validity estimates for the EMR case definitions were associated with demographic and comorbidity characteristics of the study cohorts. ConclusionsValidity of EMR data, when compared to administrative health data, for ascertaining five different chronic diseases was fair to good; it varied with the disease under investigation. Further research is needed to identify methods for improving the accuracy of chronic disease case definitions in EMR data.

scholarly journals The association of chronic diseases and mammography among Medicare beneficiaries living in Appalachia

2020 ◽  
Vol 16 ◽  
pp. 174550652093302
Author(s):  
Bilikisu Elewonibi ◽  
Chigozie Nkwonta
Keyword(s):  
Breast Cancer ◽  
Primary Care ◽  
Chronic Disease ◽  
Cancer Screening ◽  
Breast Cancer Screening ◽  
Chronic Diseases ◽  
Care Provider ◽  
Primary Care Provider ◽  
Strong Predictor ◽  
Cancer Registries

Objective: This study assessed the relationship between presence and number of chronic disease and reception of mammogram in women 65 years and older, and how this relationship is influenced by primary care provider visits. Methods: A total of 3306 women diagnosed with breast cancer from 2006 to 2008 from cancer registries in four Appalachian states were analyzed. Results: Having a mammogram within the past 2 years was associated with having at least one chronic disease. The presence of a chronic disease was associated with an increased likelihood of breast cancer screening adherence but was not a strong predictor when demographic variables were added. Conclusion: This study supports the findings that women with more primary care provider visits were more likely to adhere to breast cancer screening guidelines but having several chronic diseases presents a barrier to achieving guideline-concordant mammography screening, highlighting the importance of preventive screening for patients managing chronic diseases.

scholarly journals A Framework to Understand the Progression of Cardiovascular Disease for Type 2 Diabetes Mellitus Patients Using a Network Approach

2020 ◽  
Vol 17 (2) ◽  
pp. 596 ◽  
Author(s):  
Md Ekramul Hossain ◽  
Shahadat Uddin ◽  
Arif Khan ◽  
Mohammad Ali Moni
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Chronic Disease ◽  
Chronic Diseases ◽  
Australian Health ◽  
Disease Networks ◽  
Multiple Chronic Diseases

The prevalence of chronic disease comorbidity has increased worldwide. Comorbidity—i.e., the presence of multiple chronic diseases—is associated with adverse health outcomes in terms of mobility and quality of life as well as financial burden. Understanding the progression of comorbidities can provide valuable insights towards the prevention and better management of chronic diseases. Administrative data can be used in this regard as they contain semantic information on patients’ health conditions. Most studies in this field are focused on understanding the progression of one chronic disease rather than multiple diseases. This study aims to understand the progression of two chronic diseases in the Australian health context. It specifically focuses on the comorbidity progression of cardiovascular disease (CVD) in patients with type 2 diabetes mellitus (T2DM), as the prevalence of these chronic diseases in Australians is high. A research framework is proposed to understand and represent the progression of CVD in patients with T2DM using graph theory and social network analysis techniques. Two study cohorts (i.e., patients with both T2DM and CVD and patients with only T2DM) were selected from an administrative dataset obtained from an Australian health insurance company. Two baseline disease networks were constructed from these two selected cohorts. A final disease network from two baseline disease networks was then generated by weight adjustments in a normalized way. The prevalence of renal failure, fluid and electrolyte disorders, hypertension and obesity was significantly higher in patients with both CVD and T2DM than patients with only T2DM. This showed that these chronic diseases occurred frequently during the progression of CVD in patients with T2DM. The proposed network-based model may potentially help the healthcare provider to understand high-risk diseases and the progression patterns between the recurrence of T2DM and CVD. Also, the framework could be useful for stakeholders including governments and private health insurers to adopt appropriate preventive health management programs for patients at a high risk of developing multiple chronic diseases.

scholarly journals Cohort Profile: Effectiveness of a 12-Month Patient-Centred Medical Home Model Versus Standard Care for Chronic Disease Management among Primary Care Patients in Sydney, Australia

2020 ◽  
Vol 17 (6) ◽  
pp. 2164 ◽  
Author(s):  
James Rufus John ◽  
Amanda Jones ◽  
A. Munro Neville ◽  
Shima Ghassempour ◽  
Federico Girosi ◽  
...  
Keyword(s):  
Primary Care ◽  
Chronic Disease ◽  
Disease Management ◽  
Chronic Diseases ◽  
Medical Home ◽  
Chronic Disease Management ◽  
Intervention Group ◽  
Lessons Learned ◽  
Management Support ◽  
Sydney Australia

Evidence suggests that patient-centred medical home (PCMH) is more effective than standard general practitioner care in improving patient outcomes in primary care. This paper reports on the design, early implementation experiences, and early findings of the 12-month PCMH model called ‘WellNet’ delivered across six primary care practices in Sydney, Australia. The WellNet study sample comprises 589 consented participants in the intervention group receiving enhanced primary care in the form of patient-tailored chronic disease management plan, improved self-management support, and regular monitoring by general practitioners (GPs) and trained clinical coordinators. The comparison group consisted of 7750 patients who were matched based on age, gender, type and number of chronic diseases who received standard GP care. Data collected include sociodemographic characteristics, clinical measures, and self-reported health assessments at baseline and 12 months. Early study findings show the mean age of the study participants was 70 years with nearly even gender distribution of males (49.7%) and females (50.3%). The most prevalent chronic diseases in descending order were circulatory system disorders (69.8%), diabetes (47.4%), musculoskeletal disorders (43.5%), respiratory diseases (28.7%), mental illness (18.8%), and cancer (13.6%). To our knowledge, the WellNet study is the first study in Australia to generate evidence on the feasibility of design, recruitment, and implementation of a comprehensive PCMH model. Lessons learned from WellNet study may inform other medical home models in Australian primary care settings.

scholarly journals Comparing the prevalence of multimorbidity using different operational definitions in primary care in Singapore based on a cross-sectional study using retrospective, large administrative data

BMJ Open ◽  
2020 ◽  
Vol 10 (12) ◽  
pp. e039440
Author(s):  
Yi An Janis Lee ◽  
Ying Xie ◽  
Poay Sian Sabrina Lee ◽  
Eng Sing Lee
Keyword(s):  
Primary Care ◽  
Chronic Diseases ◽  
Chronic Conditions ◽  
Operational Definition ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
High Burden ◽  
Study Population ◽  
Study Methodology ◽  
Microsoft Office

ObjectivesMultimorbidity is a norm in primary care. A consensus on its operational definition remains lacking especially in the list of chronic conditions considered. This study aimed to compare six different operational definitions of multimorbidity previously reported in the literature for the context of primary care in Singapore.Design, setting and participantsThis is a retrospective study using anonymised primary care data from a study population of 787 446 patients. We defined multimorbidity as having three or more chronic conditions in an individual. The prevalence of single conditions and multimorbidity with each operational definition was tabulated and standardised prevalence rates (SPRs) were obtained by adjusting for age, sex and ethnicity. We compared the operational definitions based on (1) number of chronic diseases, (2) presence of chronic diseases of high burden and (3) relevance in primary care in Singapore. IBM SPSS V.23 and Microsoft Office Excel 2019 were used for all statistical calculations and analyses.ResultsThe SPRs of multimorbidity in primary care in Singapore varied from 5.7% to 17.2%. The lists by Fortin et al, Ge et al, Low et al and Quah et al included at least 12 chronic conditions, the recommended minimal number of conditions. Quah et al considered the highest proportion of chronic diseases (92.3%) of high burden in primary care in Singapore, with SPRs of at least 1.0%. Picco et al and Subramaniam et al considered the fewest number of conditions of high relevance in primary care in Singapore.ConclusionsFortin et al’s list of conditions is most suitable for describing multimorbidity in the Singapore primary care setting. Prediabetes and ‘physical disability’ should be added to Fortin et al’s list to augment its comprehensiveness. We propose a similar study methodology be performed in other countries to identify the most suitable operational definition in their own context.

Sign in / Sign up

Export Citation Format

Share Document